Solution for Prolonged Abdominal Swelling After Tummy Surgery?

Thanks for the question -
Based on your picture (and please note that a complete history and physical and report of your two previous surgeries would be required for a final plan) it appears that a re-do abdominoplasty would be a good option for you.
Here's why:
It appears that you have some additional skin, you have a scar beneath the umbilicus that would be removed with a repeat abdominoplasty and scar tissue from your seroma/hematoma could be addressed. In addition you may benefit from additional muscle plication. (You could also possible include the drain scars and bring the drains through the abdominoplasty scar next time).
Abdominal contour is dependent on:
Skin envelope
Abdominal fat (subcutaneous and intrabdominal)
Muscles tightness
Intrinsic Swelling
Fluid collections
Skin Envelope -
People complaining of "abdominal bulge" after tummy tuck typically do not have issues with too much skin - that points to issues underneath the skin.
Abdominal fat -
This can be an issue in people who may be a little bit over their ideal body weight at the time of abdominoplasty. Ways to fix this include the tried and true diet and exercise or liposuction. Be sure to allow enough time between tummy tuck and liposuction to minimize complications.
Muscle tightness -
Muscles plication (or tightening) is usually a part of abdominoplasty. Either failure of the sutures or some laxity can cause a bulge. If the change in your contour was sudden or if you felt a pop - think about the plication having ruptured.
Swelling -
This can be the most common cause of contour issues post-abdominoplasty. Patients typically have swelling for two reasons. First surgery causes trauma and the body's response to trauma is to bring additional fluid into the area that has been traumatized. In addition, abdominoplasty involves dividing lymphatic channels (very very small conduits that normally pull fluid out of tissue) - until these channels grow back the area will not be able to remove excess fluid.
It is usually the most dependent (lowest) part of the surgery that stays swollen the longest.
Fluid collections -
Seromas (serous fluid collections) or hematomas (collections of old blood) can cause distortions of contour. Normally this will improve on its own but may require drainage.
I hope this helps.

Hello, and thank you for your question regarding prolonged abdominal swelling and pressure after your tummy tuck surgery. I’m sorry to hear you’re dealing with this — it can be very frustrating when the healing process doesn’t go as expected.

Persistent swelling months after a tummy tuck can happen, and there are a few possibilities based on what you’ve described:

You could have lymphatic disruption, meaning the surgery altered the natural drainage system in your lower abdomen, causing chronic swelling.

There could be residual scar tissue (fibrosis) from the surgery, or scar tissue forming where a seroma may have been, even if it wasn’t fully diagnosed as one.

There could still be small, chronic fluid pockets that are too small to detect easily but enough to cause pressure and discomfort.

In some cases, the lower abdomen and pubic area can remain congested with fluid due to gravity, especially after aggressive lower abdominal work.

Pain during intercourse suggests that the swelling and pressure may be affecting deeper tissues, possibly involving tension or scar tissue pulling in the lower abdomen or pubic region.

Liposuction may help, but it’s important to understand that standard liposuction often won't fix chronic swelling if the underlying problem is lymphatic damage or scar tissue. In some cases, surgeons recommend:

Lymphatic massage therapy (Manual Lymphatic Drainage, or MLD) to encourage better fluid movement.

Ultrasound or MRI imaging to check for hidden fluid collections or deep fibrosis.

Revision surgery only if imaging or exams confirm there’s something structural that needs to be released or corrected.

Before moving forward with another procedure like liposuction, I would strongly suggest seeking a second opinion with a board-certified plastic surgeon who specializes in tummy tuck revisions or post-surgical complications. They may recommend imaging to get a clearer picture of what’s causing your symptoms.

You’ve come too far to live with ongoing discomfort, and you deserve answers — and relief.

Wishing you the very best on your continued healing journey.

Sincerely,
Dr. J. Timothy Katzen, MD, MBA, FASMBS, FICS
(Certified by the American Board of Plastic Surgery and President of the American Society of Bariatric Plastic Surgeons; 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; Member of the American Society of Plastic Surgeons, American Academy of Cosmetic Surgery, and RealSelf Hall of Fame)

Before moving forward, be sure to review your surgeon’s experience with tummy tuck revisions, look closely at before-and-after photos of similar complex cases, and check patient reviews to ensure you’re in experienced hands.

The presence of a significant abdominal bulge several months
following abdominoplasty surgery should be aggressively investigated.Especially if the 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, hernia formation 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 reason, it’s important to consult your plastic surgeon.Your surgeon should be able to formulate an
appropriate treatment plan.

It is truly difficult to assess your condition from the information given and it appears that your surgeon never provided you with an explanation for the swelling. From his/her recommendation, it sounds as if it is due to fat deposits as indicated from their advice for staged liposuction at a later date which may be a reasonable approach.

It is hard to say what the problem is at this point. It could be a persistent seroma or something else. It should be evlauated.

Tummy tucks are a very popular and effective way to contour the abdomen. Patients who receive this procedure should anticipate a significant recovery which will consist of discomfort, bruising, and prolonged swelling. It is possible that the component of your persistent swelling may be a collection of fluid or blood that occurred after the surgery. Your body may have created some scar tissue around his collection, making the swelling worse. If this is the case, you should work with a board-certified plastic surgeon who has a great deal of experience and abdominoplasty and abdominal recontouring. They will assess your abdomen and help determine the cause of the swelling. Your plastic surgeon may recommend a technique such as ultrasound assisted liposuction or a small revision of your tummy tuck to access this area and remove the scar tissue or collection.

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:
 

It is difficult to tell exactly what is going on from the photos, but from the history it certainly seems like you developed a seroma. I agree that additional surgery, which would include a revision of the abdominoplasty with liposuction for better contour is indicated, but I would probably get an ultrasound of the abdomen before surgery.