Did my muscle repair fail? Can this be fixed?

Question

I’m 6 months post tummy tuck with MR. I have this bulge above my belly button. I believe it’s my ab muscle because I can flex it and make it hard and I can also relax it.When I lay flat and lift my head it pops out. I eat healthy,workout 5-6 times a week.I haven’t gained weight since my surgery but I’ve noticed my belly kinda sticks out again.I had 5 kids,all big babies so my stomach muscles were definitely wrecked.Did my MR fail maybe?And if so, it is fixable? And how? :-/

Alan Gonzalez, MD, FACS · Answer

Hello @smith01234, thank you for your question and showing you pictures. Several factors should be considered, including the surgical technique applied, evaluating whether anything else is going on at a systemic level, obtaining additional testing to establish what happened and deciding on a surgical plan based on your needs and expectations. The best course of action is to consult one or several board certified plastic surgeon for more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP).

Daniel Barrett, MD · Answer

Dear smith01234,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Darryl J. Blinski, MD · Answer

Appears in posted photos you need full redo TT with layered muscle repair. Must obtain ultrasound examination to see the separation of the muscles. Fee $10,000.

Camille Cash, MD · Answer

From your photos it appears that either the muscle has separated or there is internal fat causing the contours that concern you.  An in person evaluation will help determine what the cause is and the recommended correction.  See a board certified plastic surgeon near you for an evaluation.

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment and the outcome of an operation we always need to see proper before and after pictures. If you don’t have it before and after pictures so please ask your surgeon to forward the pictures they took and use those.
The most common reason for patients having bulging of the abdomen after a tummy tuck is excess visceral fat. this can probably be seen on your before pictures and should’ve been addressed during the assessment part of your consultation after you were examined.
There are four variables that determine what someone’s abdomen looks like.
Before variables are abdominals skin laxity generally due to previous pregnancies or weight fluctuation, excess subcutaneous fat, muscle separation from previous pregnancies and lastly excess visceral or intra-abdominal fat.
When you getting an assessment the choice of procedures should be based on what variable or variables is causing the problem.
A tummy tucks primarily treats skin laxity and muscle separation. Liposuction treats subcutaneous fat.Visceral fat can only be lost through weight loss. Individuals who have excess visceral fat will have an increased interest domino pressure after muscle tightening that will eventually pass bulging.
To differentiate muscle weakness from visceral fat you can try a few different things.
Does your abdomen go completely flat when you lay on your back? if not then this real fat is most likely contributing significantly. Press your abdomen really flat with your nondominant hand. does it take a significant amount of pressure to push in your abdominal wall or does it feel loose and you can easily push in the muscle wall. If it feels tight and when pressing in against your abdomen it feels like you can’t take a deep breath when you have increased intra-abdominal pressure and it’s most likely due to reducing the intra-abdominal space through muscle tightening is part of the procedure.
Try losing five or 10 pounds and then take corresponding pictures and see if this helps.
Individuals who have excess visceral fat will often show bulging of the upper abdomen because the lower abdomen usually is more affected by the muscle tightening part of the procedure.
In a perfect world plastic surgeons would make accurate assessments and predict you have, correctly by disclosing all the variables and showing you appropriate before and after pictures of previous patients who had similar characteristics body types for reference.
Individuals who have excess visceral fat should be told they need to lose weight before having the procedure in order to get a tight flat abdomen.
Determining if someone has visceral fat should not be rocket science and most plastic surgeons should be able to make the assessment. 
You can get proper second opinion consultations if you would like but your best bet is to simply lower your weight by 10 pounds and see if it improves your outcome.
The last variable to consider is that individuals who are barrel chested tend to have an abdominal wall after a full tummy tuck that slopes in words. When creating a tight flat abdomen with muscle tightening it makes a beeline between the sternum and the pubic bone. And barrel chested individuals the sternum may sit significantly more forward than the pubic bone. This causes the upper abdomen to stick out more in the lower abdomen. And most attractive natural female bodies the upper abdomen should be slightly dinner with a very slight bulge of the lower abdomen. Having a more rounded rib cage can prevent this. This phenomenon yes sometimes exemplified after a tummy tuck.
Best,
Mats Hagstrom MD

Did my muscle repair fail? Can this be fixed?

Answers (5)

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