Failed muscle repair? (Photo)

Question

I had a full TT in April 2018 with pretty extensive MR. Every follow up since my surgery I’ve expressed my concern with my PS about possible failure. Every time I was told that my MR was in tact. Now at 10 months PO he’s saying I must have weak fascia and my muscles separated and that I will have to pay for a mini TT to have him fix my muscles. Very frustrated to say the least. Does this look like MR failure? Can I fix with ab work or will I need to re-do it to get flat?

Farbod Esmailian, MD · Answer

I usually perform muscle plication with permanent sutures to help avoid dissolving of the sutures over time and recurrence.  However, in certain patients, the muscle can be tightening extremely well and the patient can still have a slight bulge.  This is because there may be some inherent weakness and laxity of the abdominal wall that persists even though the fascia was tightening as much as possible.  It may be not because the sutures pulled through or broke.I would certainly wait at least 6 months to a year before going back in to redo the plication, but you must be aware that the same or similar outcome could occur.  You may be further tightening, but it is likely that things will stretch again a bit and you may have a smaller bulge.  Although, it may be smaller than what you have right now.Hope that helps.

Kenneth Hughes, MD · Answer

Hello. Great question. However, a personal examination is needed to determine if it is a failed muscle repair. Please schedule a consultation with a board certified plastic surgeon for a detailed surgical plan to achieve your desired results.

John J. Corey, MD · Answer

if it was there from the beginning it’s possible that the muscle was not tightened enough. It is also possible that early on you broke the stitch and things relaxed... and other times, good repair can be done but patients fascia is just weak and stretches. Discuss with your surgeon  but it is not unheard of to have to return and do a mini tummy tuck to tighten the lower muscles again, sometimes reinforced with a little bit of mesh!  The idea is not very fun but I’m sure your surgeon want to make you happy..,

Camille Cash, MD · Answer

An in person evaluation is needed to determine if your muscle repair has failed.  If you have weak fascia you may benefit from having mesh used to support the tissues during the revision.  You can visit with another board certified plastic surgeon for a second opinion if you are unsure about your surgeon's recommendation.

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after tummy tuck surgery.   Given that you are 10 months postop, I would suggest that you continue to work on strengthening your abdominal wall muscles, prior to making any decisions whether or not to return to the operating room for revisionary surgery.   In my  experience,  I have seen patients benefit from strengthening of the abdominal wall muscles after tummy tuck surgery;  this is understandable given that the patients have not been able to use or strengthen the rectus abdominis muscles prior to and after the tummy tuck procedure.  In my practice, I ask patients to start with planks and move up to more active upper and lower abdominal wall strengthening exercises. Your plastic surgeon will be your best resource when it comes to returning to specific exercises. In the longer term, if the above measures do not return your abdominal wall to a flat contour, revisionary surgery will likely be necessary.  Policy regarding coverage of expenses for revisionary surgery will vary from office to office and probably on a case-by-case basis as well. Costs of revisionary surgery may range from zero,  to anesthesia/surgery center fees, to discounted surgeon's fees.
 Generally I suggest patients who have unfavorable outcomes to communicate their concerns in a calm and constructive fashion; this form communication tends to be much more effective than confrontational communication.
Best wishes.

Failed muscle repair? (Photo)

Answers (5)

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