Should I have Liposuction to correct the broken suture from Tummy Tuck?

If the lump is from the upper plication sutures that tore, then replication is required.  If it is just some fat that is part of the upper flap then liposuction can help the area. 

Worried,

It is relatively early in your recovery from surgery.  I would wait at least 6 months and during that time get back to your normal daily routines, work activities and exercise regimens.  You can then see how the muscles redistribute their activity.  I have seen such bulging from presumed ruptured sutures flatten over time.  Although it may not completely resolve, it may improve to the point that a little touch up liposuction may be all that you need, if anything at all.  Good luck!

Hello,

While lipo can reduce the appearance of a "lump" if that lump is fatty, it cannot fix a muscular repair breakdown problem. It may make it less appreciable however. Maybe that is what your surgeon aims to do.

Tummy tuck muscular repair breakdown is very rare in my patients. Maybe your repair stretched?

Best Regards,

John Di Saia MD
Board-certified Plastic Surgeon

Hi PR. I wanted to say that Dr. Goldstein's answer to your question is important to consider. There are many causes for bulging in the upper abdomen after a tummy-tuck. It might be because the upper abdominal tissue was not cinched together tightly and the lower abdominal tissue was cinched more tightly together. This is well known to cause a bulge in the upper abdomen.

In your case, you mention that a suture broke. This is a very rare occurrence and only you and your plastic surgeon know the circumstances around being able to detect a broken suture. If you truly had a flat upper abdomen one minute, heard a suture break, then had a bulge, then you will likely need to have your tummy-tuck revised and the stitch replaced.

If the suture did break and you go ahead with liposuction, then you are in danger of causing damage to internal organs during liposuction. It is possible to be very cautious and thin the fat just under the skin, but if the suture was truly broken, then it would NOT be recommended. Have some more conversations with your plastic surgeon. Certainly waiting for 6 months before doing a revision is what I would recommend.

If the suture in the upper part of your tummy tuck ruptured, liposuction is not the answer.  A small fullness above the belly button is not abnormal after an abdominoplasty.  You cannot liposuction that area during the original surgery, so the area may be a little thick.  When a suture breaks, the fascia or covering over the muscle becomes loose.  This bulge will not go away unless you re-explore the area and repair the lax muscle.  Liposuction alone may thin the area, but not improve the overall shape.

It sounds like the buldge above your belly button is from the suture that repaired your muscles tearing.  This means that your abdominal muscles are no longer held together tightly in the middle, creating the appearance of a buldge.  This can only be corrected with surgery.  Liposuction can be an adjunct to this procedure to remove excess fat, but will not fix the cause of the problem.

Kari L. Colen, MD, NYC Plastic Surgeon, colenmd.com

There are several reasons why you may have a bulge in the upper abdominal area following a tummy tuck procedure.

For example, the bulge may be due to excessive upper abdominal skin which was not adequately pulled and transferred inferiorly at the time of your initial surgery. It could possibly be due to excessive fat which sometimes can give the appearance of a bulge in the upper abdomen (this certainly is amenable to additional liposuction).

Ruptured sutures that were used to tighten and bring together the rectus abdominal muscles may be a cause. Also, I have seen bulges in the upper abdomen due to over tightening the muscles below creating the bulge above.

Lastly, a bulge in the upper abdomen may be due to a combination of the causes mentioned above. The actual timing of when you first noticed the bulge and a good physical examination is essential in determing the cause and the best treatment as it relates to you.

I'm sure that your plastic surgeon would be the most suitable one to determing the actual etiology of your bulge and the easiest solution to correct or improve your appearence. He/she knows you the best and understands your pre-operative physical condition. Also, your Plastic Surgeon would know what techniques were employed at the time of your surgery.

I would strongly advise you to continue your dialogue with him. If your confidence is totally lost, then I would seek a second opinion with another plastic surgeon.

Thanks for your question; I hope that this is helpful to you.

Stephen Goldstein, MD

This is a good question.

Very rarely after abdominoplasty (tummy tuck) the deep sutures break and need to be replaced. I see this in my practice in patients who went out of the country for surgery and then return back to New York with problems. We are then stuck in a situation where the patient had a surgery somewhere else that now needs to be fixed. From what you describe, I do not think that you need liposuction. If the sutures truly did break or loosen, then you need to have them replaced. You definitely do not need to have the surgery completely redone, but you do need the sutures replaced. This can be done through a much smaller area through an existing incision. Liposuction is sometimes combined with abdominoplasty but not for the problems that you have.

I hope this is helpful.

David Shafer, MD
Shafer Plastic Surgery - New York City

A bulge in the upper abdomen after Abdominoplasty, which appears days or weeks after the surgery, probably indicates a disruption of the muscle repair. The sutures repairing your diastasis recti could have torn through the muscle fascia (most likely), or could have come untied (less likely). Typically, a portion of the repair "un-zips" itself, and although this is not a true hernia, it creates the appearance of abnormal bulging, especially when you do a sit-up, or otherwise tighten the abdominal wall. If a single continuous suture was used, the entire repair of the midline is at risk of un-zipping; even if multiple sutures were used for the repair, the remaining sutures are now under greater stress and risk of disrupting.

In all likelihood, you will require a repair of the disruption. If the fascia is torn, you may require an overlay of mesh material to reinforce the repair. There is a greater likelihood of seroma with the abdomen being re-opened, and of course the umbilical and abdominal scars will need to be re-done. Alternatively, the entire suture repair of the midline can be taken down endoscopically or through a small incision; although this would give your abdomen the same appearance as before surgery (some bulging, not as flat), minus the excess skin and fat.

Although this situation is not an emergency since it is not a true hernia where loops of bowel might become trapped or strangulated, it cannot be corrected by liposuction, which will not address the underlying cause. You and your surgeon should discuss the appropriate timing of re-operation to repair the muscle.

I would recommend waiting at least 6 months before considering proceeding with any revisions. This will give adequate time for everything to settle down, and then you can assess exactly what the issue is. Most likely, the bulge is not due to excess fat but rather loosening of the muscles that were tightened during the initial operation. This can usually be seen on an exam, and if that's the case, retightening the muscle would give the best long term result. The downside, however, is that it will be a much bigger procedure than simply trying to perform liposuction on the area, so I would recommend sitting down with your surgeon and discuss the pros and cons of each option.