Has my Tummy Tuck Muscle Repair Come Undone?

Question

I am 4 months post op and still have significant swelling, especially in my upper abs. But I am wondering if it is indeed swelling or has my muscle repair come undone. If I suck in my stomach then I see a tiny bit of definition, but only then. I was in great shape before surgery, so with the muscle repair and lose skin removed, I expected to see more definition.

Steve Laverson, MD, FACS · Answer

At four months, you do still have some swelling, which will likely diminish during the next few months. In addition to the possibility of residual excess skin, swelling, or relaxation of the plication, it is possible for a patient who is in great shape before abdominoplasty to actually lose some definition and have added thickness of the epigastrium (area above belly button) after abdominoplasty because of the way skin and fat are rearranged during the procedure. Plication of the abdominal wall concentrates overlying skin and fat in the midline. If this extra thickness is not completely relieved by inferior displacement of skin and fat by flap transposition, added fullness above the belly button or below the breast bone (xiphoid process) may result. My advice at this time: Wait and see.

David Shafer, MD, FACS · Answer

Without pictures or seeing you in person, it is impossible to give you specific advice.  However, if you have an unnatural bulge or contour issue, you should talk to your surgeon about your options.

	 

	Good Luck.

Michelle Spring, MD, FACS · Answer

I recommend that you see your plastic surgeon to answer your question.  Without a physical examination (above and beyond just pictures), it is very difficult to give any advice.

	Good luck!

Remus Repta, MD · Answer

Hello,

	Thank you for the question.  There are a few issues that can be resulting in the upper abdominal contour that you are describing.  Your abdominal muscle tightening might have come undone, your abdominal muscle tightening may have been insufficient, the upper abdomen area may have benefited from liposuction, other.  The contour or roundness is likely related to the abdominal wall.  The defnition is likely related to the amount of fat between your skin and the abdominal muscles.  I would touch base with your plastic surgeon and have him/her assess you.

	All the best,

	Dr. Remus Repta

David Bogue, MD · Answer

When the muscle repair comes "undone" it usually manifests as a bulge above the belly button. This can be accentuated by lying flat then lifting both your head and feet off the floor. Some of the definition (ie the 6-pack) can be disrupted from the procedure as the fibrous bands that connect the skin to the muscle fascia are cut. This can result in the loss of some definition of the 6-pack. Thankfully, most people with this degree of definition are not having abdominoplasties. Prolonged swelling is more common below the belly button. Schedule an appointment with your plastic surgeon to have them evaluate your muscle repair.

Steven Turkeltaub, MD · Answer

At 4 months you will still have swelling but typically you will see more lower down than higher up. If there were disruption of the muscle repair here, you would tend to see a significant bulge which sometimes is quite discrete.

	Without photos, it is difficult to comment on your "loss of definition". For an accurate answer, you should be seen by your surgeon who could then examine you.

Peter E. Johnson, MD · Answer

It is possible that your muscle repair did not extend all the way up to the chest. Tummy tuck can only corrrect poor posture and abdominal tone to a degree. All can allow the abdomen to relax and protrude forward, and 'suck in' as you say and have better contour. Suturing alone will not create tone and contour after tummy tuck, though if things don't look right have your surgeon take a look. The swelling thing after four months does not seem likely.
	Best of luck,
	peterejohnsonmd

Tom J. Pousti, MD · Answer

Thank you for the question. There are several causes of fullness of the upper abdominal area after abdominoplasty surgery. Some of these include fluid below the abdominal wall skin (seroma), swelling of the abdominal wall flap (tissue edema), continued excess  skin of the  abdominal wall, or laxity of the abdominal wall musculature (insufficient tightening of the plication  or relaxation/failure of the plication  sutures.

	If you palpate the abdominal wall muscles in different positions (in the upright and bent over position)  you can get a good idea if the plication  repair is intact or tight enough. If you notice a significant &ldquo;bulge&rdquo; when you are bent or when your abdominal wall is relaxed (for example after expiration of a breath) then you may be experiencing failure of the plication repair.

	Your plastic surgeon will be able to help you with this determination with physical examination done in the different positions.

	Best wishes.

Has my Tummy Tuck Muscle Repair Come Undone?

Answers (8)

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