Upper Abdomen Bulge Following Tummy Tuck on Male Patient? (photo)

Question

I am 12 days post op and from the very beginning following the procedure I have noticed my upper abdomen is not as flat as the lower. Also my lower abdomen feels much tighter and numb than the upper portion, which is what was expected, but I also expected that throughout my abdomen. I feel as though maybe the muscle repair was not performed or maybe I'm over analyzing too soon. would appreciate any and all feed back. Thanks!

Tom J. Pousti, MD · Answer

Thank you for the question.
	As always, it is best to be seen in person ( by your plastic surgeon) for precise diagnosis and treatment.
	Abdominal wall "swelling" after tummy tuck may be related to:
	1. Swelling in the soft tissues.  This may take several months to resolve and may worsen with increased activity  or at the end of the day.   Patience  is required to allow for resolution of the swelling. The swelling occurs because of the interruption of venous and lymphatic channels that occurs during the tummy tuck operation.
	2. Fluid accumulation in the space between the skin and the abdominal wall muscle.  this may consist of blood ( hematoma)  or serum (seroma).  This fluid accumulation can generally be diagnosed by physical examination ( occasionally ultrasound  may be helpful).  Treatment consists of aspiration;  several episodes of aspiration may be necessary. 
	3. Separation of the abdominal wall muscle repair may lead to a swelling/bulge appearance. This may be diagnosed on physical examination  with your surgeon examining you in different bodily positions. One of the steps of a tummy tuck procedure involves reapproximation (plication)  of the rectus muscles.  These muscles have spread apart during pregnancy and/or weight gain. Bringing them together again in the midline helps to “tighten” the abdominal wall as well as to narrow the waistline.
	4. Residual adipose tissue may be confused for swelling. Again this is most easily diagnosed by physical examination. Additional liposuction surgery maybe necessary to improve the results of surgery.
	Generally, it takes many months for swelling to resolve after tummy tuck surgery and it may take up to one year  (or greater)  a complete skin redraping  to occur.
	I hope this helps.

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding an upper abdomen bulge following a tummy tuck on a male patient.  Thank you for your history, and thank you for your photos.  Since you are only 12 days from your tummy tuck or abdominoplasty, the area pictured above your umbilicus or belly button is swelling.  This swelling could be normal, a seroma, or a hematoma; however, a seroma or hematoma would be unlikely.  It is too early to tell anything, 12 days postop.  You must wear your compression garment and follow your plastic surgeon's instructions.  Follow-up with your plastic surgeon is very important to be sure you do not have a seroma or hematoma.    Regarding the rectus abdominis muscle repair, it is too early to determine anything 12 days after your abdominoplasty.  If you are concerned that the muscle repair is not done, you can request an ultrasound, CT scan, or MRI of the abdomen.   These radiographic techniques will help to elucidate if the muscle repair was done, and if any of the sutures have broken.  In conclusion, it's too early to tell anything.  You must wait at least 6 to 8 weeks until the swelling subsides. Please take a look at the above radiographic studies to investigate whether the rectus abdominis was repaired.  However, even 6 to 8 weeks after surgery, most plastic surgeons would not recommend repeat surgery to repair the muscle if the muscle had not been repaired.  Therefore, most experienced plastic surgeons recommend you wait at least 4 to 6 weeks before making any determination.  Good luck.  I hope I've answered your question regarding an upper abdominal bulge 12 days following a tummy tuck on a male patient.  I hope this information helps you find answers regarding your tummy tuck or abdominoplasty.  If you have any questions regarding tummy tuck or abdominoplasty, please contact an experienced, board-certified plastic surgeon.  Since the tummy tuck is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing the tummy tuck.  Do your research.  Ensure they have performed at least 150 tummy tuck surgeries and have the before and after pictures to prove it. Please carefully look over their before and after pictures and check their reviews on RealSelf.   If you cannot find an experienced tummy tuck surgeon in your neighborhood, consider traveling out of state. Sincerely, Dr. Katzen.  (Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Stephen Salerno, MBBS, FRACS · Answer

Hello and thank you for the question and photos.

	It is quite early after the surgery to start thinking that something has gone wrong.  I think you should give it at least 3-6 months before the final results will settle in.  You will have some persistent swelling in the abdominal area for some time yet.  If the swelling persists then it could be due to a persisting diastasis of the recti muscles, it could be some excess fat that is bulging still or it could be some excess skin.  With regards to the numbness it is more common to have lower abdominal numbness more so than upper abdominal numbness.  The numbness in the lower abdomen will improve to some extent, but not completely.

	Regards

	Stephen Salerno

George Commons, MD (retired) · Answer

Your bulging is concerning but it is very early.   If it persists it means you did not have a repair of the upper rectus diastasis.  That would be an error in technique.  See your doctor and get explanations.  My Best,  Dr C

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