I had a tummy tuck and muscle repair a year ago but my belly button has never stopped leaking

Question

The surgeon who did my surgery checked to see if there were any remaining sutures and did not find any and has just brushed me off by saying it will heal by itself. I have now gone to another surgeon who did a ultrasound which my Surgeon refused to do and has said that I have a 5mm to 7mm cavity leading to my ambilicalcord. Can someone PLEASE advise me how this could be fixed? And if it would close on its own. I am so depressed please help Update: Just to add I have had swabs taken from my belly button which confirmed I don't have an infection

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your inquiry regarding the fact that you had a tummy tuck with muscle repair a year ago, but your belly button has never stopped leaking.  Thank you for your history.  This is not an uncommon problem.  During the muscle repair of an abdominoplasty (tummy tuck), sutures are used.  Most experienced board-certified plastic surgeons use permanent sutures to repair the rectus abdominis muscle from the xiphoid (bottom of the sternum) to the umbilicus (belly button), and then from the umbilicus to the pubic region.  Since permanent sutures are used, that means the permanent sutures never dissolve.  Sometimes your body rejects these permanent sutures, or the suture becomes infected.  In the body’s attempt to reject the suture, a tunnel is made from the suture to the skin above.  This tunnel is called a fistula.  Fistulas can lead to chronic draining skin openings, typically around the belly button.  Most plastic surgeons would agree that you have a suture fistula left from the muscle repair.  The correction of this requires the removal of the offending suture.  This is typically performed under local anesthesia in the office.
Tissue dissection is carried down to the offending suture, and the offending suture or sutures are removed.  This can jeopardize the rectus repair.  It depends on whether single individual sutures were used one by one from the xiphoid to the umbilicus, versus using a running baseball stitch from the xiphoid to the umbilicus.
Since your fistula probably involves a permanent suture, your situation will probably not resolve on its own unless the offending permanent suture is removed.  Good luck.  Most plastic surgeons offer free virtual or in-office physical consultations.  Therefore, explore what other plastic surgeons have to say.  If you have any more questions regarding tummy tucks, abdominoplasties, or abdominal liposuction, contact an experienced plastic surgeon.  Since the tummy tuck surgery is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience in performing tummy tucks.  Do your research.   If you cannot find an experienced tummy tuck plastic surgeon in your neighborhood, consider traveling out of state.  Sincerely, Dr. Katzen, MD, MBA, FACS, FICS. ( Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Leila Kasrai, MD, FRCSC · Answer

This would most likely require surgical intervention since it’s already been over a year since your surgery. It’s unfortunate that your original surgeon no longer responds to your concerns. Please find another surgeon to get this repaired.

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

Hi, sorry to hear that you have not healed despite a significant period of time passing since your previous surgery. It is difficult to provide accurate advice without performing an examination in person, but it may be that the wound needs refreshing and re-suturing as after a year if a cavity has formed it is unlikely to heal without intervention. It is possible that this could be performed under local anaesthetic with you awake as a daycase procedure.

Matthew C. Camp, MD · Answer

The wound can be freshened to remove the fibrinous slough, and gauze packing placed twice daily. Slowly the wound will heal from the bottom up. Have faith - it will heal. It may take months.

Stefan Mark Szczerba, MD · Answer

There is something not healing or remaining after your tummy tuck a year ago... somebody needs to explore that umbilical area and look for either retained sutures or simply areas that have not healed but need to be cleaned out.  My suspicion is on retained sutures.  There are still some surgeons who use either just a few or multiple sutures that are permanent- those your body will continue to spit out and cause drainage until removed.  If you need to reach out and discuss further, give our office a call the number is 847-853-9900.  Best Wishes 847-853-9900!!

Dana Goldberg, MD · Answer

This sounds like an infection. Mycobacteria can cause delayed, lingering infections and can require months of antibiotics. Also, if there is a cavity, the opening may need to be enlarged to allow the wound to be packed.

Your surgeon is being lazy and dismissive. Find a new one or have your primary care doctor send a culture and refer you to an infectious disease doctor.

Pawel Szychta, MD, PhD, DSc · Answer

It sounds like you’re dealing with a post-surgical complication related to a cavity near your belly button, and I understand how frustrating and worrying this situation can be.Given that you’ve already been dealing with this for some time and the cavity has been identified through ultrasound, it’s less likely that the issue will close on its own without intervention. Cavities larger than a few millimeters often need some kind of treatment, particularly if they haven’t resolved after several months.While small post-surgical cavities or seromas sometimes reabsorb, a 5-7mm cavity is relatively large, and it’s important to consult a surgeon who is experienced in dealing with post-surgical complications. Leaving it untreated could potentially lead to further issues, such as infection, even if your current swabs show no infection now.It’s important to remember that while the healing process may not have gone as expected, there are solutions to address this issue and get you back to feeling your best. Stay proactive in seeking out the right treatment, and don’t hesitate to advocate for your health.

Camille Cash, MD · Answer

If this area is still leaking after a year it is not likely to stop on its own and must be addressed.  If your surgeon is not helpful I encourage you to visit with another board certified plastic surgeon to discuss your options.  The area may need to be opened in order to address the underlying issue.  Be sure to bring your ultrasound report along to the visit.