Why Do I Have Upper Abdominal Fullness After My Tummy Tuck?

Q: Dr. Eppley, I had a full tummy tuck three months ago. I opted liposuction with my tummy tuck. I am very pleased with the way the bottom of my abdomen looks, however, I have quite a bit of fat on my upper abdominal. I was under the impression that you would do liposuction on the upper abdominal area during the procedure, however, it wasn’t. Can you advise why? I did pay for the tummy tuck and liposuction. I have researched it quite a bit to make sure I didn’t misunderstand, and it looks like that would be the “norm” if you had a tummy tuck and lipo that it would be done on the upper abdominal area, however, it wasn’t in my case. I look forward to hearing from you.

A: This particular tummy yuck question is not uncommon and there is a very straightforward answer. The concern about fullness in the upper abdominal area is one of the most prevalent after surgery issues after one has had a tummy tuck. One does not have to look too hard on any plastic surgery forums on the internet to see how common this tummy tuck question is.

This question is so common that in every tummy tuck consult I emphasize to patients about this issue and, while liposuction may be done in the flanks and lateral abdominal wall, I do not perform it in the upper abdominal region. Thus, one may be left with an upper abdominal region that may be more protrusive than in the lower area where all of the tissues were cut out if they have any fat thickness in their upper abdomen originally.

It is not the norm in a full tummy tuck to perform full abdominal liposuction on the upper abdominal skin flap. This is avoided by most plastic surgeons because of its devascularizing effect on the skin flap and the risk of causing poor wound healing, central    wound dehiscence and even overt tissue necrosis between the new belly button and the incision line. One also does not have to look to hard online to see some disastrous results when upper abdominal liposuction is done with a full tummy tuck. While it may not occur in every such case, one devastating tissue necrosis event can take months to heal and create a permanent abdominal wall deformity.

This makes going for the very flattest total abdominal result possible by widespread use of liposuction at the time of a full tummy tuck a risky manuever. This is one that I will not do out of concern for patient safety and to avoid risks of a postoperative complication. This is why I point this issue out during the initial consultation and emphasize that secondary liposuction may be needed for flattening the upper abdomen six months or more after the procedure when it is safe to do so.

Dr. Barry Eppley

Indianapolis, Indiana