2 year post op belly bulge. What are my options? (Photo)

Question

I had a full tummy tuck 2 years ago. I have this lower belly bulge that won’t go away. My Dr was amazing and did an incredible job. He moved away so I saw another Dr who thinks it’s fine but ordered an MRI just to be sure. I hope I didn’t spend thousands of dollars and have major surgery to have this bulge for the rest of my life. I would have just dealt with the way it was before. It wasn’t that bad. I workout a lot and am hoping I didn’t mess something up. Hoping for some other opinions. Thank

Gary M. Horndeski, MD · Answer

You would benefit from a repeat tummy tuck with mesh reinforcement. If you are not planning future pregnancies, I recommend abdominoplasty with mesh reinforcement. The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Wayne I. Yamahata, MD · Answer

The most likely reasons for the bulge involve either the abdominal wall or intraabdominal contents. If the problem is in the abdominal wall, this can generally be improved by muscle plication. Regarding intraabdominal conditions, if the bowels or organs are the cause, this would be treated by your primary care physician and referral to a specialist as needed. If the problem is increased visceral fat, the only effective treatment is weight loss. Begin with a return visit to your surgeon to obtain a proper diagnosis and to discuss your options.

Carmina Cardenas, MD · Answer

If the voluminous area just appear may be the result of weight gain as subcutaneous fat or visceral fat and a bit of pushing the muscle. So the improvement will be observed after losing the  weight.  It may also be some internal swelling like colon or uterus, if so you need to be seen by a Gynecologist or Gastroenterologist. 
If it has been like that since after surgery, most likely you have a little volume of fat which remains after Tummy tuck and just need some liposuction. 
Be encouraged. 
Dr. Cárdenas

Daniel Barrett, MD · Answer

Dear Fierce113495,
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

Connie Hiers, MD, FACS · Answer

If it is fat, liposuction can remove the excess. If it is weak muscles, EMSculpt treatment can be done. If it is an old seroma cavity, it would need to be removed through your exisiting scar. Hopefully the MRI will show what is present.

Camille Cash, MD · Answer

From your photos the contour that concerns you is likely either from visceral/internal fat or a weakened muscle wall.  Visceral fat is improved with weight loss.  It cannot be addressed with a tummy tuck or liposuction.  If you have a weakened abdominal wall you may need further correction, potentially with mesh to help this not reoccur.

Daniel Urias, MD · Answer

The belly bulge is likely from weakening of the abdominal wall in the lower abdomen. It may have recurred after your tummy tuck, if your previous surgeon plicated the abdominal wall. This can happen and your one option is to revise the plication.

Mats Hagstrom, MD (license on probation) · Answer

Bulging of the abdomen after a tummy tuck is generally due to either excess visceral, fat or insufficient muscle tightening.
There are a few other variables, such as individuals or barrel, chested with the sternum sits significantly forward in relationship to the pubic bone they can have bulging of the upper abdomen after the procedure.I suggest having a few second opinion in person consultations with other plastic surgeons in your community. It shouldn’t be that difficult to assess your abdomen to see if you have insufficiently corrected, muscle, separation, or if visceral fat is contributing.
One way to differentiate between muscle, separation, and excess visceral fat is to see if your abdomen goes flat when you lay on your back.
If it does, then access, visceral fat, it’s probably not causing the problem and it’s more likely to insufficient muscle tightening.
You should confirm that muscle tightening was done as part of the procedure. Ask for a copy of your medical records, especially your operative report and have another plastic surgeon. Read through the report to confirm that muscle tightening was done.
Assessing your abdomen shouldn’t be that difficult. An experience plastic surgeon should be able to figure out what’s going on, including assessing if revision surgery is indicated or not.
I would highly recommend getting a copy of your operative report and having another surgeon read that report while getting a second opinion assessment.
Best,
Mats Hagstrom, MD