Assuming the muscle tightening was done correctly, we must remember that we are only tightening what is there already.
If there is too much fat in the abdomen, the result will not be good.
If the muscles are weak and untrained, the result will not be good.
If the patient has a lax fascia, it sometimes has a good result initially, only to stretch out later with time.
Mesh can help a bit, but the whole circumference of the fascia is often simply weak in some patients, so they must watch their weight as much as possible and keep their core as strong as possible.
Many patients believe that after a tummy tuck they will have a flat tummy. This is not always the case, for the reasons above. Surgery is a partnership and both parties must do their part.
Muscle repairs tend to work well without mesh except in very specialized cases. If mesh becomes infected it is a nightmare so most of us try to do without it. Have a long talk with your surgeon about this before going forward.
John Di Saia MD
Tummy tuck failure; what is next?
Your pictures do show fullness in the abdominal area. There are four things that can result in fullness. Loose skin ( this should have been taken care of previously but you still have some); fat ( have you gained weight?); weakness of your abdominal wall ( if the plication failed I think it would be prudent to consider some type of external support with mesh) and finally fat on the inside ( this would be noted on exam and not treatable with surgery).
Tummy tuck revision with mesh--is this the solution?
In most cases, a good secure muscle repair and adequate skin resection (plus the resultant internal scar layer that helps to reinforce the abdominal wall) at the time of tummy tuck will yield a good, long-lasting result. In some cases, intra-abdominal fat (mesentery and omentum) can contribute to trying to get the equivalent of a "ten-gallon head into an eight-gallon hat!" The abdominal contents are fitted into a tightened abdominal cavity after muscle repair, and this, combined with stretchy or lax tissues in some individuals, can lead to the result you are showing. So, thus far, it could be excess residual fat, or weak tissues, or both.
When you are laying down, does you abdomen flatten or become concave? If you keep your knees locked and do a straight-leg raise, what does your abdomen do? Protrude in the middle? Or just get firm and tight? These are helpful parts of determining an answer to the dilemma you pose, and this requires physical examination.
Mesh can help to reinforce a weak or stretchy abdominal wall, but remember that the mesh itself must be sewn to something. What happens when those tissues stretch and bulge? The fact that your breasts are showing the same characteristics may mean you are indeed one of those patients born with poor skin elasticity and collagen content, or an even more rare cases of genetically-inherited connective tissue disorder (such as Ehlers-Danlos syndrome) that causes a defect in collagen synthesis.
For breast revision and reinforcement, acellular dermal matrices (such as Strattice or Alloderm) can provide some additional support for breast lift patients who just have inadequate tissue of their own (very few, IMHO). These dermal matrices are very expensive, and of course still do not guarantee a satisfactory long-term result. Sometimes just a better surgical "design" or "pattern" that takes into account a certain degree of elasticity and stretch over time is a "better" solution, or at least the more common one!
Mesh for tummy tuck revision
The answer is in the muscular foundation. The skin will never be an important factor in holding your abdominal contour. It would be interesting to know how firmly with effort you can pull your stomach in, and if your stomach is convex when you are on your back. Revision with a firm muscle repair, permanent sutures should do. Mesh is not a bad idea, just seems unnecessary for most of us.
As for mesh in the breast, a firm no, though your surgeon might consider an allograft, such as Strattice, if your implants repeatedly bottom out.
Best of luck,