Very hard nodules under incision line 8 months post-op. How can I get rid of them?

Thank you, lynn55, for your question regarding the hard nodules you're feeling under your incision line 8 months after your tummy tuck. Based on your description and history of experiencing fat necrosis after surgery, it’s likely that these nodules are areas of fat necrosis, which occur when fat cells die due to a lack of blood supply. These hardened areas can form small lumps or masses of dead tissue under the skin.

Health Concerns:
Fat necrosis is usually not a serious health issue. While it can feel uncomfortable or concerning, it is generally a benign condition that does not pose a long-term health risk. However, if the nodules change in size, become painful, or show signs of infection (redness, warmth, or discharge), you should follow up with your surgeon to ensure there is no underlying problem.

How to Get Rid of Them:
Massage may help soften the nodules over time and encourage the tissue to break down. Some patients find that regular, gentle massage of the affected area improves the texture of the skin and reduces the size of the lumps. However, in some cases, the nodules may persist despite conservative treatments like massage.

If the nodules do not resolve on their own or if they are bothersome, surgical removal is an option. Your surgeon can remove the areas of fat necrosis through a minor procedure. I recommend discussing your concerns with your surgeon, who can examine the nodules and provide the best course of action for your specific case.

Sincerely,
Dr. Katzen

Dear lynn55,
I understand your concern. Generally speaking, this can be caused by sutures used to close the incision. 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

I've seen this quite frequently after tummy tuck procedures during the course of my career and it is a relatively common occurrence that can have multiple explanations. While it is certainly possible that these could represent localized areas of fat necrosis, another likely explanation is excessive scar tissue formation around the sutures used in the deepest layer of your surgery that are usually placed to hold the tension of your skin closure. I don't know the details of your surgical procedure, but perhaps large sutures were placed in that deep layer. Some people form more scar tissue than others, so there's no way of knowing or predicting when this is going to happen, or to whom. Most of the time, these knots of scar tissue soften over time and get smaller, especially with massaging. However, if they persist beyond a year, or are bothersome, they can be surgically excised through small incisions. Good luck.

It's hard to assess you without photos, and even then, it's impossible to assess the feeling of the scar tissue and quality of it over photos. There can definitely be different things causing this: scar tissue that creates the "lumps", permanent stitches that can be felt over the skin, granulomas. It's best to ask your surgeon what they think, and if it's something expected from your healing process.

I have seen lumps in tummy tuck scars and I just remove them under local anesthesia. Go back to your original surgeon

You may have more nodules of areas of fat necrosis which will require an excision to be removed. Massage will not do much. Go back to your surgeon and be checked.

It's difficult to determine the nature of the nodules that concern you without further information. If they are directly under the incision line they may be suture abscesses. These can often be addressed in the surgeon's office and tend to heal well once treated. I encourage you to return to your surgeon for an evaluation.

Without posting photos, best to have an in person or virtual consultation my over the Internet, real self guess is these are what we call “ stitch abscesses“. This might be due to a permanent suture being used in the subcutaneous closure of your tummy tuck. Best to ask the surgeon who did your tummy tuck for a copy of our report or if they use permanent sutures in the closure? Again best of virtual consultant in person consult of multiple areas of these lumps under locally in anesthesia could range from $2000-$5000