Is Pouched-look After Tummy Tuck Swelling?

Is the pouched look 4 weeks after tummy tuck just swelling? I had a full Tummy Tuck 4 weeks ago and now I'm nervous because I still look like I have a pouch. Will it go away?

Doctor Answers 10

Tummy tuck recovery- swelling after abdominoplasty

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it is very common to develop a pouch in the lower abdomen several weeks after a tummy tuck. The reason for this is that swelling or edema gathers with gravity in the lower part of the abdomen. wearing abdominal girdles help, but most of all it just takes time.

You still have swelling

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 You should check with your doctor to be sure you don't have a seroma, which is a collection of fluid after the drain has been removed.  Otherwise, this is probably swelling that should improve over the next few months.

Contour Problems After Tummy Tuck

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Thanks for your question -
It is common to have abdominal swelling after abdominoplasty. Four weeks usually is enough time from some of the swelling to begin to improve.

When thinking about abdominal contour here are things to consider:
Skin envelope
Abdominal fat (subcutaneous and intrabdominal)
Muscles tightness
Intrinsic Swelling
Fluid collections

Skin Envelope -
People complaining of "abdominal bulge" after tummy tuck typically do not have issues with too much skin - that points to issues underneath the skin.

Abdominal fat -
This can be an issue in people who may be a little bit over their ideal body weight at the time of abdominoplasty. Ways to fix this include the tried and true diet and exercise or liposuction. Be sure to allow enough time between tummy tuck and liposuction to minimize complications.

Muscle tightness -
Muscles plication (or tightening) is usually a part of abdominoplasty. Either failure of the sutures or some laxity can cause a bulge. If the change in your contour was sudden or if you felt a pop - think about the plication having ruptured.

Swelling -
This can be the most common cause of contour issues post-abdominoplasty. Patients typically have swelling for two reasons. First surgery causes trauma and the body's response to trauma is to bring additional fluid into the area that has been traumatized. In addition, abdominoplasty involves dividing lymphatic channels (very very small conduits that normally pull fluid out of tissue) - until these channels grow back the area will not be able to remove excess fluid.
It is usually the most dependent (lowest) part of the surgery that stays swollen the longest.
The majority of swelling usually resolves after the first 4-6 weeks but there may be residual swelling for up to 6 months.

Fluid collections -
Seromas (serous fluid collections) or hematomas (collections of old blood) can cause distortions of contour. Normally this will improve on its own but may require drainage.

I hope this helps. Talk to your plastic surgeon and see which might be contributing to your abdominal contour.

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"Pouching "after Tummy Tuck

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A "tummy tuck" done in surgeon A's o.r. can be very different from that done in surgeon B's. Was aggressive suction of the flanks or sculpting of the mons area done because thy can add to the swelling.

In any case swelling does not completely resolve until 3 to 6 months.

Barry H. Dolich, MD (Retired)
Bronx Plastic Surgeon

Pouch 4 weeks after abdominoplasty is not normal.

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Unfortunately, this does not sound like swelling. From your description, either you have a seroma (fluid collection) or you had incomplete correction during surgery.

The first thing to do is have a sonogram which will tell your doctor if you have any liquid which needs to be aspirated. If a seroma is not removed, it can convert into internal scar tissue, which is then permanent.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Still very early, but likely just some swelling

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Assuming you have to fluid collection present, such as a seroma, you likely just have some normal swelling that will resolve on its own with time. To be safe, I would see your surgeon so he can examine you to verify this. If there is some fluid present, however, he may want to aspirate it to speed up the healing.

Reasons for a pouch after a tummy tuck

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1- swelling- should go away within 3-6 months

2-Scar contraction at the suture line can cause the incision to indent - this will make the tummy look like it has a bulge.

3-Hematoma or seroma - a collection of blood or fluid that will give a bulge - either way, the fluid should be removed.

see your doctor and ask, which of these things you see.

Best of luck.

Picture please?

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There will be swelling aftetr the procedure, but you should see a significant improvement right after surgery.  If you were to send a frontal, quarter and side view, I would be able to be more specific.


Wait a full two months

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In our Santa Rosa abdominoplasty practice, we tell patients to wait two months before judging a final result. The pouch you refer to could be just residual swelling. It could also be a fluid collection called a seroma, so go back to your surgeon and make sure there is no fluid that needs to be aspirated with a syringe. Your surgeon may also want you to wear a compression garment if it is just swelling. Usually it takes 2 months to see the final result so hang in there during this time!

Discuss with your surgeon

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I would discuss it further with your plastic surgeon. It is too early to look at the final result. In cases where a large abdominal flap was present before surgery, the upper abdomen might still have some bulge due to intra-abdominal fat content.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.