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February 07, 2009

Abdominal Irregularities after a Tummy Tuck in Oxnard: One Year After Surgery

A few days after seeing another surgeon's patient, who was unhappy with a painful abdominal bulge one week after a tummy tuck, into my office walks in another dissatisfied 45-year-old tummy tuck patient from Oxnard--but she is one year after her surgery.

I had a tummy tuck approximately 12 months ago.  My upper abdomen is perfect, but, right underneath my belly button on the right side, there is a bulge.  I have no idea what this is from.  Is it a weakness in my muscles?

The potential causes of this irregularity are different one year after surgery than they are immediately after an operation....

  • inadequate fat excision or liposuction at the time of the surgery (which is an artistic error)
  • inadequate or asymmetrical skin excision (which is also an artistic error)
  • muscular weakness (either because the stitches used to tighten the muscles came loose or because recent weight fluctuations re-stretched out the muscles in some areas)
  • chronic seroma (which is a benign fluid collection that never fully resolves on its own)
  • organized hematoma (which is the scar that replaces an undrained blood collection)
  • organized fat necrosis (which is the scar that replaces dead fat cells)

In most of the above circumstances, repeat surgery is required to correct the complication.  However, a mini-abdominoplasty approach is usually adequate, and the full incision does not usually need to be reopened.

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Comments

Saint Davids Botox

It really stinks when you have to go back and have a surgery to fix the problems from the last surgery. What really helps is making sure you get the right doctor in the first place. People should look for one with experience and the proper training. Maybe then they wouldn't have to come back in a year to fix it.

Victor

Hi Dr. :
I had an abdominoplasty about seven weeks ago, inthe morning my stomach is flat (exactly how I wanted) but later in the day my lower stomach bulge out and I feel tenderness in the area, the bulge becomel bigger if I sit and stand up (in this process I feel abdominal muscle spasm),this normal? or this will be like this forever?

Thanks
Victor

Michael Pickart


Dear Victor,

Nice to meet you...electronically!

Do not fear the worst. It has only been seven weeks since your operation, and your results are still fresh. There is still residual swelling, and the muscle repairs and skin incisions are not fully healed. Those spasms are almostly certainly normal.

However, definitely see your plastic surgeon. I suspect that you are healing fine, but please ask him whetheryour bulgecould be a seroma (a collection of fluid beneath the skin flaps). Seromas can usually be treated by aspiration (simple removal of fluid with a needle, under local anesthetic, in the office).

I hope this helps! You are always welcome to get a second opinion in my office in Ventura, California. My telephone number is 805-648-4567.

Sincerely,
Mike Pickart


Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

428 Poli St.,#2C, Ventura, CA 93001
(805) 648-4567 | fax (805) 641-0811


To: info@pickartplasticsurgery.com

tummy tuck

So where do you make an incision for this mini tuck to take out the bulge? Does that mean the patient will now have a scar that will fall above the panty line?

Another Oxnard tummy tuck gone bad

I also had a tummy tuck exactly a yr ago, and I have the same problems as your other stories. Very unsatisfied w/ it all. Have a huge bump in the lower part of my stomach. The worse belly button in the world. My scars don't seen to be getting any lighter, even after a yr.

Michael Pickart

Dear Another Oxnard tummy tuck gone bad,


I am disappointed for you. Who was your surgeon? Please let him or her know that you are dissatisfied. Perhaps there are some maneuvers that can improve your result.


Do you live in Oxnard? My office is just a few minutes away, in Ventura. I would be happy to provide you with a second opinion. I just obtained a new phone number: (805) 654-8800. Do call!


In my tummy tuck practice, not 100% of my patients are totally satisfied. (Just being honest.) But 90% agree that there was significant improvement.


I have surgically revised many tummy tucks, and the patients do develop more confidence in their contour improvements and do frequently experience better scars. Also, I can teach you some scar massage techniques that can minimize scar thickness and prominence. I even have a laser that can lighten the redness of some keloid-type scars.


Hope that I can help,
Dr. Mike Pickart

Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

1746 S. Victoria Ave., #250, Ventura, CA 93003
(805) 654-8800 | fax (805) 654-8802

To: info@pickartplasticsurgery.com

Julie

I had a tummy tuck almost one year ago (march 23) My lower stomach will sometimes get rock hard and kinda bloated looking, its not really painful just uncomfortable, would this be muscle spams due to it healing? Im really concerned about this. Please help.

Michael Pickart


Dear Julie,


I am sorry that you are concerned about the result of your tummy tuck. My best suggestion: Schedule an appointment with your surgeon.


Hell probably tell you that your swelling is normal. However, he should check for unusual complications (such as seroma).


You need some peace of mind! See your doctor!!


If you are in the area of Ventura, California, I would be happy to see you. I am a Board Certified Plastic Surgeon, and I love to help.


Sincerely,
Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

1746 S. Victoria Ave., #250, Ventura, CA 93003
(805) 654-8800 | fax (805) 654-8802

To: info@pickartplasticsurgery.com

Angie

I am 2 weeks post op tummy tuck and lipo. When I stand up and begin to walk, my abs become rock hard and the spasms pull me into a "C" position. This occurs everytime I am upright making it hard to get the exercise I need for recovery. Is this normal and if so, how long will this LAST.

Michael Pickart


Dear Angie,


These post-operative muscle spasms are normal for 1-4 weeks. Please call your Board Certified Plastic Surgeon. He should be able to allay your anxieties. I frequently prescribe Valium for muscle spasms; ask him whether Valium would be right for you.


Sincerely,
Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

1746 S. Victoria Ave., #250, Ventura, CA 93003
(805) 654-8800 | fax (805) 654-8802

To: info@pickartplasticsurgery.com

Farzana

I had a full tummy tuck with lipo of abdomen and flanks just a little over 3 months ago. Since I saw my new tummy for the 1st time I noticed this bulge just above my BB. It feels spongy and looks as though an organ is pushing outwards. In the morning it is pretty flat but still there but by bedtime its as if I am prego but it looks awkard cuz its just my upper abdomen that is bulging. I went to my GP as I was having constipation issues for months (even prior to my TT) Allergy testing showed gluten, dairy, egg, peanut and tons of other food allergies. Ultrasound abdomen was normal. Just had a test done today to see if it could be bacteria in my intestines because although I am avoiding all the foods I have allergy to, I still have the bulge. GP says I might need to see a GI doc. I also read that due to all the meds taken before/after TT that it can change the flora in the tummy. Sorry bout the long story. Maybe it helps others.

Farzana

I also just wanted to say I am still VERY happy I went through the TT. There is a HUGE difference! My feeling is its nothing to do with the surgery and that its something in the inside that has changed.

Farzana

Okay, this was supposed to go first LOL !

I had a full tummy tuck with lipo of abdomen and flanks just a little over 3 months ago. Since I saw my new tummy for the 1st time I noticed this bulge just above my BB. It feels spongy and looks as though an organ is pushing outwards. In the morning it is pretty flat but not quite. By bedtime its HUGE and looks awkard cuz its just my upper abdomen that is bulging. I went to my GP as I was having constipation issues for months (even prior to my TT) Allergy testing showed gluten, dairy, egg, peanut and tons of other food allergies. Ultrasound abdomen was normal (thank goodness, muscles are okay). Just had a test done today to see if I have bacteria in my intestines because although I am avoiding all the foods I have allergy to, I still have the bulge. I am taking priobiotics and digestive enzymes, which are not helping. GP says I might need to see a GI doc. I read that due to all the meds taken before/after TT that it can change the flora in the tummy. Sorry bout the long story. Maybe it helps others.

Michael Pickart


Terrific, Farzana! I am glad that you had such a positive experience. Most of my patients are thrilled about their tummy tucks, and unhappy patients are unusual.


Congratulations,
Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

1746 S. Victoria Ave., #250, Ventura, CA 93003
(805) 654-8800 | fax (805) 654-8802


To: info@pickartplasticsurgery.com

Michael Pickart


Dear Farzana,


Since your tummy tuck was just 3 months ago, it is possible that the epigastric fullness is just swelling. My diagnosis is consistent with your description of the fullness as spongy. Swelling can require 6-12 months for full resolution.


Please let your plastic surgeon know about your concerns. He may want to photograph the area to confirm its resolution over time.


FYI, sometimes patients have excess fat in the epigastrium that is not easily or safely removed during the tummy tuck itself. This fullness may be swelling, but it could also be some of that excess fat. Occasionally, I warn my patients that secondary liposuction is necessary to perfect the tummy tuck--6-12 months later. Please dont be alarmed! Just be aware that minor revision liposuction sometimes aids a result.


Congratulations on your otherwise terrific result!


Sincerely,
Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

1746 S. Victoria Ave., #250, Ventura, CA 93003
(805) 654-8800 | fax (805) 654-8802


To: info@pickartplasticsurgery.com

Farzana

Thanks so much for the quick reply, Dr. Pickart ! Having a TT was one of the best decisions I have made! I also thought it could be swelling or fluid collection, but wouldnt that show on the ultrasound, which was normal? I asked my PS to order one 1.5 months ago but he didnt feel I needed so that is why I went to see my GP for it. My PS did do lipo only on this area one month ago and although there is a little differnce, that "spongy protrusion" is still there :-( The weird thing is that line you see in the midline (which shows you have tight muscles) disappears exactly where this bulge is. I wish it was just swelling LOL !

Farzana

I wish you were closer to where I live so I could see you for a second opinion. I called 3 other PS' and they all told me to go back and see my PS who did the procedure. Nobody wants to see me.

Michael C. Pickart, M.D., F.A.C.S.

Dear Farzana,

If you wait for the right sale, airplane tickets can be affordable! You would be welcome in my office.

But don't neglect your own plastic surgeon. He or she may be able to alleviate your anxieties, and confirm for you that your fullness is just swelling. (I hope.)

Sincerely,
Michael C. Pickart, M.D., F.A.C.S.

Farzana

Dr. Pickart, I did see my PS yesterday. He said some people are just built like that (upper bulge). He does not feel like I have a hernia or any problems nor does he feel at this point he needs to see me anymore. He asked I go to my GP here on. I never had this weird bulge (even prior to having my kids). In fact, I noticed it after the procedure. Oh and the test I had to check for bacteria in my intestines . . . negative. I guess I will see my GP again. Maybe I should see a GI. IDK. Very frustruating as I am getting no answers as to what the cause of this is :-(

Mills

My TT was done 6 months ago and although it looks flat when I am standing, i still have a bulge right beneath my belly button and also when i sit down my stomach looks like nothing has been done. I freaking out. i keep telling myself its just swelling but i continue to see the rolls as i sit.

Tina Cooper

Hi Dr. I had a tummy tuck procedure 2 and a half weeks ago well I notice two days ago a bulge on the right upper side of my abdomen.My abdomen is flat except for this bulge should I be worried?

Michael C. Pickart, M.D., F.A.C.S.

Dear Tina,

I am sorry that your experience has not been as "smooth" as you might have hoped. (I'm sorry; I couldn't resist the bad joke.)

My advice: Please call your plastic surgeon, and get this "bulge" evaluated. It is probably normal swelling, and will probably resolve on its own. However, it could be a seroma (a fluid collection), fat necrosis (a bit of dead fat), a hernia, etc.

Honestly, I can't be your doctor over the internet. You need a proper evaluation from a Board Certified Plastic Surgeon, preferably the one who did your surgery. At the least, you deserve the reassurance that the bulge will go away.

If you are in the Ventura, California, area, I would be happy to see you. 805-654-8800.

Sincerely,
Mike Pickart

Rhonda

I had a tummy tuck 10 months ago. My stomach wasn't flat like I was told it would be. The doctor told me at first my stitches came undone. Then he told me it was fat and I needed to lose weight, but before the surgery he told me I didn't need to lose weight. He told me he didn't want to see me anymore. Now I look like I am 4 months pregnant, no weight gain. I paid 7500 with a result that I wasn't told I would have.

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