Is Pouched-look After Tummy Tuck Swelling?

Question

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?

Sean Younai, MD, FACS · Answer

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.

J. Timothy Katzen, MD, FACS · Answer

Hello trestar614. Thank you for your question regarding whether the pouched look 4 weeks after a tummy tuck is just swelling.

At four weeks post-op, it is quite common to experience swelling. Swelling can persist for several weeks to months after a tummy tuck, which can cause the area to appear pouched or bloated. This is a normal part of the healing process as your body adjusts and recovers from the surgery.

However, it's important to continue following your surgeon's post-operative care instructions, including wearing compression garments, staying hydrated, and avoiding strenuous activities that could exacerbate swelling. If you have any concerns or if the swelling seems excessive or is accompanied by other symptoms like severe pain, redness, or fever, it is crucial to reach out to your plastic surgeon for an evaluation.

Patience is key during the recovery period, and in most cases, the swelling will gradually subside, and your final results will become more apparent over time.

Good luck, and I hope this helps answer your question regarding swelling and the pouched look after a tummy tuck.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS

Steven H. Williams, MD · Answer

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 envelopeAbdominal fat (subcutaneous and intrabdominal)Muscles tightnessIntrinsic SwellingFluid 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.

Shahram Salemy, MD, FACS · Answer

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.

Robert M. Freund, MD · Answer

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.

Scott E. Kasden, MD, FACS · Answer

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.
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Francisco Canales, MD · Answer

Hello
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!

Hisham Seify, MD, PhD, FACS · Answer

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.

George J. Beraka, MD (retired) · Answer

Hi!
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.

Richard P. Rand, MD, FACS (retired) · Answer

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.

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