8 Weeks Post OP...Do I Look Swollen? I Have Gained Weight Again, And Have Excess Skin Still? (photo)

Question

I'm 8 wks post op and the swelling just wont go down. I know it takes a while for it to go away, but I don't know if this is going to be my end result. Am I swollen, gained weight or still have excess skin?!? Can't tell if my muscles were pulled back far enough. I see my PS next week and I can't wait.

Richard H. Tholen, MD, FACS · Answer

Although much of your post-op swelling has resolved by 2 months post-op, your scars are still pink and immature, and your abdominal tissues still have some lymphatic swelling that will gradually resolve over several more months. However, this swelling is relatively minor compared to the degree of residual protrusion you are showing in your photographs.

	This can be due to several factors, including one commonly not considered by patients--residual intra-abdominal fatty tissue. In most tummy tuck patients, the abdominal skin is loose and the muscles stretched (usually from pregnancy, but also after massive weight loss or other causes), and a tummy tuck will tighten the muscles (plication or muslce "repair") and remove the excess skin. This also involves a new skin opening for the umbilicus (causing the scar you and most patients have with a full tummy tuck) and the hip-to-hip scar. The abdomen is flatter because of the tighter abdominal "container," as well as the tightened skin/fat flaps. The thinner you were pre-op, the thinner the subcutaneous fat layer beneath the skin.

	Let's say, however, we have a patient who carries a lot of "extra" weight not just in her subQ fat, but also in her abdominal contents (mesenteric and omental fat) and has a rounded or protruding belly on this basis. A tummy tuck in this kind of patient will end up failing to create a significantly-flatter abdomen because of the intra-abdominal contents trying to be squeezed into a tighter (muscle-tightened) abdominal container. Sort of like trying to put a 12-gallon head into a 10-gallon hat! It won't fit, and the same problem occurs with tummy tuck patients with excess INSIDE fat--either the muscle repair tears through, or the attempt to tighten the abdominal wall just doesn't work that well against the tension of the intra-abdominal contents. It does look as if you still have a bit of loose skin, but that is not the reason for your protruding abdomen.

	It's either the scenario I discussed above regarding your "inside-the-abdomen" contents (which your surgeon should have addressed in the pre-operative evaluation, and discussed with his/her recommendations), or it's loss of plication sutures (tearing through). Or perhaps both:( 

	You could still have some excess skin and fat, but this degree of protrusion is usually one of the two things noted above.

	In a few patients, constipation and/or bloating can cause this degree of protrusion, but you would certainly be aware of difficulties in this department, and then the "fix" is relatively easy.

	Seroma is unlikely at 8 weeks, but this too is something your surgeon can easily diagnose and treat.

	Bottom line--go see your surgeon and see what is going on. It would be wise for you to see your pre-operative photographs as well. Ask your surgeon or his nurse to see them. This may help you understand the answer! Best wishes!

Jeff Angobaldo, MD · Answer

Thank you for submitting your question.  Swelling after a full abdominoplasty will last for many weeks after surgery.  Final results take 6-12 months. Some patients with excessively lax skin may develop laxity after surgery.  Rest assured if the laxity persists in 6-12 months, a revision can be performed.  Discuss concerns with your Plastic surgeon.

Miguel Delgado, MD · Answer

In eight weeks you should see the major difference.  You will have some changes but minimal in my opinion.  I would like to see your abdomen flatter and tighter.

Tom J. Pousti, MD · Answer

Thank you for your question and photos. 

	As always, it is best to be seen in person ( by your plastic surgeon) for precise diagnosis and treatment.

	Abdominal wall "swelling" after tummy tuck may be related to:

	1. Swelling in the soft tissues.  This may take several months to resolve and may worsen with increased activity  or at the end of the day.   Patience  is required to allow for resolution of the swelling. The swelling occurs because of the interruption of venous and lymphatic channels that occurs during the tummy tuck operation.
	2. Fluid accumulation in the space between the skin and the abdominal wall muscle.  this may consist of blood ( hematoma)  or serum (seroma).  This fluid accumulation can generally be diagnosed by physical examination ( occasionally ultrasound  may be helpful).  Treatment consists of aspiration;  several episodes of aspiration may be necessary. 
	3. Separation of the abdominal wall muscle repair may lead to a swelling/bulge appearance. This may be diagnosed on physical examination  with your surgeon examining you in different bodily positions. One of the steps of a tummy tuck procedure involves reapproximation (plication)  of the rectus muscles.  These muscles have spread apart during pregnancy and/or weight gain. Bringing them together again in the midline helps to &ldquo;tighten&rdquo; the abdominal wall as well as to narrow the waistline.
	4. Residual adipose tissue may be confused for swelling. Again this is most easily diagnosed by physical examination. Additional liposuction surgery maybe necessary to improve the results of surgery.
	Generally, it takes many months for swelling to resolve after tummy tuck surgery and it may take up to one year  (or greater)  a complete skin redraping  to occur.

	I hope this helps.

Ronald Levine, MD · Answer

Swelling is common at this stage of recovery. Tips on swelling:wear your compression garment as advisedcut back on sodiumdon't sit around all day - walk around to promote circulationdrink plenty of water and go to the washroom regularlyThis doesn't look like it will be your end result. It's way too early to see that, yet.

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