Stomach Looks Larger After Tummy Tuck - Is there a problem?

Thanks for your question -

It is difficult to say without an examination. Abdominal bulges that occur after your initial healing can represent several things.
It may be a fluid collection that has occurred after your drains were removed (this could include hematoma or seroma. These will usually resolve on their own but may require drainage. Your description of the area being hard point more towards a hematoma.
It may also represent a separation of your muscle repair. This can be something that may need surgical revision.
It may just be residual swelling within the tissue itself.
Be sure to address your concerns with your plastic surgeon.
I hope this helps.

Hello amalex,

It's understandable that you're concerned about the changes in your upper abdomen following your tummy tuck surgery. There could be various reasons for the swelling and tightness you're experiencing at this stage of your recovery.

One possibility is that fluid may be accumulating in the tissues, even if there isn't a drainable collection present. This swelling can occur as part of the body's natural healing response, similar to how tissue swells when injured. Since tummy tuck surgery can disrupt lymphatic channels, it may take some time for this swelling to resolve. Gentle massage techniques can sometimes help encourage fluid drainage and alleviate swelling.

Another potential factor could be differences in the tightening of the muscle layer during the surgery. Over time, these differences may balance out as your body continues to heal.

It's also possible that a stitch used to secure the muscles together may have torn, contributing to the sensation of tightness. While your surgeon initially ruled out this possibility, it's worth considering as a potential cause.

Given the complexity of the healing process, it's often difficult to pinpoint the exact cause of persistent swelling and tightness. In many cases, these issues may improve on their own with time and conservative measures, such as wearing a girdle and massaging the area as advised by your surgeon.

If the swelling and tightness persist beyond six months post-surgery and significantly impact your comfort and quality of life, it may be necessary to explore further treatment options, which could include additional surgery to address the underlying issue.

Regarding your question about taking an X-ray, imaging studies such as X-rays may not provide useful information in this context. It's best to follow up with your surgeon for further evaluation and guidance based on your specific symptoms and circumstances.

I hope this information helps provide some insight into your situation. Please continue to follow up with your surgeon for ongoing monitoring and support throughout your recovery journey.

Best wishes for a smooth and successful recovery.

Sincerely,
Dr. Katzen

Your story seems interesting.  With all due respect, I have not seen a truly flat abdomen after 4 kids. Regardless, assuming that there is no seroma (fluid collection), one possibility could be a loosening, uneven, or incomplete muscle plication. The fact that you started out flat after the surgery leads me to think of loosening, or breaking of the repair.This loosening could be from over straining during the first 6 weeks. The sutures holding the muscle  can break, or cheese-wire through the fascia. This loosening of the muscle repair could give the appearance you describe. Unfortunately, if this is the case the only way to fixit is to repeat the operation. Lastly make sure you're not pregnant again.Good luck,Dr Results

This is an interesting problem. Bulging after surgery in the abdominal area can be due to a number of factors: 1) Fluid collections - these are generally detected as firm distension of the skin, and there is a slosh, or wave effect on palpation. 2) Hernia - this is usually felt as a distinct area of swelling in the abdominal wall, this can be reduced with with manual pressure. The other three factors are fat between skin and muscle (usually this is the fat you can pinch), fat under the muscle (This is usually felt as firm distension of the abdomen), and posture. Since you describe this as firm distension, I am inclined to think it is fat under muscle, or posture. Does the contour change when you stand up straight? I think it is highly unlikely that you have muscle separation or hernia. Maintain a healthy lifestyle, and keep in touch with your surgeon. If you do have a correctable problem I am sure he will sort it out and offer a solution. Best wishes
Matthew C Camp MD

The presence of a significant abdominal bulge four months
following abdominoplasty surgery should be aggressively investigated.
Especially if this bulge wasn’t present in the immediate post-operative period.
This type of bulge could occur for a variety of reasons including swelling,
seroma formation, encapsulated hematoma, residual muscle weakness, recurrent
separation of the muscles, intra-abdominal fat, excess subcutaneous fat and
possibly fat necrosis.Under
these circumstances it’s appropriate to obtain ultrasound and possibly MRI
studies. Depending upon the results revisional surgery may be indicated. For
these reasons it’s important to consult your plastic surgeon. Your surgeon
should be able to formulate an appropriate treatment plan.

Persistent abdominal fullness after a tummy tuck can be due to intra-abdominal fat, poor muscle tone, subcutaneous fat requiring liposuction, breakdown of the muscle repair, edema/swelling, seroma, hematoma, fibrosis, fat necrosis, pseudocyst, hernia, improper garment wear, etc.

Tummy tucks are a very popular and effective technique to contour the abdomen. During the surgery, we lift up your skin and fat layer and assess your muscles. If there is a separation of the muscles or some weakness, we commonly use sutured techniques to tighten the muscles and give you a smaller waist. There may be several causes for the bulging that you are seeing in your upper abdomen. It is possible that this bulging may be a small collection of fat. It is also possible that this bulging may be due to some of the sutures having come undone.

Your best bet is to be evaluated by a board-certified plastic surgeon who has a great deal of experience with abdominoplasty antibody contouring. They will be able to assess your bulging and determine which procedure will help correct this mess.

To learn more about tummy tucks, see photos, and help you decide which one is best for you, please visit us at the link below:

Without examining you it would be difficult to say what the cause of this is. Perhaps it is swelling?  It may also be the plication of the abdominal muscles?  It could also be fluid?

As you are aware, the tummy tuck procedure involves tightening the muscle/fascial layer which flattens the anterior abdominal wall. Additionally, when the fat/skin layer of the abdomen is cut out (excised), it is removed in an oval shape. The middle portion of the excised fat/skin layer which is directly above the pubic area is very tight, whereas, in contrast, the ends of the incision near the flanks the skin is loose.
At four months, you should NOT be seeing in the standing position significant abdominal bulging. This is especially true if you were flat to begin with. There are several possibilities to explain what is going on. It does require a thorough examination and possible imaging studies. Please continue to follow up with your plastic surgeon. At worst, a revision may be required.
Most likely your surgeon talked and informed you prior to your tummy tuck procedure about the potential need for additional procedures and revisions. Your treating plastic surgeon knows you the best, knows your anatomy, and, knows the operation he performed on you. I would strongly advise you to go back to your plastic surgeon and discuss your issues with him/her.
I hope you find this helpful!

Assuming you do not have a complication and you don't have significant residual edema inyour abdominal flaps, it is possible that your muscles have a certain contour due to your posture. Remember that posture can often contribute more to a person's "physique" than surgical correction. Try improving your posture and consciously tightening your abdominal muscles and see if your contour improves. It is also possible by smoothing out and tightening the loose skin that you reveal the underlying muscular contour more. If your muscles were very weak before the surgery, surgery by itself will not make them stronger, only closer together. Surgery in that respect is a static operation and your abdominal contour is, in many respects, determined by dynamic factors like muscle strength and muscle tone that are affected by pregnancies, especially C-sections. If your surgeons has done all he can, you might need to start on exercise, toning, and posture exercises, all of which are helpful and recommended in any case.