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.

It is too early to predict what if anything will need to be done.   I would recommend waiting to see how you heal.  Only then can you plan you revision, if necessary.  Depending how the muscle was tightened, you may need to have the entire repair re-done.  In such a case the entire tummy tuck area will have to be opened up to expose the muscle repair which then needs to be revised.

Sincerely,

Martin Jugenburg, MD

Regarding: "2nd Tummy Tuck Needed for Failed Muscle Repair - Best Method?  I had a full tummy tuck 3 weeks ago. I have never seen a completely flat abdomen. I took pictures at 2 days post op and there was a slight bulge above my belly button. At my 2 week post op PS thought that I might have a failure of the muscle repair but to wait until my 6 week appt to re-evaluate. My question is what is the best way to correct the bulge? A second full tummy tuck? Endoscopically? After a FTT how far should my belly extend when I am pushing outward?"

A persistent above the belly button bulge can be caused by multiple causes. To get a successful resolution, the cause of your bulge must be diagnosed before any treatments are tried. I would suggest you wait 8-10 weeks for much of the inflammation to go away and then have your surgeon examine you. If in doubt a CT scan may be obtained. A disrupted muscle repair correction would depend on how the muscle was repaired originally (single stitches or a running stitch) and how much of the muscle length sepatated. Residual fluid can be aspirated with a needle. Residual fat can be liposuctioned.

A wait and keeping in touch with your surgeon is the best way to proceed at this point.

Good Luck

Dr. Peter Aldea

The key thing is to figure out what the cause of the bulge is?  Is it swelling, is it a fluid collection, is it a hematoma, is it a weakness in the muscles.  An exam may help determine this and then you can go from there.

The best advise is to follow up with your surgeon to express your concerns. There is no best way,only choices. Perhaps it may improve with time to some degree to make any revision less aggressive. Hope for the best but don't lose hope. Your surgeon knows all of the options for you to consider.

Perhaps. some of the sutures, holding your muscles together, broke.  I agree with your plastic surgeon.  if things don't improve in the next several weeks, one could enter the umbilicus incision, and repair the problem, if it exists.  Good luck.

The cause of this must be determined first.  It can be simply swelling in the tissue, or residual fat above the umbilicus, or fluid trapped under the skin (seroma), or maybe a muscle repair problem.  An ultrasound can help determine which of these is the culprit.  Probably a muscle repair problem would be the least common as long as you went to a very experienced plastic surgeon. 

Three weeks (even 6) is too soon to consider secondary surgery after an abdominoplasty.  It takes time for the swelling to go down and chances are you may not need a second surgery. I would not consider it for at least 3-4 months.  If the problem persists, there are several choices and I would explore them all with your surgeon.  Consider:


a muscle tightening suture that broke

not enough tightening (sometimes a horizontal tightening adds to the vertical one)

fluid collection (seroma, usually in the lower abdomen)

excess fat (assuming liposuction was not done )

the belly button was reset too low 


Don't be in a rush.  An abdominoplasty is a big procedure.  Give the healing process time.