Stomach Looks Larger After Tummy Tuck

I had a tummy tuck with muscle repair almost 4 months ago. My stomach was generally flat before the procedure; I only had massive stretch marks and "loose" skin from 4 children. There was no liposuction needed.

Right after surgery my stomach was nice and flat, but about 6 weeks after (once I stopped wearing compression garment) my stomach started to developed a pooch. It's flat along the inciscion line and then about an inch from that all the way up past my belly button, I look like I have a 3 month pregnant stomach. It's also very hard and when I flex my stomach muscles it is very hard,not soft, to present a fatty area.

My surgeon said it was just the anatomy of my muscles. I'm not overweight and have not changed in weight since my procedure more than maybe 2 pounds. Is there a problem? I feel worse now then I did before.

Doctor Answers 11

Could be your posture

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Beverly Hills Plastic Surgeon

Abdominal bulge after tummy tuck

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Continue your follow-up care with your plastic surgeon

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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!

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

Perhaps Intra-abdominal fat

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You could still have a little persistent edema. However, you may have intra-abdominal fat. Gently palpate your abdominal wall. You should be able to discern the fat above the muscle from the muscle itself. If the fat above the muscle is thick, you either have swelling or fat. I normally include liposuction with an abdominoplasty because the upper abdominal fat is thicker than the lower abdominal fat. During an abdominoplasty the upper abdominal fat is brought down to the lower incision. If you do not thin it, it will appear thicker.

If the muscle itself is bulging, you most likely have fat inside the abdomen pushing out on the muscle causing a buldge. Diet and exercise is the only way to lose that fat.

William H. Huffaker, MD
Saint Louis Plastic Surgeon
4.9 out of 5 stars 51 reviews

Investigate... you may need revisional surgery.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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.

Persisitent abdominal bulging after tummy tuck

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Bulging of abdomen

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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?

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Need photos

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It is hard to give an accurate analysis without seeing any photos but something sounds amiss. I recommend seeing your Board Certified Plastic Surgeon.

Geoff Barnett, MBBS, FRACS
Melbourne Plastic Surgeon

Changes post tummy tuck

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

If you were flat initially postop, and now have fullness it is either a fluid collection called a seroma or your muscle repair may have separated. An ultrasound of your abdominal wall can determine if it is fluid which can then be removed. If the muscles have separated, they will need to be repaired again or left as they are. Good luck.

Upper abdominal swelling after a tummy tuck

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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:

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.