Abdominal Bulge - Is this a failed muscle repair or possibly a hernia formation? (Photos)

Thank you for your question regarding an abdominal bulge and whether it is a result of a failed muscle repair or hernia formation after your tummy tuck or abdominoplasty. Thank you for your pictures and your history. Most plastic surgeons would agree that your abdominal bulge is due to your 15-pound weight gain after your extended tummy tuck with muscle repair. Fifteen pounds is a lot of weight. Most plastic surgeons would believe that with further weight loss, this mass should disappear. This left-sided mass is not due to a failed muscle repair. During a tummy tuck, muscle repair is the repair of the rectus abdominis muscle. The rectus abdominis muscle is a midline paired abdominal structure that extends from your sternum to your pubic bone. During a tummy tuck, the rectus abdominis is plicated or brought together. Typically, plications bring in the waist about 6 to 10 cm. This plication is performed in the middle of your abdomen, in the line from your sternum to your belly button and pubic region. Plication is not in the left upper abdomen, as you described. Muscle repair was not performed here because the rectus abdominis muscle doesn’t exist in the left upper quadrant. The rectus abdominis exists centrally in your abdomen from your sternum to the pubic region in the midline. Also, it is highly doubtful that this mass is a hernia. Hernias in this area are exceedingly rare. If you are concerned, I would suggest an ultrasound or even a CT scan. However, I believe the results will be normal. Therefore, most plastic surgeons would agree that this bulge is due to your 15-pound weight gain. Anatomically, in this area, this is the area of the transverse and descending colon. This is where food is processed, and further water weight is extracted from the stool. If you have a history of constipation, this can be present as abdominal distention, especially on the left side of the abdomen, as you describe, and as you circled. You must follow up with your plastic surgeon. Thank you for your interesting question regarding an abdominal bulge and whether this is a result of a failed muscle repair or hernia formation after a 15-pound weight gain two months following an extended tummy tuck. Good luck! Sincerely, Dr. Katzen. (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.)

From your photograph it seems you have a complex situation with extreme looseness of your abdominal wall and what I think is significant umbilical distortion. Your weight gain may or may not play a significant role in this. I would absolutely recommend you return to your plastic surgeon who could better diagnose the situation and perhaps offer some ideas about going forward. Good luck with things.

The abdominal wall has 2 components: the muscle as well as the fascia. The fascia is the lining of the muscle. Increasing your mechanical strength of the abdominal wall through exercise can increase the muscle strength and help. Your fascia cannot be helped by exercise. At the time of surgery, usually the fascia is repaired. It may be possible that you have gained weight and the intra-abdominal fat you have gained is now pushing your anterior abdominal wall anterior and the strength of the fascia and muscle is not able to hold it flat. You can start abdominal core exercises such as sit-ups, planks and pilates or undergo abdominoplasty again with mesh reinforcement. The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight. You appear to have generalized bulging and not a specific hernia. A hernia is a complete loss of strength of the fascia layer.

Best Wishes,

Gary Horndeski, M.D.

I encourage you to return to your surgeon for an evaluation. You may have more visceral fat as a result of the weight gain contributing to the contour. The fascia may have stretched as well. Your surgeon can determine if further tests are warranted.