10 months after tummy tuck, bulge in lower abdomen. What can this be? (photos)

Question

I have a bulge in my lower abdomen that's worse on my right side. My PCP sent me to get a CT scan but it doesn't show anything abnormal. I'm so confused what's going on wit my lower abdomen this far out after surgery?

Johanna D'Agostino, MD · Answer

Hi Krislinka,Thanks for sharing the photos. A full physical exam is needed for proper assessment. However, I may be inclined to say, based on these pictures, that the abdominal wall needs to be tighten more. Once its tightened assessment of any excess fatty tissue and / or excess skin can be corrected if present. Unfortunately, a surgery will be needed to address this problem. Please discuss with your board-certified plastic surgeon who can perform a detail exam and provide you with options to improve your previous surgical results.

Semih Yildiz, MD, FEPOBRAS · Answer

The photos show lower abdominal fullness with some right-sided asymmetry, but photos cannot tell whether this is residual fat, loose skin, scar tethering, swelling, or relaxation of the abdominal wall/muscle repair. A CT scan that does not show a hernia, mass, or fluid collection is reassuring, but it does not always explain a standing contour problem after a tummy tuck.

At 10 months, it is reasonable to be evaluated by your operating surgeon with an exam both standing and lying down, including checking the muscle repair while you tighten your abdomen. The solution depends on the cause: liposuction may help residual fat, scar or skin revision may help tethering or laxity, and a muscle-repair issue would need a different plan. If the bulge is rapidly worsening, painful, red, draining, or associated with fever, you should be seen urgently.

J. Timothy Katzen, MD, FACS · Answer

Hello krislinka. Thank you for your question regarding the bulge in your lower abdomen.

I appreciate your history and your photos. First, I would like to ask if you had muscle repair done during your tummy tuck. If you did, there is a possibility that the muscle repair might need to be redone. Sometimes, the sutures can fail or the muscles can separate again, causing a bulge.

Another possibility for the bulge could be visceral fat, which is fat around the internal organs. This type of fat cannot be removed through surgery and must be addressed through weight loss. I suggest considering some of the new weight loss medications, which have shown promising results in helping with weight loss.

I wish you the best of luck in addressing this issue. Please follow up with your plastic surgeon to discuss these possibilities and determine the best course of action.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS

Wayne I. Yamahata, MD · Answer

A proper diagnosis of your condition would require an in person physical examination. A follow up appointment with your surgeon would be appropriate at this time. If possible, bring your CT scan with you to the appointment.

Albert Ko, MD · Answer

Thank you for your question and photos! My question to you would be, how far out from surgery are you? Also, have you gained any weight? I recommend that you visit your surgeon for an in person exam and discuss your concerns. Best of luck!

Alan Gonzalez, MD, FACS · Answer

Hello @krislinka, thank you for your question and showing you pictures. I understand your concern. It is important to take into account several aspects among which is the surgical technique applied, and to evaluate if there is something else at a systemic level. The best course of action is to consult one or several board certified plastic surgeon for more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez MD, FACS. International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

George Bitar, MD · Answer

Without an examination, it would be difficult to determine what has caused the bulge of your lower tummy.  Based on your photographs, you can see a bulging, especially on the left side of your tummy.  A CT scan was a good place to start to make sure there is nothing serious causing the bulge and can ensure there is no hernia or fluid.  A CT scan needs to be carefully assessed by your surgeon to look at the finer details that the radiologist generally would not assess.  You could have differences in the skin and fat of the lower tummy, which can also be assessed by examination.  On the CT scan, one side would appear thicker than the other.  Another possibility is that the strong lining on top of the muscle has stretched.  Because there is no disruption of that strength layer, there would be no hernia on the CT scan, but the laxity would be seen as the lining on the muscle being longer on one side than the other. I would recommend seeing your surgeon with a copy of your CT scan images, so they can examine you and carefully review the images for the fine details.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs and I am sorry that your current outcome has not been what you anticipated.  I would recommend seeking out an opinion from a board certified plastic surgeon to get the best advice, but If the CT scan showed no issues (seroma, hematoma, hernia, etc), most likely there is laxity of the underlying muscle and irregularities between the thickness of the skin contributing to your result.  An improvement can be achieved, but will require additional surgery.

Daniel Barrett, MD · Answer

Dear krislinka,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ashley Thorburn, MD · Answer

If you're experiencing a bulge in your lower abdomen 10 months after a tummy tuck, there could be a few potential reasons for it:
1.) Swelling or Edema: It's not uncommon to experience swelling or edema in the months following a tummy tuck surgery. This can sometimes result in a temporary bulge in the treated area. However, significant swelling should have subsided by 10 months post-surgery. If the swelling is persistent or worsening, you should consult your surgeon.
2.) Seroma: A seroma is a pocket of fluid that can accumulate in the area where the surgery was performed. This can lead to a bulge or swelling. Seromas can sometimes occur after surgery and might require drainage or other medical attention.
3.) Hernia: In some cases, a bulge in the abdomen could be indicative of a hernia. A hernia occurs when an organ or tissue pushes through a weakened area of the abdominal wall. This can sometimes develop after surgery, especially if there was an incision made in the area.
4.) Muscle Separation or Weakness: The tummy tuck procedure involves tightening the abdominal muscles. If there's a separation or weakening of these muscles over time, it could lead to a bulge in the lower abdomen.
5.) Scar Tissue Formation: Scar tissue can sometimes form in the healing process, and it might contribute to the appearance of a bulge. This could be due to how the scar tissue forms or how it adheres to underlying structures.
6.) Incomplete Correction: Depending on the technique used and the individual's unique anatomy, the tummy tuck might not have fully corrected all aspects of the abdominal area, leading to the persistence of a bulge.
It's important to consult with your surgeon or a medical professional to determine the exact cause of the bulge. They can perform a physical examination, possibly order imaging tests, and provide you with personalized advice and recommendations based on your situation. If you experience any pain, discomfort, or changes in the bulge, seek medical attention promptly.

10 months after tummy tuck, bulge in lower abdomen. What can this be? (photos)

Answers (17)

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