Tummy tuck, 18 months post op - hard pooch in lower abdomen. Should I be concerned? (photos)

Phoenix2288, it would be helpful to know if you had muscular tightening (plications). You may have laxity in your muscular wall which may need to be fixed. This also may be a herniation, especially if you noticed the bulge after activity such as lifting something heavy. Another possibility is a fluid collection know as a seroma which would need to be drained. I recommend you follow up with your surgeon for further evaluation as they can do a thorough examination. They may find imaging such as ultrasound to be helpful in this scenario to determine the cause. Hope this helps

Hello @phoenix2288, thank you for your question and showing you pictures. It is important to take into account several aspects among which is the surgical technique applied, and to evaluate if there is something else at a systemic level to make you still swollen. The best course of action is to consult one or several board certified plastic surgeon for more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez MD FACS

Thank you for your question regarding a tummy bulge 18 months after a tummy tuck. It appears that this bulge is from the pubic region to the umbilicus. With a person of your body build with minimal body fat and minimal excess skin, this could only be muscle weakness. To be sure, I would suggest a pre-operative MRI. I am pretty sure that this will establish an area of muscle weakness. If it is, I suggest an incision be made in your prior tummy tuck scar and dissection be carried to the umbilicus or even the sternum. Your rectus abdomonis muscle needs to. Be reevaluated. If the muscle is weak, your rectus needs to be tightened with a permanent suture. I would do this from the umbilicus to the pubic region. In addition, if this upper abdomen is weak or lax, I highly suggest muscle plication from the sternum to the umbilicus. Thank you for your question regarding a tummy bulge 18 months after a tummy tuck.
If you have any more questions regarding the tummy tuck or abdominoplasty, please contact my office. Since an abdominoplasty can be a difficult procedure, please seek an experienced, board certified plastic surgeon with significant experience performing tummy tucks. Do your research. Make sure your chosen plastic surgeon has performed at least 100 abdominoplasties. Make sure they have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. Good luck! Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and ​member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Dear phoenix2288,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for your question about recovery from tummy tuck and for including photos.

For specific questions like this and about your recovery in general, it is best to speak directly with your doctor or doctor’s representative – such as his or her nurse, or the physician on call for the practice.

You will likely get many differing opinions from members of the RealSelf Community, but they have not personally seen or examined you. Nobody should know you or your unique set of circumstances better than your doctor.

If you feel you are not being listened to or you are doubting your doctor’s recommendations, then it is certainly within your rights to seek a second opinion and get the advice from another board certified physician. This should be done through an in-person consultation with a thorough evaluation, including a review of your history, review of all prior treatment and with a physical examination.

Obviously, if you think that you are having a medical emergency or other serious problem, you should call 911 and/or go to your nearest emergency room.

Best Wishes.

Your photos did not show your scar or the "muffin" so I would go back to your surgeon and discuss your concerns.

I encourage you to return to your surgeon for an evaluation. There could be a number of factors contributing to the hardened area that concerns you, but an exam is needed to give any recommendations.

The contour of your abdominal wall is usually created by skin, fat, muscle wall and conceivably due to visceral fat in individuals who have excess visceral fat.
Skin laxity is not contributing and neither is fat so your abdominal wall contour is either related directly to the shape of your muscle wall unless you have a fluid buildup from an undrained seroma.
Sometimes the shape of the pelvis and thorax can influence the shape of the muscle while after a well done tell me tuck. Other times the shape of the muscle wall can be related to how the procedure was performed.
I don’t think anyone can give you a good assessment based on pictures alone.
You did include quality before and after pictures which is the right way to post with concerns about the surgical outcome.
In your case I don’t think we can visually identify where the problem is or if the revision is indicated.
The first person to review your outcome with is your provider. The person who did the surgery would be the one who could most accurately assess why the outcome looks the way it does.
Excessive tightening of the lower abdomen is more common than under tightening. excessive tightening of the lower abdomen causes bulging of the upper abdomen and this is especially true for individuals who are barrel chested or have excess visceral fat.
It’s possible that this is related to insufficient muscle tightening but that is pretty rare in the hands of most plastic surgeons.
If you can’t get the answers you need from your provider then I suggest scheduling in person consultations for a second opinions.
For a second opinion consultations bring a formal copies of your before and after pictures in a copy of your operative report. These are all available from your surgeons office if you request them.
Best,
Mats Hagstrom MD