3 years post op - lower belly protruding & very hard constantly (Photos)

Hello,The cause may be weak and thin abdominal muscles. When the abdominal muscles are weak and underdeveloped, even if muscle plication has been performed, the stitches can tear the muscle, leading to a loss of the plication's effectiveness. Alternatively, if the abdominal muscles are very weak, gas and bloating in the intestines can contribute to this appearance. I recommend that you undergo an examination.

Dear Considerate88127,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Thank you for your question and for providing your photos and history. Based on your photos, it appears that your primary concern is a firm, protruding lower abdomen three years after your tummy tuck. Since you have minimal body fat and no excess skin, the issue is likely related to muscle weakness or an incomplete rectus abdominis plication during your initial surgery.

When performing a tummy tuck, many surgeons repair the rectus abdominis muscles, which may become separated due to pregnancy, weight changes, or other factors. This repair is typically done with permanent sutures to tighten the abdominal wall. If this was not performed, or if the repair has since weakened or separated, it could result in a firm, distended lower abdomen as the muscle cannot adequately hold the abdominal contents in place.

To address this issue, revision surgery may be necessary. A plastic surgeon would make an incision along your previous tummy tuck scar, elevate the skin and tissue, and repair the rectus muscles from the sternum to the pubic symphysis using permanent sutures. In some cases, mesh may be added to reinforce the repair, providing additional support to the abdominal wall.

I recommend consulting with a board-certified plastic surgeon who has extensive experience in revision procedures. Be sure to discuss whether rectus muscle plication was initially performed and how a revision could improve your results. This type of procedure can significantly flatten and strengthen your abdominal area, resolving the firmness and discomfort you are experiencing.

Sincerely,
Dr. J. Timothy Katzen, MD, FASMBS, FICS

Please see your surgeon for an assessment. It could be caused by a variety of reasons, and an in-person exam would be necessary. Surgery may be required to resolve the issue.

Thank you for your query. There may be a loosening of the muscle repair in the lower part of the abdomen or some visceral fat . This can be confirmed with an MRI. Please discuss your concerns with your Plastic surgeon who can examine you and help you with your concerns. All the best!

I encourage you to return to your surgeon for an evaluation. The reason for the contour of your abdomen could be related to many things. There may be a seroma present, the muscle repair may have failed, to name just a couple. Your surgeon can assist you in finding out what is occurring.

I would suggest having an ultrasound of CAT scan to look for an unresolved seroma or mass of some kind.

A hard, firm area in your lower abdomen after surgery could be due to factors like scar tissue, a hernia, or a fluid collection such as a seroma. Since uterine issues have been ruled out, it's important to consult your doctor for a thorough evaluation to determine the cause and receive appropriate care.

Thank you for the question and including photos. If you have ruled out any intra-abdominal mass, then I believe the most likely problem is laxity of your abdominal wall. I assume your surgeon tightened your muscles when you had your tummy tuck. Maybe they weren't tightened enough, or maybe the sutures broke. IDK. But, that is what it looks like to me. I would recommend tightening your muscles. This can be done through your same scar. It would be like a mini tummy tuck, just without needing skin removal.

To make equality assessment without an examination, we need quality pictures.
Look at our plastic surgeons take before and after pictures to get an idea.
Don’t try to over emphasize the problems by you seeing different angles.
As a general statement, there are four variables that determine what the abdomen looks like.
These are abdominal laxity due to previous pregnancies or weight loss.
Excess subcutaneous fat.
Muscle separation from previous pregnancies.
excess visceral or intra-abdominal fat.
And your case We can immediately eliminate skin laxity and excess subcutaneous fat.
This only leads muscle separation and visceral fat as potential culprits.
Considering that you are lean with very little body fat, and this is a new problem I would lean towards thinking that insufficient muscle tightening is the primary problem.
It’s unusual for muscle tightening from a tummy tuck to weaken overtime, but not impossible.
Some people have weak and thin, abdominal fascia.
It’s always important to see a complete set of proper before and after pictures.
Knowing what you look like before the procedure can tell a lot.
If you have any way of getting your before and after pictures from your previous provider, that would be very helpful.
I should also say that Skeletal structure also has an impact on the abdominal wall.
The abdominal muscles basically connect from your rib cage to your pelvis.
Therefore, a straight abdominal wall should make a B line between your sternum and your pubic bone.
Individuals who are barrel chested may therefore have an upper abdomen bulges in the lower abdomen.
Individuals who have a narrow rib cage and more round pelvis, may have some bulging of the lower abdomen.
Your situation is complex and you absolutely need in person consultations to get quality assessment.
Usually we can differentiate between these tissue variables.
If you weren’t thin, I would say visceral fat is the most likely corporate but in your case that is not what’s happening.
I recommend having a few in person consultations with plastic surgeons in your community.
If you have access to the surgeon, who did your procedure, you should also get a copy of your operative report.
For second opinion, consultations always schedule those as in person consultations, avoiding virtual consultations period
Come prepared for second opinion consultations bringing with you a complete set up before and after pictures and copies of your operative report if you can get them.
Best,
Mats Hagstrom MD