Is Muscle Re‑Tightening Worth Considering? Other Surgeons Say It’s a Complicated Revision. (Photos)

Question

I’m 1 year post‑tummy tuck with rectus plication. My operative report documented a 2.5 cm diastasis before surgery.My CT scan shows no diastasis and no hernia. My surgeon said no further imaging is needed and recommended starting an abdominal strengthening program.I also had a dynamic abdominal wall ultrasound showing: • No separation under strain • Linea alba: 0.8 cm (upper), 1.6 cm (mid), 0.2 cm (lower)I’m concerned because the measurements are different in each area, and my abdominal contour has been getting worse over time, especially in the lower abdomen. When I engage my core or lie down, my abdomen looks flat, but when relaxed I see a soft bulge that has become more noticeable.I contacted a few other surgeons. They said my repair appears intact based on imaging and that re‑tightening the muscles is a complicated revision surgery, usually best done by the original surgeon.I’m trying to understand whether muscle re‑tightening, liposuction, or a combination could improve this contour, or if the uneven ultrasound measurements suggest fascia laxity or another issue.Seeking opinions from skilled surgeons experienced with post‑tummy‑tuck contour problems when imaging appears normal.

Gerald Minniti, MD, FACS · Answer

First, I'm sorry your surgeon placed your incision so high on your abdomen and gave you the unusual appearing belly button. Both can be corrected. Photos can be difficult to interpret, but the measurement of your linea alba sounds wide to me, but more importantly, correcting abdominal wall protrusion isn't always corrected by simply reducing the diastasis. Frequently, the muscle fascia itself over the entire abdominal wall has expanded and needs tightening, which means overcorrecting the diastasis is necessary. Performing this in a revision surgery is not a complicated surgery, contrary to what other surgeons have told you. If you haven't been exercising your core for the last 9 months, you should have been. I do agree with your surgeon that you should be exercising. Give it 3 months, but I suspect your abdomen will still bulge. What I would envision for you is liposuction of the abdomen followed by a revision abdominoplasty, which would include abdominal wall tightening, readvancement of your skin using progressive tension sutures, revising the belly button and lowering the scar. No drains necessary.

Frank Agullo, MD · Answer

From your photos, it seems that you still have abdominal wall laxity, and when you lay down, this looks like it's corrected. It also seems like you still have some excess subcutaneous fat between the skin and the muscle. I see patients like you routinely, where the diastasis was repaired, that's just the separation between the rectus muscles. But during pregnancy, or when patients gain weight and then lose it, the fascia is stretched throughout the abdomen, not just between the rectus muscles. Performing core exercises will strengthen the muscle, but will not tighten the fascia. That's why I often recommend performing a triple plication, where I plicate from the sternum to the pubis, bringing together the fascia of the rectus, and I also plicate the obliques to the lateral edge of the rectus. This is called a triple plication, which in essence creates an internal corset, or waist trainer.

John LoMonaco, MD, FACS · Answer

Hard to say without an exam, but there does seem to be more fullness that you might want.  This is from skin excess, fat excess, swelling,m muscle laxity...or a combination.

It depends on which one(s) are the issue when deciding what to do about it.  Liposuction, muscle tightening, weight loss, lymphatic massage, or skin tighteneing with another surgery are all options.

Zoran Potparic, MD · Answer

It is impossible to conclude, based on these photos and your history, whether loose muscle tone is the major cause of residual abdominal laxity. However, there is no doubt that there is significant fat as well as some skin laxity in particular in lower abdomen. Belly button would also benefit from revision? Liposuction with additional skin excision, lowering the scar, BB revision would be some of the options to consider. I hope this helps. Good luck.

Is Muscle Re‑Tightening Worth Considering? Other Surgeons Say It’s a Complicated Revision. (Photos)

Answers (4)

More Tummy Tuck Revision Questions

Loose muscle and skin and distended stomach 10 years after tummy tuck - What procedure can correct this? (Photos)

33 year old - should I have a tummy tuck revision to lower the scar and repair my belly button? (Photos)

Revision tummy tuck five years later - what is the risk of necrosis? (Photo)

Muscle repair revision - is it possible to not have enough skin? (Photos)

Can my tummy tuck scars and belly button from a 2021 mommy makeover be realistically improved or revised? (Photos)

FDL tummy tuck in 2019. Pregnancy and weight gain have caused big changes. Where do I go from here? (Photos)

WE SEND PRETTY
EMAILS