8 weeks post-op I've had a hard, protruding pouch since week 2. What is wrong? Should I be worried? (photos)

Question

My concern is a protruding hard pouch I have has since week 2 post tummy tuck. It goes from below the belly button to the mons pubis. I have raised with my PS. He is not concerned yet.They have sent me a second 4 panel binder to put on over my original compression body suit. This helps flatten but it comes back. The 1st two images were taken first thing in the morning and last one was after a full day of wearing my new binder. What is wrong and why am I not flat yet? Should I be worried?

Kenneth Hughes, MD · Answer

Hello. Great question. Thank you for your pictures. However, you are still early in your recovery process. There is still swelling involved. Only an in person consultation can determine if you have fluid collection. I will suggest to schedule a follow up appointment with your surgeon. If concerns persist, please consult with a board certified plastic surgeon for a detailed examination.

Richard Rahdon, FRACS · Answer

Hi there
There are two common causes of post- op swelling. The first is a fluid collection (seroma) and the second is oedema (general swelling in the tissues, like fluid in a sponge). Seroma doesn’t change during the day and needs a needle drainage to make it go away. Oedema will go away with compression. It looks like you have oedema so compression is the right treatment for you.

Robert M. Wald, Jr., MD · Answer

At 8 weeks, swelling is still present and more time is needed for healing. It can take up to 1 year for complete healing. In addition to the the compression garment, I would suggest heat and massage of this area. This will increase the blood flow in this area and hopefully enhance the healing. Please be patient as this is a slow process. Sometimes fluid can accumulate under the abdominal flap and I would discuss this with your surgeon.

Nelson Castillo, MD · Answer

Thank you for sharing your question and series of photographs and I am sorry that your results have not been what you anticipated.  It is difficult without an in-person examination to determine what may be taking place. In most cases this is persistent swelling which will resolve spontaneously given sufficient time.  It is important, however, to ensure that other issues are not taking place - discrete fluid collection, muscle laxity, or residual adipose tissue.  Since your surgeon knows the full details of your operation, they are in the best position to provide you with a diagnosis and treatment option.  Best wishes.

Camille Cash, MD · Answer

You are still early in your recovery where swelling is present and expected.  You will not be able to see your final results for 9-12 months from surgery.  I encourage you to continue to follow the advice of your plastic surgeon.  The use of compression should be helpful.  I know it is hard to be patient, but that is what is needed as more changes are ahead as healing continues.

Diane I. Duncan, MD, FACS · Answer

Thanks for your question! It can take up to a year for swelling to resolve after a tummy tuck, and since swelling drifts downward with gravity's assistance, we most commonly see swelling build up right around the incision line to the pubis. That being the case, I usually recommend a couple different things to our patients. One option is for our patients to wear their compression at night for longer than initially recommended post-op (I tell me patients 6 weeks, but some wear it at night to 3 months). Addition of Topifoam (or similar) to the area can also help even things out. Discuss options with your surgeon, and also make sure that they check for the possibility of a seroma or hematoma!Best of luck!

8 weeks post-op I've had a hard, protruding pouch since week 2. What is wrong? Should I be worried? (photos)

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