How can I address a bad abdominoplasty result; is there any less invasive way than a full procedure all over again? (Photos)

Full abdominoplasty & mastoplexy. Resulting bulging stomach & protruding belly-button - verified via CT Scan, a 4-5 cm wide diastasis recti still exists from just below umbilicus to the xyphoid process. What is the likelihood that I could have torn the muscles completely apart without knowing it even though I didn't exercise at all for 2 mos.+, etc.? Vs. Is it possible that the sutures weren't placed as indicated in the operative report? Anxious about revision. Any advice is welcome.

Doctor Answers 4

Loss of domain

your problem is a bit unusual but not uncommon in in relatively thin women who exercise... although you most likely DID have a diastasis repair at your initial tummy tuck, this did not hold up because of a combination of factors: 

1. disparity between intrabdominal contents and the space within which to put them....particularly if you have a small pelvis and/or low diaphragm, the natural place to bulge is at the abdominal wall

2. attenuation/weakening of the abdominal wall fascia or coating....this can result in stretching/loosening of suturing

3. shortening of the oblique muscles....I believe that this is the MOST compelling issue in that with pregnancy and/or prior weight gain, the separation of the midline rectus muscles is accompanied by  shortening of the obliques....further efforts at strengthening core muscles only makes the bulging in the middle WORSE as the stronger core/obliques serve to separate you further

I have had this happen in my own practice and have dealt with more complicated forms of this in non-cosmetic surgery patients who are very sick (so called 'loss of domain')....I have learned (and my patients have benefitted from) and now address these issues by rebalancing the abdominal wall by lengthening the obliques rather than just simply attempting the same diastasis repair a second time (even with mesh, etc.).

I advise you to take your time finding the right surgeon and do it properly...

Revision abdominoplasty with diastasis repair and scar lowering

Muscle diastasis is visible and it should be repaired. It is possible that sutures did not hold for some reason after diastasis was repaired? This is something that only your surgeon could comment on. However, you will benefit from secondary repair of diastasis as well as lowering of the abdominal scar. This should be done in the same surgery. Good luck. 

Zoran Potparic, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 15 reviews

Diastasis

I am so sorry to hear you are unhappy. Unfortunately I can not think of any other way to fix the diastasis without surgery again. The appearance of the belly button may be able to be improved as well during that surgery. The unevenness below the belly button that is sunken in is likely just thinner skin and tissue and the only way to add volume back is fat transfer which would have to be done in a totally separate operation from the revision surgery. An in office exam would be a much better way to give you a better idea. Happy to see you anytime. 

Sincerely

DrRickAZ

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 45 reviews

Abdominoplasty

How far are you after your surgery.    It appears that the only way to repair your rectus separation is to do an abdominoplasty type approach.  It is near impossible to speculate why this happened.  Best of luck.   Dr Commons

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