Does this look like a muscle repair failure or another issues? 49, 5'6, 125 lbs 4 months post (photo)

Question

I am 49, 5 '6, 125, had tummy tuck with light lipo on hips & flanks 4 months ago. I look like I still need a tummy tuck! Please tell me if something looks wrong to you or just maybe a lot of swelling. The puffy stomach & thick body make me wish I never had surgery! No pre-pictures but pre-surgery I had a thin middle with excess skin due to pregnancy (carried pregnancy mainly in the front). Now my entire middle is thick & I look like a man. I waited years to treat myself, now I look worse.

Tom J. Pousti, MD · Answer

I'm sorry to hear about the concerns you have after tummy tuck surgery.  As you likely know, your plastic surgeon will be your best resource for precise diagnosis, advice, and the most meaningful reassurance...
Generally, 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.
Often patients will like their “flatness” immediately after surgery; then, these same patients are disappointed for a period of time once swelling of the tissues occurs. In the longer term (this may take several months and even up to one year), the swelling dissipates and the skin of the abdominal wall "redrapes"  over the smaller underlying  musculoskeletal framework (where the abdominal wall muscles have been brought together again in the midline). 
Often, patients will report that the swelling increases as their activity level increases and gets worse later on in the day. Sometimes, the use of compressive garments may be helpful to control the edema. The swelling resolves many months (and even beyond one year post op in some cases) as the lymphatic and venous systems begin functioning normally.
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.
 Disruption of the muscle plication is best diagnosed on physical examination with your surgeon examining you in different positions (your plastic surgeon will be in the best position to accurately advise you and/or provide you with accurate assessment and/or meaningful reassurance.
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  in some cases (this factor does not seem to be likely in your case).
Generally, it takes many months for swelling to resolve after tummy tuck surgery and it may take up to one year (or greater) for complete skin redraping  to occur.
I hope this helps.   Best wishes for an outcome that you will be pleased with longer-term.

Leila Kasrai, MD, FRCSC · Answer

At 4 months it is still early on in your recovery. Please allow at least 6 months for the initial swelling to subside, as it is certainly contributing to the “thickness” and “puffiness” you mentioned. At that time, you can reassess your results and speak to your surgeon about your concerns, should have any.

Camille Cash, MD · Answer

I'm sorry you are unhappy with your tummy tuck.  Without pre operative photos it's difficult to comment on specifics.  Your photos do not show any obvious signs of muscle repair failure.  Your hip area may benefit from some touch up liposuction or excision of dog ears, but it is still too early to tell. I encourage you to discuss your concerns with your surgeon.

John J. Corey, MD · Answer

I agree that a little more time is needed to see your final results however I don’t know if Liposuction was done at the time of your initial surgery. Some surgeons do while others feel it adds a degree of risk to circulation. Discuss your concerns with your surgeon and he may be willing to do some contouring Liposuction to your tummy and pubic area once you are healed.

Farbod Esmailian, MD · Answer

What you may be experiencing is soft tissue edema (swelling) which may require longer time in you to resolve.  In most patients the turn around time is 4-6 months.  However even after this time there will be good days and bad days.  Most often in the morning, everything is soft and flat, but by the end of the day swelling kicks in and the tissue feel firm and doughy.I would discuss this with your plastic surgeon and see if he/she recommends for you to maybe go back to a compression garment (spanx) for the time being.Hope that helps.

Does this look like a muscle repair failure or another issues? 49, 5'6, 125 lbs 4 months post (photo)

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Does this look like a muscle repair failure or another issues? 49, 5'6, 125 lbs 4 months post (photo)

Answers (10)

Answer: Maybe a touch up

Answer: Maybe a touch up

Answer: Tummy Tuck and Swelling

Answer: Tummy Tuck and Swelling

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Recommended reading

Everything you need to know about Tummy Tuck

Our mission is to create a world where every investment in modern beauty is Worth It.