Muscle repair fail? I had my tummy tuck 7 months ago (Photo)

You've circled the area you believe is a failure in the rectus repair, but that cannot be confirmed by photography. I can see the more prominent abdominal fullness from top to bottom, but to me that looks like the abdominal wall wasn't activated in the more recent photo. What I can see with certainty is a belly button that was not trimmed and inset artfully, leading to a larger feature on the abdomen than normal. Also, there is residual skin and fat at the apices of your long scar, leaving you with shoulder like peaks at the hips instead of a confluent sweep from waist to lateral thigh. Your surgeon did a very nice job on your breast lift, but was thwarted with implant migration, a common problem with augmentation mastopexies. Many surgeons, including myself, have started to use an internal bra mesh to secure the implants for the primary procedure (as opposed to using it for just repairing implant dropout), and that is what you'll need to reposition your implants. Once that's done, you'll be able to appreciate the nice work your doc did on the lift.

Hello, and thank you for your question regarding possible muscle repair failure and the fact that you had a tummy tuck seven months ago. Thank you for your history and your pictures. Comparing your postoperative tummy tuck pictures to your current pictures, you may have gained weight. A change in the appearance of the love handles or the superior iliac crest region can evidence this. Gaining weight after a tummy tuck can lead to the accumulation of visceral fat and, therefore, distention of the anterior abdominal wall.
It is unlikely that you ruptured the muscle repair. Most plastic surgeons use permanent suture to reconstruct the abdominal wall. Therefore, it is unlikely that you completely disrupted the rectus abdominis muscle repair. Your breast implant bottoming-out is unrelated to the rectus muscle repair. Implant bottoming-out is also unrelated to the muscle repair failure (if it had failed). To correct your bottoming-out implants, consider the insertion of breast mesh and possibly the repositioning of the inframammmary fold more superiorly. This can be done with internal permanent sutures. In regards to the abdomen, you should consider getting a CT scan or an ultrasound. This will help to determine whether the rectus abdominis muscle repair has failed. Good luck. Most plastic surgeons offer free virtual or in-office physical consultations. Therefore, explore what other plastic surgeons have to say. If you have any more questions regarding tummy tucks, abdominoplasties, or abdominal liposuction, contact an experienced plastic surgeon. Since the tummy tuck surgery is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience in performing tummy tucks. Do your research. If you cannot find an experienced tummy tuck plastic surgeon in your neighborhood, consider traveling out of state. Sincerely, Dr. Katzen, MD, MBA, FACS, FICS. ( Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

These are good questions. In terms of the muscle repair coming undone, it is really hard to tell based on the pictures alone. With an in person exam, it will be much clearer to tell what exactly is going on. In terms of the breast implants bottoming out, this can be due to a variety of reasons. It can depend on a couple factors like: how big the implants are, the quality of your skin tissue. For example, if the size of the implants are very large and the tissues that hold up the implants are poor quality, over time the implants may descend and drop, lower than what is acceptable. In certain scenarios, using a mesh (internal bra can help support the breast implants to prevent it from dropping. Hope this helps!

Dear MNmommy90,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is 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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Unfortunately, I think you are correct on both counts. The photos definitely confirm inferior migration of our implants and strongly suggest failure of the rectus plication. Both will eventually need to be surgically corrected.

Your implants are too large and heavy for your tissue to support. You may need to go smaller and use mesh as an internal bra. an examination, may be an ultrasound, is needed to see what is going on with your abdomen. go back to your surgeon.

Hello, from your photos one could think that the muscle repair was loose, it is necessary to confirm with a physical evaluation and an image study in which we can appreciate the muscles, if so it is necessary to perform a corrective surgery, it would be very good to consult with your surgeon.

There are a few reasons that can lead to the contour that concerns you. One, as you mentioned, is that your muscle repair has failed which would require a revision for correction. Another is subcutaneous fat. If it is from this, liposuction should improve it. The other potential cause is visceral fat. This is the fat around your organs behind the muscle wall. This can only be addressed through weight loss as liposuction or a tummy tuck cannot lessen it. It does appear your implants are bottoming out which is unrelated to your abdominal contour. See your surgeon for an evaluation.

The most common reason for people to have a bulging abdomen after a tummy tuck is because of excess visceral fat. This can usually be seen on preoperative pictures. It’s also important to note if there is any changes in weight from your preoperative weight. Ideally, we need to see a complete set of property before and after pictures to understand your candidacy for the procedure in the first place.
There are generally four tissue variables to determine what the abdomen looks like. These are.1) abdominal skin laxity typically due to previous pregnancies or significant weight loss2) excess subcutaneous fat3) muscle separation from previous pregnancy4) excess visceral or intra-abdominal fat
Usually the problem is one or more of these tissue variables whether someone has had surgery or not. It’s possible that the muscle repair was done insufficiently but this is a pretty rare outcome.
Considering that your implants also bottomed out, maybe your plastic surgeon is lacking the skill to do quality work. Usually the problem is visceral fat, and can be determined on preoperative pictures or if the patient has gained weight since surgery.
I suggest you follow up with your provider and have him or her address your concerns and give you an assessment. It shouldn’t be that difficult to differentiate between the four tissue variables described above. The problem is almost always traced back to one or more of those and differentiating Isn’t that difficult.
If you don’t get to help you need from your current provider to schedule a few in person, second opinion consultations.
For second opinion consultations I recommend patients bring a complete set of proper before and after pictures and a copy of your operative report. These are part of your medical record and you can get copies by asking your current provider.
Best
Matt hagstrom, MD.