November 08, 2026 | Abdominoplasty, Ask Dr. Agullo, Body Contouring
Each week on RealSelf I get questions like these (all five below were posted this year):
Is this swelling? Scar tissue? Did my muscle split?
Typically there’s a picture, usually from the side. The time frame can be 8 months ago, 15 months ago, 5 years ago. Compression, massage, everything has been done. And there’s still that bulge.
What follows are five such questions, anonymized and reworded a bit, with my responses. I’ve made a few tweaks for clarity and brevity.
Swelling changes from day to day and week to week. Tissue doesn’t. Once things stabilize, the question is which layer is producing the bulge you see: skin, fat, scar tissue, fluid or the abdominal wall itself.
“I am 15 months out from a mini tummy tuck. Is this bulge lymphatic swelling or scar tissue?”
Answered on RealSelf, Oct 2026.
Fifteen months after a mini tummy tuck, a bulge that hasn’t budged is no longer swelling. Swelling fluctuates, often noticeably from week to week. If the lump or bulge is in the same location day after day, it’s likely not swelling. It could be a pocket of fluid (seroma) which developed a sac (pseudobursa) around it.
Some bulging over a scar could also be fat that was not removed. Mini tummy tucks do not usually remove fat from the lower abdominal flap, so any fullness there could just be the tissue that is sitting on top of your tummy tuck scar. If there is no fluid collection, the bulge could be related to fat or to laxity of the abdominal wall either from stretching or from not being tightened enough. Lymphatic massage will not help any of these situations.
Mini tummy tucks typically only address the area below the belly button, so a gap above it could still be present, even after a mesh repair. Have an ultrasound to rule out pseudobursa (chronic fluid collection), and see your plastic surgeon for an examination to sort out the cause.
“Should a c-section shelf get a mini tummy tuck, liposuction or a scar revision?”
Answered on RealSelf, Jun 2026.
A mini tummy tuck is a great option for the shelf deformity as the skin is removed in the area of the shelf, the c section scar revision is performed which takes out the scar and releases the tethering to the deeper tissues and often liposuction can be performed through the mini tummy tuck incision to help contour the upper abdomen.
Liposuction alone unfortunately would likely worsen the shelf deformity as the fat would be removed underneath the tethered down c section scar and worsen the shelf. Revision of the c section scar alone would help release the tethering of the scar and help flatten out the shelf but wouldn’t address the skin laxity or the fat pad above the scar.
If you had two c sections you need to be examined to see if you also have a separation of the muscles (diastasis rectus) underneath which may contribute to the fullness under the shelf. If that is the case then you will need more of a complete tummy tuck procedure with repair of the muscle separation as opposed to just a mini tummy tuck procedure.
“My diastasis was repaired and I still bulge. Is muscle re-tightening worth it?”
Answered on RealSelf, Jul 2026.
Often when patients have pregnancy or go through gaining and losing weight we stretch not only the separation between the two muscles called diastasis but also stretch the entire abdominal wall fascia (the connective tissue that is attached to and supports the muscles). Core exercises can help strengthen the muscle but will not address the laxity of the fascia. From your pictures it looks like you may still have laxity of the fascia. Sometimes this is hard to appreciate because when you are laying down it appears much better. It also looks like you still have a little bit of extra fat (this layer of tissue sits between the skin and the muscle called subcutaneous fat).
I would consider a revision to address these areas of concern. When I perform tummy tucks for patients that have previously had a repair of the diastasis I will do what I call a triple plication. This involves plicating the fascia from the sternum (breast bone) down to the pubis to bring the two rectus muscles and their fascia back together, and plicating the oblique muscles and fascia to the lateral edge of the rectus muscles. This essentially creates an “internal corset” or “waist trainer.”
“A revision tummy tuck five years later: what is my risk of necrosis?”
Answered on RealSelf, Jun 2026.
The biggest risk to flaps is not reopening a tummy tuck. The biggest risks are nicotine (even small amounts from a patch, gum or vape), uncontrolled diabetes, aggressive undermining of the flap, aggressive liposuction of the flap, and closing too tightly. Delay actually helps the blood supply!
If a patient is healthy, nonsmoker etc. The risks go way down. I would avoid nicotine for several weeks before hand, eat a protein rich diet as recommended by your doctor, avoid gaining weight between now and your procedure. I would discuss with your doctor making sure the entire flap is not aggressively undermined or liposuctioned at the same time.
Having an arm lift at the same time should be okay as it has a different blood supply. I would examine the firmness or bulge in the lower abdomen while standing to determine if it’s fat, fascia or a small hernia as management can be different for each.
“Eight months out, my belly button started draining a little smelly fluid. What should I do?”
Answered on RealSelf, May 2026.
I had a patient just like this earlier this year. She was 8 months out from a tummy tuck with muscle plication. Everything had gone well until her belly button began draining a small amount of foul smelling drainage. See your doctor as soon as you can. This could be something simple or it could be something that requires a small revision in the OR. Either way it needs to be addressed and will likely not get better on its own.
Delayed drainage from the belly button after an abdominoplasty can be from a number of causes. In my experience most commonly this represents a stitch abscess from an infected permanent suture that was placed during the plication of the muscles. Other times there can be a cyst or sinus that forms around a permanent suture that was placed in the deeper layers. Less commonly there can be a more chronic infection in the deeper layers around the area where the muscles were repaired.
Management is dependent on the cause of the drainage but antibiotics alone are unlikely to resolve the problem. Most of the time identifying the cause and removing the permanent suture or draining or excising a sinus or cyst will resolve the problem. See the surgeon who did your procedure for an in person evaluation.
The Short Version
| What you see | What it usually is | What sorts it out |
|---|---|---|
| A bulge that changes week to week | Swelling, still settling | Time, compression, the recovery plan |
| A bulge that sits in the same spot after a year | A pseudobursa, leftover flap fat or a loose wall | An ultrasound and an exam standing up |
| A shelf over a c-section scar | A tethered scar with fat rolling over it | A mini tuck with release and flap lipo, or a full tuck if there is diastasis |
| A belly that flattens lying down | Stretched fascia beyond the midline | Triple plication, the internal corset |
| Drainage from the navel months later | A stitch abscess or sinus tract | Find and remove the suture; antibiotics alone rarely do it |
Price questions have their own posts: liposuction and tummy tuck cost and tummy tuck versus panniculectomy, which covers what insurance will and will not pay for. What the first two weeks look like is in recovery at home after plastic surgery. The procedure itself is on my tummy tuck page. My commentary on the revisions behind these questions is on Dr. WorldWide, and the practice’s version, with the belly button and scar answers, is on Southwest Plastic Surgery.
Why Choose Dr. Agullo
I am certified by the American Board of Plastic Surgery and the American Board of Surgery, completed my plastic surgery fellowship at the Mayo Clinic, and serve as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly has listed me as a Top Doctor every year from 2014 through 2026. Many of the tummy tucks I do are revisions of surgery done elsewhere, which is why every bulge gets the same order of questions: is it moving, which layer is it in, and what does the exam say standing up.
Ready to Talk?
Bring your operative report if you have one and your timeline since surgery. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. You can also read my answers on RealSelf. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
