Swollen Belly 4 Months After Tummy Tuck? (photo)

Question

I had a tummy tuck last July the doctor did a second opertion in Dec, 2011 to remove more skin. I was very happy with the results and had an almost flat stomach. The last couple months my stomach has been distending. I had an ultrasound done and was told I had a gall stone but that it was not causing this distention. The cosmetic surgeon said there was no fluid build up. I am very disppointed and perplexed as to what is happening.

S. Larry Schlesinger, MD, FACS · Answer

This being your second procedure, your lymphatics, those vessels that drain the abdominal wall, may be buried in scar tissue or have been inadvertently injured during the second surgery.  This can lead to a much slower resolution of swelling.  Even at 4 months, I would wear a compression binder because the cause of your swelling may be suboptimal lymphatic drainage which can definitely be aided by pressure. 

	I noted from a previous question of yours that you are or were a smoker.  Smoking inhibits wound healing and this may have led to a possible separation of the muscle repair done on the first and possibly redone on the second operation.  If, in fact, you started smoking after the second procedure, I would recommend you stop and allow your tissues to heal themselves.  If, on the other hand, you are not smoking, congratulations on overcoming a very difficult problem. 

	When muscles are repaired, there is swelling from the placement of sutures, and this can take months and months to resolve.  As a past president of the Northwest Society of Plastic Surgeons, I know the plastic surgeons in Portland are some of the best in the world, and I am sure your plastic surgeon is one of them.  Take your concerns and possibly the Real Self comments to your plastic surgeon, and see if there is anything more that has been suggested which he or she might advise.

Richard J. Bruneteau, MD · Answer

It’s unusual for patients to have
severe swelling 4 months following abdominoplasty surgery.When this situation arises it’s important to
determine the cause of the swelling.Prolonged post-operative swelling can occur for a variety of reasons.Possible causes of prolonged
swelling include seroma formation, muscle repair dehiscense, impaired lymphatic
drainage, and residual fat accumulation.When this situation arises it may be necessary to obtain an ultrasound
or CT study to rule out seromas or muscle dehiscense. If seroma formation is
noted, it’s important that a drain be placed to avoid secondary complications
such as infection and wound breakdown.If muscle separation is noted, it should be repaired surgically to
correct the bulge.In the vast majority of patients
prolonged swelling is related to poor lymphatic drainage.Under these circumstances, it’s important to
be patient and continue using a compression garment.In addition lymphatic massage, stretching,
and physical activity may be helpful as well.It’s important to discuss this
problem with your plastic surgeon.Your
surgeon should be able to perform a physical exam and formulate a treatment
plan that addresses your anatomic findings and achieves your aesthetic goals.

Tom J. Pousti, MD · Answer

Thank you for the question.
	As always, it is best to be seen in person ( by your plastic surgeon) for precise diagnosis and treatment.
	Abdominal wall "swelling" after tummy tuck may be related to:
	1. Swelling in the soft tissues.  This may take several months to resolve and may worsen with increased activity  or at the end of the day.   Patience  is required to allow for resolution of the swelling. The swelling occurs because of the interruption of venous and lymphatic channels that occurs during the tummy tuck operation.
	2. Fluid accumulation in the space between the skin and the abdominal wall muscle.  this may consist of blood ( hematoma)  or serum (seroma).  This fluid accumulation can generally be diagnosed by physical examination ( occasionally ultrasound  may be helpful).  Treatment consists of aspiration;  several episodes of aspiration may be necessary. 
	3. Separation of the abdominal wall muscle repair may lead to a swelling/bulge appearance. This may be diagnosed on physical examination  with your surgeon examining you in different bodily positions. One of the steps of a tummy tuck procedure involves reapproximation (plication)  of the rectus muscles.  These muscles have spread apart during pregnancy and/or weight gain. Bringing them together again in the midline helps to “tighten” the abdominal wall as well as to narrow the waistline.
	4. Residual adipose tissue may be confused for swelling. Again this is most easily diagnosed by physical examination. Additional liposuction surgery maybe necessary to improve the results of surgery.
	Generally, it takes many months for swelling to resolve after tummy tuck surgery and it may take up to one year  (or greater)  a complete skin redraping  to occur.
	I hope this helps.

Moneer Jaibaji, MD · Answer

Thank you for your question and the photo. It is difficult to give you an online answer to why your stomach is distending. You already have had two surgeries and the most appropriate way to address your concern is with in person exam. Having said that, there several reasons for stomach distention after tummy tuck; weight gain, disruption of midline placation, lack of excursive etc.

Remus Repta, MD · Answer

Hello,

	There are a few possible sources for fullness to increases after a tummy tuck including weight gain, seroma, and pseudobursa.  If your weight has been stable and you do not have any fluid collection present you may have to entertain the idea that a pseudobursa could have formed.  This diagnosis would be more likely if there was a period of seroma formation during your recovery.  A pseudobursa also tends to cause some tightness and discomfort of the abdominal wall as the scar tissue restricts its activity.  Unfortunately it is difficult to obtain radio-graphic evidence of a pseudobursa and the diagnosis will need to be made by history and physical examination.

	All the best,

	Dr Remus Repta

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Answers (5)

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