1 year post op, tummy tuck with lipo 360. Why is my belly not flat? It looks as if I'm pregnant Why is this? (Photo)

Hello,
Thank you for reaching out with your question about why your abdomen isn't flat one year after undergoing a tummy tuck and for providing your picture and medical history. There are a few potential reasons for this issue.
Firstly, one reason could be visceral fat accumulation, which is the fat surrounding your internal organs. Even after a tummy tuck, visceral fat can prevent your abdomen from appearing flat.
Another reason could be related to the surgical procedure itself. If the rectus muscles were not properly repaired or not repaired at all during your tummy tuck, this could affect the flatness of your abdomen. Additionally, fluid accumulation, such as a seroma or hematoma, can also cause your abdomen to appear less flat. However, since your CT scan did not indicate these issues, they may not apply to your case.
Given these considerations, most plastic surgeons would suggest a few options. Firstly, they might recommend dietary changes such as a ketogenic diet with calorie restriction, reduced carbohydrate intake, and elimination of sugar. Additionally, exercising for more than an hour daily can be beneficial.
Monitoring your percent body fat is also important. This will help in tracking your weight loss and understanding your body composition.
A tummy tuck revision might be considered if these lifestyle modifications do not yield the desired results. In your specific case, this could involve re-plication of the rectus muscle. Some surgeons also use abdominal mesh to flatten the abdomen further.
It's important to understand the limitations of plastic surgery and that results can vary based on your starting point. From your provided picture and history, it seems like you have achieved a good result. Each body is unique, and thus, postoperative results can differ.
I hope this information helps clarify your situation one year post-tummy tuck. Wishing you the best in your ongoing journey.
Sincerely,
Dr. Katzen

Dear Gentle920337,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is 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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

There can be several reasons for the contour that concerns you. If it is subcutaneous fat then liposuction of the area should improve it. Muscle wall laxity is another. In that case further repair of the abdominal wall is needed. A third potential cause is visceral fat. This is the fat around your organs and cannot be addressed with liposuction or a tummy tuck. Weight loss will improve the appearance of the abdominal contour from visceral fat.

There are generally four tissue variables that determine what the abdomen looks like.
This is true whether someone has had cosmetic surgery or not.
The four variables that determine what the abdomen looks like are.
1) abdominal skin laxity typically due to previous pregnancies or weight loss.
2) excess subcutaneous fat.
3) muscle separation from previous pregnancy.
4) excess visceral or intra-abdominal fat.
The number one reason patients bulge after a full tummy tuck is excess visceral fat. A tummy tuck primarily treats abdominal skin, laxity, and muscle separation.
You don’t have thick layers of subcutaneous fat in your preoperative picture does not show evidence of visceral fat.
It doesn’t look like skin laxity is contributing significantly after your tummy tuck.
It is rare that muscle separation fails after this procedure.
It’s possible you had a tummy tuck that did not include muscle tightening.
If that’s the case, then that would be the explanation for why your results look the way they do.
Without an examination or access to your operative report we can’t really give you a good answer or make an accurate assessment.
I suggest scheduling a few in person second opinion consultations.
For second opinion consultations come prepared to bring with you a complete set of proper before and after pictures and a copy of your operative report.
Obviously The first stop should be following up with the provider who did the procedure.
Best,
Mats Hagstrom, MD