I've Had a Hematoma for 4 Months. Above the Belly Button and Upper Stomach That Bulges Out. Will Lipo Help This Area? (photo)

This is tough to tell from the photos, but I doubt that four months later the collection is drainable.  If a needle aspiration of the fluid is possible, then you may consider leaving in a drain percutaneously placed by a radiologist.  Otherwise, i would let this settle and then bring you back and perform a more definitive correction of this in the OR.

Good luck

Dr. Vasisht

South Shore Plastic Surgery

It sounds like you have had a rough go of things.  My next step would be to figure out from the ultrasound or other imaging including a CT scan, how big is the hematoma and whether any of it is liquid or not.  If the blood is still mostly liquid, it can be removed with lipo or simple aspiration in the office.  If it is a thick organized collection of scar tissue, liposuction may not remove it and you may need to have a revision tummy tuck. I would discuss these options with your physician.  Good luck.

      If the ultrasound showed hematoma, the next question should be : how large is the collection?  If this is large enough to drain or remove, then this should be done.  Kenneth Hughes, MD Los Angeles, CA

If there is still a bulge 4 months out and it is firm you could also consider heat,massage and ultrasound which should help this resolve without surgery.

Dr. Swift had great comments as you tummy bulge could be from laxity of your upper abdominal wall so you do need to have it carefully and thoroughly evaluated before jumping in with liposuction.  I find this problem in patients who have a very large, protuberant tummy that does not go flat when laying supine.  Tightening of the bottom pushes it out on top.  If this is the case, a reoperation will be needed, assuming your tummy does go flat when laying down supine on your back.

Dear Chulita, You should have your upper abdominal bulge carefully evaluated by your Board Certified Plastic Surgeon. Physical examination and an ultrasound of your abdomen will determine what is causing the bulge. It can be a collection (hematoma or seroma), fat or laxity of the abdominal muscles. The findings will determine whether liposuction is the appropriate treatment.

Its difficult to know exactly what is going on without examining you. If you currently have a hematoma, I would wait until this is resolved before having any more surgery, and even then, considering the various issues you have had, I would wait at least 6 months for things to settle down. Best of luck.

Usually physical examination will determine if  a post-operative fluid collection exists.  If it is not clear by examination, ultrasound or CT scan may be helpful.  If a large hematoma is present, formal surgical drainage and insertion of a drain may be necessary.  If only a serous fluid collection is present, the surgeon may be able to aspirate the fluid in the office under local anesthesia. 

To understand what can be accomplished by a tummy tuck, one must consider the anatomy of the region.  Four anatomical layers contribute to the abdominal appearance.  The layers are listed below from the outside to the inside.
 
1. Skin
2. Fat beneath the skin (subcutaneous fat)
3. Abdominal muscles
4. Intra-abdominal contents (organs and fat within the abdominal cavity)
 
Tummy tuck can only improve layers 1 through 3.  A tummy tuck removes excess skin.  Fat from beneath the skin is also removed during a tummy tuck.  Liposuction may be used as well to assist in removal of fat from beneath the skin.  The abdominal muscles are tightened during a tummy tuck to flatten the abdominal contour.  A tummy tuck cannot remove excess fat from within the abdominal cavity.  The effect produced by abdominal muscle tightening is limited by how much fat is inside a patient's abdominal cavity.  Therefore, not every patient can have an absolutely flat stomach after a tummy tuck.  The presence of abdominal cavity fat can be estimated preoperatively by having the patient lie on their back.  If the abdomen continues to protrude upwards while the patient is lying down, significant fat exists inside the abdominal cavity.  This fat and the resulting abdominal protrusion will not be corrected by a tummy tuck.  If a particular patient has significant fat within the abdominal cavity, I make that patient aware of this limitation of tummy tuck before the surgery. 
 
As a result of pregnancy, the lower portion of a woman's abdominal wall may be more stretched out than the upper portion.  While the objective is to evenly tighten the entire abdominal wall during a tummy tuck, sometimes the lower abdomen will be slightly tighter than the upper after surgery.  This will cause a relative bulge in the upper abdomen by shifting the abdominal cavity fat upward.  This usually resolves over time as the lower abdomen relaxes.  
 
The preoperative photos presented appear to indicate the presence of significant fat within the abdominal cavity which would not be improved by a tummy tuck.  The postoperative photos, show that excess skin and subcutaneous fat have been removed from the lower abdomen, resulting in a nice improvement in that area.  The upper abdomen appears relatively unchanged postoperatively as I would expect due to the presence of fat within the abdominal cavity.  The lack of change in the upper abdomen coupled with the significant improvement in the lower abdomen may make the upper abdomen appear to bulge more than it actually does.

If I thought the problem was a hematoma, my inclination would be to place a drain. From the photo, I can't tell what this might be. Hematoma or seroma are possibilities, as are persistent fat in the abdominal wall, or bugling of the abdominal muscles. I suspect the latter plays a bit role in the contour. A physical exam should be able to distinguish between the alternatives. I am not sure that liposuction would be my choice.

Best wishes. 

Only an in person exam can tell but your preop photos suggest excess intraabdominal fat. TT can't fix this and it can prevent a flat result. Fluid should be drained if possible. Stick close to your doctor.