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