Why Do I Have An Upper Abdominal Bulge After A Mini-Tummy Tuck And A Muscle Repair?

Q: Dr. Eppley,  I came upon your case study thru google –Case Study: Secondary Liposuction After Tummy Tuck Surgery.  I am 3 months post op for diastasis repair (to above button) and c-section scar revision . I did not have a full tummy tuck and no liposuction. The skin was pulled down at area of incision. I had a drain at upper abdomen below ribs for 5 days. There is persistent skin elevation there, like a bulge, delimiting the curvilinear path of the drain.  Dr says it’s fibrosis and to massage area.  I’ve done this daily and no change. I am now wondering if this is fat as you state in your case study.  I am, and was, very thin, especially upper abdomen. The area is soft to touch and no fluid (ultrasound was done).  It’s just so odd that it follows the path of the drain yet what you state in article makes a lot of sense. Any advice will be greatly appreciated as this is very disturbing for me to look at . Thanks!

A: If I understand what you had done…a muscle repair to a level above the umbilicus and some form of a mini-abdominoplasty. (c-section scar revision) The key in determining why this bulge exists has to do with the muscle repair and how the abdominal skin was elevated to do it. I suspect that the muscle repair was done through a ‘tunnel approach’ above the belly button given that a  mini-abdminoplasty incision was used. This means a tunnel of abdominal skin and fat was raised above the belly button to perform the muscle repair rather than a wide undermining of the upper abdominal skin flap. When the muscle was sewn together, this creates a midline bunching or bulge because the side tissues remained attached to the muscle. As the muscle is brought in by suturing, so is the side tissues pushing them together in middle. The fact that a drain was temporarily there is coincidental not causatory. (I have never seen a drain cause a raised skin tract) In essence, this is an ‘excess‘ of abdominal skin and fat that has created the bulge. The best treatment would be for some small cannula liposuction to reduce the underlying fat thickness and the overlying bulge.

Dr. Barry Eppley

Indianapolis, Indiana