Upper Belly Bulge After Tummy Tuck

Question

Two years after my Tummy Tuck, my upper belly is still bulging. I do crunches and weights and it still pops out past my lower belly. Why is it still bulging? Is this subcutaneous fat?

Sam Jejurikar, MD · Answer

The most likely reason for your persistent upper abdominal bulge is residual laxity (looseness) of the paired midline muscles of the upper abdomen.  If the initial plication (muscle tightening) of the upper abdomen was disrupted, not tight, or not performed, the intra-abdominal contents will still push the upper abomen outward.  In fact, if the lower abdominal plication is still intact, the upper bulge may be worse than it was preoperatively, as it may be the only place that the intra-abdominal contents can push out.  Other possibilities for causing the bulge are residual fat of the upper abomen or a hernia, but these are less likely.
Your best option is to be evaluated by a board-certified plastic surgeon.  If the cause of the bulge is residual laxity of the abdominal wall muscles, the only effective treatment is repeat abdominal wall plication.  Unfortunately, no amount of abdominal wall exercises will treat this condition alone.
Best of luck!

J. Timothy Katzen, MD, FACS · Answer

Hello jolee65,

Thank you for reaching out with your concerns about the bulging in your upper belly following your tummy tuck procedure. While it's challenging to provide a definitive assessment without photos, I can offer some insights based on your description.

One possibility is that the bulging in your upper belly could be due to visceral fat. Visceral fat is the type of fat that surrounds your internal organs and is not visible from the outside. Unlike subcutaneous fat, which is found just beneath the skin, visceral fat is deeper within the abdominal cavity. Losing weight through a combination of diet and exercise is typically the most effective way to reduce visceral fat.

Alternatively, if the bulge is caused by subcutaneous fat, which is fat located just beneath the skin, there are different approaches to address it. One method to determine if the bulge is subcutaneous fat is the fat pinch test. This involves pinching the skin and tissue in the area of concern. If you can grasp a significant amount of tissue, it may indicate subcutaneous fat.

If subcutaneous fat is the culprit, liposuction could be an option to remove excess fat and improve the contour of your abdomen. Liposuction is a surgical procedure that suctions out fat from specific areas of the body to create a more sculpted appearance. Your plastic surgeon can evaluate your condition and discuss whether liposuction is suitable for addressing your concerns.

It's essential to consult with your plastic surgeon for a thorough evaluation and personalized recommendations based on your unique anatomy and goals. Your surgeon can assess the cause of the bulging and recommend the most appropriate course of action to achieve the desired results.

I hope this information helps shed some light on your situation, and I encourage you to schedule a consultation with your plastic surgeon for further guidance.

Sincerely,
Dr. Katzen

Eddy Dona, MBBS, FRACS · Answer

One thing to understand about abdominal fat is that fatty tissue exists deep to the skin, and this is the fat which you can pinch between your fingers.
Then of course there is the fatty tissue that lies deep to your muscle and surrounds your abdominal organs. This fatty tissue you cannot feel but can see. This is the person you see with a very full and prominent belly – most of that is the internal fat.
Now a tummy tuck only removes the skin and the fatty tissue in front of the muscle. The surgeon does not go deep to the muscle so the fatty tissue around the organs is never reduced surgically.  Therefore, whilst the muscles are typically tightened to help tighten the waistline, the intra-abdominal fat will remain.
This fatty content can only be reduced through an overall reduction achieved through weight loss via diet and exercise. This is often why many people still notice that their abdomen remains “full” after surgery.
Yet a simple fatty pinch test will reveal that most of the problem lies deep to the muscles. That is, the fatty tissue deep to your muscles is the main contributing factor to a persistently fuller girth which is bigger than you might desire.
In fact, in certain individuals the upper abdomen can appear larger after surgery. The typical person who experiences this is someone that has a large lower abdomen with a fatty apron. With the removal of the apron the person undergoes a massive improvement and reduction to the lower abdomen. Now whilst the upper abdomen also becomes smaller, the degree of change is less than that of the lower belly, and therefore it becomes more noticeable.

Richard J. Bruneteau, MD · Answer

An upper abdominal bulge following abdominoplasty can occur
for a variety of reasons. In someone who is two years post-op, swelling would
be unlikely. A large number of structural defects need to be considered as possible
causes for this problem.These
include abdominal wall hernias, separation of the upper abdominal wall muscle
repair, excess subcutaneous fat, excess intra-abdominal fat, fat necrosis, over
tightening of the lower abdominal muscles and chronic seroma formation.Unfortunately,
it’s not possible to determine the cause of your upper abdominal bulge without
a physical examination. In some cases, additional studies may be necessary to
determine the exact cause of this problem. This may require a CT scan or
possibly ultrasound studies.Under
these circumstances it’s appropriate to consult your plastic surgeon. Your
surgeon can hopefully determine the cause and address the problem.

Jerome Edelstein, MD · Answer

Please see your surgeon about your concern. It could be one of several problems, such as excess fat that was not removed or muscle separation which was not corrected during your surgery. Either way, your surgeon should be able to make a better assessment. Best of luck.

Vivek Bansal, MD · Answer

Thank you for your question. Have your abdomen evaluated by your surgeon. There maybe e some swelling in the area, or a collection of fluid. Have an evaluation and determine the root of the problem.  If it is a fluid collection, this can be removed with a needle, and with compression, may remain away. I hope this helps.

Upper Belly Bulge After Tummy Tuck

Answers (11)

Answer: You would benefit from a physical exam, and possible further studies...

Answer: You would benefit from a physical exam, and possible further studies...

Answer: See your surgeon

Answer: See your surgeon

Answer: Upper Belly Bulge After Tummy Tuck

Answer: Upper Belly Bulge After Tummy Tuck

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Everything you need to know about Tummy Tuck

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Upper Belly Bulge After Tummy Tuck

Answers (11)

Answer: You would benefit from a physical exam, and possible further studies...

Answer: You would benefit from a physical exam, and possible further studies...

Answer: See your surgeon

Answer: See your surgeon

Answer: Upper Belly Bulge After Tummy Tuck

Answer: Upper Belly Bulge After Tummy Tuck

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Recommended reading

Everything you need to know about Tummy Tuck

Our mission is to create a world where every investment in modern beauty is Worth It.