2nd Tummy Tuck Needed for Failed Muscle Repair - Best Method?

As you have heard, a bulge can be from several different things in the early post-op time period.  It could represent swelling, a fluid collection (seroma, etc.), residual subcutaneous fat, fascial relaxation with intact sutures, or suture breakage / pull through.

The most important thing you need is a correct diagnosis, which is not something I can tell from your photos.  You may benefit from a CT scan to check things out, if physical diagnosis is not clear.  The correct diagnosis leads to the treatment plan - residual fat would be treated with liposuction, fluid collection would be treated with aspiration or a drain, and suture breakage would be treated with re-do plication.

If it turns out to be the sutures, I would wait until after the inflammatory post-surgical changes settle down prior to going back in.  (Inflammed tissues don't hold sutures well.).  I would repair it through an open approach, opening the middle third of your incision.

 

All the best,

It’s not unusual for patients to
have swelling in the immediate post-operative period following
abdominoplasty.  This swelling
usually takes about 6 to 8 weeks to resolve, but in some cases may persist for
up to 3 to 4 months.  For this
reason, discussion of revisional surgery is premature at this point in time.

Persistent abdominal bulges can
occur for a variety of reasons. 
These include residual muscle weakness, excess skin,
intra abdominal fat, excess subcutaneous fat and seroma formation.  The treatment of these problems is
specific and based on the cause of the condition.

At this point in time, it’s
important to be patient.  If the
bulge persists an appropriate evaluation should be under taken and appropriate
treatment instituted.

First off you should not attempt to push outwards. It is in your best interests to perform core strengthening. In regards to your upper abdomen, it could be due to several causes, In many instances, it is fat which can be removed at a later operation and should probably NOT be removed at the initial operation due to concerns with the blood supply to the lower abdominal skin. Diagnostic imaging may help determine the cause of the fullness.