What Causes Upper Tummy Bulge After Tummy Tuck?

I have researched the Tummy Tuck procedure extensively. Online, I have been coming across people who, at 3-5 years post op, have flat lower abs but also have upper belly bulge. They had nice initial results. Why might this have happened and how can it be prevented, if any?

Doctor Answers 7

Several different factors influencing longevity of muscle repair with tummy tuck

First, it really depends on the muscle repair technique

Second, it can be effected by muscle strengthening regimens.

For example, mini tummy tucks may only repair the muscle below the umbilicus, leaving the upper abdominal muscles to separate.

When a full muscle repair is perfomed, I generally prefer a two layer repair which I feel is more likely to maintain the correction over the long run. However, there is considerable variation among experienced surgeons in regard to technique and materials

Even if the enitre muscles are repaired, exercise regimens that produce separation of the muscles may cause the diastasis to recur. For this reason, I generally recommend that patients pursue core strengthening using a Pilates supervised technique in which the abdominal muscles aare contracted to the spine rather than bulging outwards as with crunches stressing the repair

Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

I have not seen this.


There are several possible reasons to get upper abdominal fullness after a tummy tuck:

1) Only a mini abdominoplasty was done. This should not be done too often.

2) The upper abdominal skin and fat were not slid down sufficiently.

3) The separation (diastasis) of the muscles in the upper belly was not repaired.

But all these problems would be apparent right away. You are talking about someone whose upper belly initially looked good after abdominoplasty, and 3 years later developed fullness there. This I have not seen, and I cannot explain it without examining the patient.

I don't believe the "popped stitches" theory, because after a few months, the internal scar tissue holds the repair together and stitches are no longer necessary. In fact, we use dissolvable stitches to repair the muscles, and the repair holds up just fine.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Bulging after a tummy tuck

This can be caused by loosening of the stitches or weight gain. Despite our efforts to tighten the abdomen as much as we can, certain events can happen that reverse this tightness. An abrupt increase in abdominal pressure with severe coughing can "pop" some of the stitches. Gaining weight will cause the loose areas of the abdomen to bulge as well. I hope this helps!

Several possibilities for bulges after tummy tuck

There are several possibilities for bulges after tummy tuck. During the tummy tuck, the fascia is usually plicated (brought together) to tighten up the muscles. If this becomes loose, then a bulge can form in the location of the looseness. This can happy immediately after surgery or years later. This is very rare. If the bulge appears soon after surgery, you may have a seroma or fluid collection that can simply be drained and rarely needs surgery. In the vast majority of tummy tucks things like this do not happen. Good luck with your surgery.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

Bulges after tummy tucks

If a mini tuck was performed with no tightening of the fascia, this could cause a bulge in the upper abdomen. Mini tucks can be performed with full fascial tightening (I e hybrid tummy tuck (TM). Still even if a beautifully performed full tummy tuck was performed bulges can result. Remember that the patient's fascia is aggressively tightened, not completely replaced with a young fascia that has never had the stretching of childbirth. Your doctor should be realistic with you. Not every abdomen will be flat after a tummy tuck if there is fat inside the abdomen or the fascia is especially loose.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

Fat Redistribution

I like Dr. Beraka's answer, so I will not repeat his excellent summary.

I would just add that when you take fat out of the body, via lipo or Tummy Tuck, the body readjusts its total fat content according to the "calories in, calories out" balance.

If there is no change in diet or activity level, the body will continue to store fat, but since the fat cells in the lower abdomen are gone, it will look to store fat in nearby areas. The upper abdomen is a common place for the fat to go.

Ricardo L. Rodriguez, MD
Baltimore Plastic Surgeon
4.5 out of 5 stars 94 reviews

Couple of reasons for residual or recurrent upper abdominal fullness

First of all, be wary of drawing conclusions from, or comparing one patient to another in, photos. They don't always tell the full story. If aggressive liposuction is performed on the epigastric region, lymphatic drainage is disturbed and one can develop a roll of induration and edema. I don't think this is what you are really referring to but this can happen. Another reason is that, depending on the type of abdominoplasty, the soft tissue that is tightened the most is the tissue of the lower abdomen closest to the incision and the region tightened the least is the area furthest away in the upper abdomen. If one tightens the muscles maximally, narrowing the horizontal dimension or circumferential dimensions of the upper abdomen, the soft tissue cannot be tightened horizontally without a vertical incision so that the soft tissues can gather and appear fuller. Finally, it might be a relative effect whereby the upper abdomen looks more full because the lower abdomen has been tightened maximally in comparison.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

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.