Having a bulge or fullness above the belly button is a common concern after abdominoplasty (tummy tuck surgery). There are a few potential reasons why this may occur:
Swelling
Swelling is normal after any surgery and this is one of the most common causes of bulging above the belly button after a tummy tuck. During the operation, the abdominal tissues are handled extensively which causes inflammation and fluid buildup post-operatively. This swelling peaks at around 2-3 weeks and can persist for several months.
Swelling above the belly button occurs because the area above the umbilicus was operated on during the tummy tuck. The upper abdominal skin was lifted up and tightened, and the upper abdominal muscles were tightened. This results in swelling and bruising which can cause fullness or bulging.
Post-surgical swelling gradually resolves on its own over the first 6-12 months after the operation as the inflammation subsides and fluid is reabsorbed. Wearing the compression garment as instructed also helps minimize and control swelling.
Scar tissue
Another source of fullness above the belly button after a tummy tuck is scar tissue formation. When the skin and muscles are brought together during the abdominoplasty, internal scars develop during the healing process. This scar tissue can become thick or rigid in some cases, leading to an external bulge.
Scar tissue may start developing within the first few weeks after surgery but tends to become most pronounced several months later. The upper abdominal area is particularly prone to scar tissue as it experiences the most tension for closure.
Scar tissue maturation takes up to 1-2 years during which time the bulge may improve on its own. Massage techniques may help soften the scar tissue. In severe cases of hardened scar tissue, steroid injections or surgical scar revision may be necessary.
Skin laxity
Insufficient tightening and removal of excess skin during the abdominoplasty can also contribute to bulging above the belly button after tummy tuck surgery. Sometimes if the upper abdominal skin Flap was not adequately elevated and tightened, it can settle and sag after the operation leading to fullness.
Lax skin above the umbilicus gives the appearance of a bulge because the loose skin is bumped out by the contents of the abdomen. For some patients, a surgical procedure called a panniculectomy may be required to fully correct and flatten the area by removing the overhanging skin fold.
Liposuction issues
Problems with liposuction techniques can be a source of abnormal bulging or contours in the upper abdomen after a tummy tuck. If fatty deposits were incompletely removed or the cannula was placed too superficially, it can leave behind irregularities that show through the skin.
Persistent fatty bulges may be improved with repeat liposuction to smooth the area. In some cases, a focal bulge of hardened fat, called fat necrosis, develops which requires excision. Poor liposuction technique can also damage the tissue planes and blood supply leading to contour problems during healing.
Muscle repair failure
In a full tummy tuck procedure, the abdominal muscles are tightened using sutures to close the separated muscle, called diastasis recti. If these sutures rip through the muscle during healing, the muscle repair can fail. This allows the abdominal contents to push outward and create a bulge or hernia.
Failed muscle repair may require revision surgery to re-approximate the abdominal muscles properly. The surgeon may use stronger sutures, add mesh reinforcement, or opt for a different repair technique.
Seroma
A seroma is a collection of fluid that can accumulate in the space between the skin and muscle after abdomiinoplasty. This occurs when drainage tubes are unable to evacuate all of the fluid third spacing after surgery.
A seroma causes swelling and a visible fluid bulge which is most apparent above the belly button where the skin was elevated during the tummy tuck. Seromas usually resolve slowly with time as the fluid is reabsorbed. A needle drainage procedure may be done to evacuate larger seromas.
Hematoma
Bleeding into the space between the abdominal skin and muscle can form a hematoma after abdominoplasty. A large hematoma will cause bruising, swelling and bulging which is often more noticeable above the navel.
Small hematomas often resolve with self-absorption but larger ones may require surgical drainage. Preventive measures include stopping blood thinners before surgery and avoiding strenuous activity too soon after the procedure.
Conclusion
The most common causes of bulging or fullness above the belly button after a tummy tuck are swelling, scar tissue formation, insufficient skin tightening, liposuction irregularities, muscle repair failure, seroma and hematoma. The bulge tends to improve gradually in most cases once the healing process is complete.
Patients may be able to expedite resolution of the bulge by wearing their compression garment, gently massaging, avoiding straining, and allowing time for complete healing. In severe or persistent cases, corrective procedures or scar revision may be recommended by the plastic surgeon to address the abdominal contour issue.
Frequently Asked Questions
How long does swelling last after a tummy tuck?
Swelling typically peaks at around 2-3 weeks after a tummy tuck and then subsides gradually over the next 6-12 months. Wearing the postoperative compression garment can help minimize swelling during the healing period.
What causes lumps after tummy tuck?
Some of the most common causes of lumps after a tummy tuck are swelling, fluid collections like seroma, scar tissue formation, small hematomas, and fatty necrosis from liposuction. The lumps tend to gradually improve in most cases as the healing process runs its course.
How can I get rid of the bulge above my belly button after tummy tuck?
Allowing time for complete healing and resolution of swelling is the most effective way to reduce bulging. Wearing your compression garment diligently, massage, scar treatments, and avoiding straining/heavy lifting can also help. For persistent bulging, surgical scar revision or repeat liposuction may be warranted.
What causes the abdomen to look bloated after tummy tuck?
The bloated appearance of the abdomen after abdominoplasty surgery is primarily caused by post-surgical swelling as well as mild fluid retention from surgical trauma. As the swelling resolves over the first year, the abdomen will look less bloated and swollen.
Is a hard stomach normal after tummy tuck?
It is normal for the abdomen to feel firm, tight, and swollen for the first 3-6 months after a tummy tuck while the tissues are healing. Some hardness under the skin may also come from scar tissue formation. Over time, the tissues soften making the abdomen feel less firm and tight.
How long does it take for your stomach to go down after a tummy tuck?
For most patients, the very swollen and distended post-surgical abdominal contour begins to ‘go down’ around 6-8 weeks after surgery. Mild residual swelling and abdominal tightness often remains for 6-12 months until the healing process is fully complete.
Can a seroma cause a bulge after tummy tuck?
Yes, a seroma is a potential cause of bulging after a tummy tuck. A seroma is a fluid collection that occurs between the abdominal skin and muscle. This will appear as a visible fluid bulge, often above the navel where the skin was dissected during the procedure.
What causes rippling after a tummy tuck?
Rippling or ridges on the abdomen after abdominoplasty may be caused by insufficent fat layering during closure, over-aggressive liposuction, or inadequate skin flap advancement. Loose skin can also show rippling. Corrective options include fat grafting, liposuction or skin excision.
How can I massage my tummy tuck for best results?
Tummy tuck massage should involve gentle kneading, stroking, and effleurage movements. Use a non-scented lotion or oil to minimize friction on the skin. Focus above the belly button where swelling is most pronounced. Massage for 5-10 minutes once or twice daily, avoiding any painful or sensitive areas.
Tummy Tuck Bulge Treatment Options Table
| Cause of Bulge | Treatment Options |
|---|---|
| Swelling | Compression garment, massage, time |
| Scar tissue | Massage, steroid injections, surgical revision |
| Skin laxity | Panniculectomy (skin excision) |
| Liposuction issues | Repeat liposuction, excision |
| Muscle failure | Surgical reinforcement of muscle repair |
| Seroma | Drainage aspiration, time |
| Hematoma | Drainage, time |
Conclusion
Bulging or fullness of the upper abdomen is a common occurrence after tummy tuck surgery. The most frequent causes are post-surgical swelling, fluid collections, scar tissue, insufficient skin tightening, and liposuction irregularities. In most cases, the bulge improves gradually over time as the healing process runs its course.
Patience along with post-operative care measures can help reduce bulging during recovery. Persistent or severe bulging may warrant additional procedures such as scar revision surgery or repeat liposuction to address the contour issues. Close communication with your plastic surgeon is key to determining the right course of action for bulge resolution.
