PLEASE help - Do I need a revision from my endoscopic Tummy tuck? (photos)

I had an endo TT (diastasis recti & umblical hernia) twins prego. Plication only (no fat/skin removed). I’m 3 mths PO & depressed - rounded pooch belly. 1st photo bikini-before, 2nd-after (plus 2 afters). My surgeon says give it 6 mths & repair if needed, but I feel sick about the cost (with little result) & worse thinking about going through this again (out of state too). Could this flatten out or is this my result? Revision? If so, when is it safe? Could it just not work on me? Thanks!

Doctor Answers 5

Do I need a revision from my endoscopic Tummy tuck?

From you photos it appears that you still have  a lot of laxity of the abdominal muscles.  I am no expert on endoscopic surgery (I finished my training before they started being used in general surgery) but I have a hard time imagining that a rectus diastasis could be repaired from the inside out using a scope. The layer that is repaired with a standard tummy tuck is the rectus fascia which is the outer most layer of the abdominal musculature and is just not accessible from the abdominal cavity.  The scope would need to navigate through basically 3 layers of muscle and fascia to get to the layer of the rectus muscle and fascia.  Maybe I lack imagination but I just cannot fathom fixing the diastasis using this approach. 

The umbilical hernia on the other hand is readily repaired from the inside out.  The hernia is basically a hole in the inner most layer of the abdominal wall.  Using the scope, the contents of the hernia (usually just some fat) can be pulled back into the abdominal cavity and the small defect fixed with a few stitches. 

I am wondering if the your surgeon was a plastic surgeon or a general surgeon.  Most general surgeons would not have much experience with tummy tucks and may be misguided in thinking that the laxity seen in patients like you is basically a hernia which it is not.  In any case, I recommend you get a second opinion from a surgeon certified by the American Board of Plastic Surgery. 

Seattle Plastic Surgeon
5.0 out of 5 stars 73 reviews

Did your surgeon communicate to you that you would be noticeably flatter?

If so, then you have a legitimate gripe about your results.  Most surgeons would not use an endoscope when the goal is to flatten an attenuated tummy like yours.  Any particular reason you did not just have an open tummy tuck where your umbilical hernia could be repaired at the same time?  If your goal was to simply repair your diastasis and umbilical hernia, then its likely it was done... you just needed something more aggressive for a more obvious result.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

PLEASE help - Do I need a revision from my endoscopic Tummy tuck?

Thank you for your pictures and questions. In body contouring surgery, selecting the procedure that is appropriate for the patient is the most important thing to consider. Most patients are not candidates for an endo procedure such as this and I think you would fall into that category. Choosing the wrong procedure results in wasted money and an unhappy patient and I am sorry about that. I would agree with the other PS on here that you likely need a mini tummy tuck with skin resection. Make sure you see a board certified (ABPS) plastic surgeon for a consultation.

Best of luck!

Dallas Buchanan, MD
Spokane Plastic Surgeon
5.0 out of 5 stars 30 reviews

Revision tummy tuck after endo procedure

An in-person evaluation is needed in order to offer specific advice, but it appears that you would benefit from a revision to tighten the abdominal wall further. This could probably be done with a mini tummy tuck, using a short scar placed low where it can be easily concealed. An umbilical float would be done in order to extend the repair into the upper abdomen.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 54 reviews

PLEASE help - Do I need a revision from my endoscopic Tummy tuck?

Thank you for the question and photos. Unfortunately, the preop and postop photos look exactly the same, and this will not get better with time. You will need another surgery. In this type of patient like you, I prefer the EVE tummy tuck procedure. This is done through a small low pubic incision not longer than a C-section scar and you will need an umbilical float. I prefer a two layer muscle repair. You should wait for another 2-3 months prior to considering repair. This will allow the dissected tissues to heal, soften up and be workable. See your surgeon and discuss your concerns. Remember, doing the same procedure over again and expecting different results is unrealistic. Otherwise, seek a second in person opinion from a board certified plastic surgeon experienced in advanced body sculpting techniques. Good luck.

George Marosan, MD
Bellevue Plastic Surgeon
4.8 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.