Upper tummy bulge - can I do anything about this? (Photo)

Question

I am 9 months post op from a Fleur-de-Lis Abdominoplasty. A few months ago, I have started to have a bulge on my upper abdomen. The picture of the flatter tummy was taken 3 months post op, the other one was taken recently. I was wondering what is the most likely cause and if there is something I can do better about it. My weight is the same as when the first picture was taken.

Andre P. Marshall, MD · Answer

Hi Livoie, 
Thank you for your questions and pictures. An upper abdominal bulge after tummy tuck can be caused by loosening of the muscle repair, hyperplasia (growth) of remaining fat cells in the upper abdomen an increase in visceral fat, or just normal bloating/swelling. You will see swelling that comes and goes for several months to well over a year after any tummy tuck. There is no definitive answer without a formal exam. We do recommend you speak with or ask your surgeon directly. Give your body ample time to heal along the way. Best wishes during your continue recovery. 
Dr. Andre P. MarshallDouble Board Certified Plastic SurgeonBeverly Hills, CA 90210

J. Timothy Katzen, MD, FACS · Answer

Thank you for reaching out with your concerns about an upper tummy bulge nine months following your FL tummy tuck. Your pictures are quite informative and help in assessing the situation.
From what is visible, the bulge could either be a collection of fat or potentially a hernia. My first recommendation is to consult with your original surgeon for a precise evaluation. If a hernia is suspected, an ultrasound might be necessary to check for any fascial defects.
In case it's not a hernia, we're possibly looking at either localized fat accumulation or a weakened abdominal wall. If a fascial plication (muscle tightening) was not performed during your FL tummy tuck, this could potentially contribute to weakening of the fascia and the subsequent bulge.
Therefore, revisiting your plastic surgeon for a thorough assessment is crucial. An ultrasound may indeed be required to determine the exact nature of the bulge. If the ultrasound results are negative, implying no hernia or significant fascial defect, then the focus might shift to lifestyle modifications such as caloric restriction and increased physical activity to address the issue.
I hope this guidance helps you in taking the next steps to resolve the upper tummy bulge you're experiencing post your FL tummy tuck.
Sincerely,
Dr. Katzen

Daniel Barrett, MD · Answer

Dear Livoie,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

I would go back to your surgeon and be examined to see if the muscle tightening has weakened or come loose.

Camille Cash, MD · Answer

Thank you for your photos and question.  If your weight has stayed the same the bulge may indicate that your muscle repair has failed in the upper abdomen.  I encourage you to visit with your surgeon for an examination.

Peter Andolina, DO · Answer

So I have had this same thing happen to one of my fleur de lis patients. There are 2 things that can be going on here. The first is that the upper portion of the rectus plication may have failed. This seldom happens but it is definitely in the differential diagnosis. The second option is that there was not enough skin and tissue taken from the superior aspect of the abdomen during your surgery. This is what happened to my patient. A fleur de lis can be a bit tricky because you need to take enough skin to bring things in horizontally but not so much that the closure is too tight . You also have to be careful not to undermine the skin during the surgery. I think you should go back to your surgeon. You may simply need a revision where some more tissue is removed.

Douglas Taranow, DO, FACOS · Answer

It is difficult to be totally accurate from a photos, but it appears that the upper abdominal plication may have released or stretched out.  This is seen with either suture failure or weight gain.

Darryl J. Blinski, MD · Answer

Great posted photos! I recommend in office ultrasound, I offer this procedure @$500) to determine if recti split or fat or seroms. Once a dx is determined then hopefully it id fat - liposuction could correct.If split rectus or seroma that is more aggressive surgery to improve the flatness. Best to virtual consult with...

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment and a surgical outcome we need to see proper before and after pictures. If you don’t have before and after pictures then ask your surgeon to forward the ones they took. To take your own after pictures use the timer on your camera or have someone else take the picture. Pictures should be taken from about 8 feet away showing your full torso from your neck to your knees wearing undergarments standing in a neutral position showing your front, side and back side.
There are two primary reasons patients will have bulging after a full tummy tuck with muscle tightening.
The first and most common reason is patients who have excess visceral or intra-abdominal fat. That condition can usually be seen on before pictures and that is one reason why having access to before and after pictures is helpful in making an assessment. individuals who have excess visceral fat will develop increased intra-abdominal pressure from muscle tightening as part of a full tummy tuck and muscle tightening is usually more effective on the lower abdomen causing the upper abdomen to bulge after the procedure.
The second reason someone may have a bulging upper abdomen is if they have certain anatomic relationships. in particular individuals who are barrel chested or have a chest that has a deep anterior posterior distance compared to the lateral width of the thorax. Another way to view this or to understand it is individuals whose sternum sits in front of their pubic bone will have a back sloping abdominal wall with a bulging upper abdomen after a tummy tuck that includes muscle tightening. ideally the sternum and pubic bone should be on top of each other creating a true vertical line to get a straight flat abdomen from the procedure. The third possible reason is insufficient muscle tightening but this is a pretty rare reason for upper abdominal bulging after a full tummy tuck.
Sometimes it can be a combination of variables.
I suggest you follow up with your provider and discuss your concerns with him or her.
Best,
Mats Hagstrom MD

Jose A. Munoz, MD - Account Suspended · Answer

Hi and welcome to our forum!From your photos, the difference in appearance of your upper abdomen is noticeable. The upper abdomen has become somewhat fuller, suggesting that perhaps some internal deep fascial sutures have loosened or disrupted. As the procedure involved a vertical limb incision at anterior midline, a secondary repair can be performed under direct vision without having to open up the entire abdomen.15% of cosmetic surgeries can be improved with secondary revision. Revisit your plastic surgeon for evaluation and discussion.Best wishes...

Upper tummy bulge - can I do anything about this? (Photo)

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