What is causing this? What can be done to fix it? At my 1 year post op my surgeon stopped all contact with me.

Question

Tummy tuck lipo 360 on 3/30/23 All seemed normal until 12/2023. when I experienced a lower abdomen swelling when walking or standing for longer periods. 6/2024 I find out I have kidney cancer. Dr performs open nephrectomy down midline of abdomen removes all cancer on 8/1/2024. Today im cancer free. The upper stomach is misshapen, lower tummy more swollen than before, when standing or walking Lying down sometimes doesn’t help it go away. Sometimes the swelling feels hard. Why ? Fixes?

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question and congratulations on being cancer-free. Based on your history of a tummy tuck with liposuction, followed by an open nephrectomy, the swelling and shape changes you’re experiencing could be related to several factors.

First, it’s important to understand that abdominal surgeries, especially major procedures like a nephrectomy, can impact the healing and dynamics of the abdominal area. The swelling and hard feeling in your lower abdomen could be due to several possibilities:

Lymphedema or Fluid Retention: The nephrectomy, combined with your prior surgeries, may have disrupted lymphatic drainage in the abdominal area, leading to fluid accumulation and swelling.

Hernia Formation: The midline incision for your nephrectomy may have weakened your abdominal wall, creating the possibility of a hernia. This could explain the persistent swelling and hard feeling, especially when standing or walking.

Scar Tissue (Adhesions): Internal scarring from multiple surgeries could be restricting normal tissue movement, leading to a misshapen appearance or hard areas in your abdomen.

Residual Fat or Tissue Irregularities: The combination of liposuction and swelling from subsequent surgeries may have left areas of uneven fat distribution or scar tissue contributing to the misshapen appearance.

To address these concerns, here’s what you can do:

Consult a Specialist: Seek out a board-certified plastic surgeon who specializes in revision surgery and abdominal contouring. They can evaluate your current condition with imaging (such as ultrasound or CT scan) to rule out complications like hernias or significant scar tissue.

Lymphatic Therapy: If lymphedema is contributing to the swelling, working with a specialist in lymphatic drainage massage or compression therapy may help reduce fluid retention.

Surgical Revision: Depending on the findings, you may benefit from a surgical revision. This could involve tightening any loosened muscle repair, removing scar tissue, or contouring the upper abdomen and addressing lower abdominal swelling.

Lifestyle Modifications: Supportive garments, avoiding activities that increase abdominal pressure, and maintaining a healthy diet can help manage swelling while you work toward a resolution.

It’s unfortunate that your original surgeon has stopped communication with you. However, many experienced surgeons, including myself, are happy to provide consultations for cases like yours to help you regain confidence and comfort. I encourage you to seek a second opinion soon to ensure a thorough evaluation and appropriate care plan.

Sincerely,
Dr. Katzen

Ira H. Rex III, MD · Answer

It seems you certainly have a very complicated situation and it is impossible to give you a good opinion without an examination and review of your recent medical history.

Ajaya Kashyap, MD · Answer

Thank you for your query. It is difficult to say without photos, but I would recommend an MRI and an examination by an experienced board certified Plastic surgeon, as the midline abdominal surgery seems to be the cause of the change in shape. There is the possibility of a hernia as well that has to be ruled out. All the best!

Stefan Mark Szczerba, MD · Answer

I would give this time.  You've had necessary surgery through a prior surgical area compounded with additional scar formation from liposuction- you have got to let this settle for about a year before letting someone address this.  I would ask for your prior operative report and check for the use of permanent sutures with the initial surgeon or find a new surgeon for a second opinion and a review of the operative report.  Best Wishes!!

Connie Hiers, MD, FACS · Answer

You did not post photos, so I suggest meeting with a plastic surgeon, being examined, and discussing your options.

Camille Cash, MD · Answer

I am so happy to hear that you are cancer free!  The contour of your abdomen could be related to many things but since you had cancer and surgery after your tummy tuck and liposuction I would begin with your oncologist or primary care physician for an evaluation.

What is causing this? What can be done to fix it? At my 1 year post op my surgeon stopped all contact with me.

Answers (6)

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