Abdominoplasty

Abdominoplasty – Tummy Tuck Risks

Use the information below to learn about abdominoplasty risks or schedule a tummy tuck consultation at our center serving San Jose , the East Bay, and surrounding areas to discuss these factors with Dr. Lowen.

The Scar

The scar is probably one of the main reasons women put off having an abdominoplasty. The scar is most likely to heal as a fine line within 6-12 months. Dr. Lowen tries to make the incisions so that the scar can be hidden behind clothes, pants or bathing suit. With care, it can be placed under the line of a string bikini.

Only if there is some strong genetic component that may cause the patients’ to scars to spreads, becomes depressed or hypertrophic (ridgy and raised). Otherwise they should heal as a fine line.

If after analysis, it appears that a mini- abdominoplasty is possible, the scar will be shorter, and in the case of an endoscopically-assisted abdominoplasty, virtually non-detectable.

Closure of the abdominoplasty incision in the HLTA is done in a special and time consuming way. Permanent, but soft, braided nylon sutures are placed deep in the tissues to engage the supporting collagen network of the skin called the superficial fascia. Then another layer of smaller sutures is placed for support just underneath the dermis of the skin. Finally the skin is carefully repaired using absorbable sutures.

The scar heals as a ridge which gradually settles. This technique helps prevent the undesired risk of scar spreading or depression which is usually described as a risk of abdominoplasty scars. However, healing depends on individual factors, and a small percentage of people heal with excess scarring, even if the skin tension has been appropriate and the incision gently and precisely sutured.

For these patients, there are special aids to healing. First there is silicone gel sheeting worn over the incision for several months. This flattens the scar and decreases redness, by an unknown mechanism. Our practice uses commercially available sheets, costing about $50-70, which adhere to the skin and can be comfortably worn inside clothing. The sheets are shaped to fit the incisions, and usually last as long as treatment is needed. Our center also uses the Versapulse vascular laser which helps flatten and soften raised or red scars of any age. Several treatments at three to four week intervals are very helpful in improving scars.

Swelling or Edema

The surgical term for swelling is edema. Edema is a normal consequence of surgery and indeed any injury as you know from the small bumps or injuries you may have had. It is not possible to look smooth and flat until the swelling has gone down. Since the incisions across the lower abdomen have interrupted the lymphatic channels leading to the collecting system at the groin, and the elevation around the umbilicus has likewise interrupted an important outflow tract in that area, swelling is prolonged.

It is important to wear a binder or girdle like garment to decrease swelling after tummy tuck surgery. The pressure from the outside helps decrease fluid accumulation until the lymphatic’s regrow. Also minimal activity initially, other than walking, limits edema. The lower abdomen will look puffy for four months and it will take about six months for things to really settle down and the tissues to soften to their normal state. Mini or endoscopically-assisted abdominoplasty (Palo Alto) will have a much shorter duration of edema, since the incisions are much smaller and there is less extensive undermining to produce edema.

Asymmetry

There are commonly slight differences in the tummy tuck incision from side to side. Small irregularities in surface contour may occur and be noticeable in the post-operative period. These usually become much less apparent as healing progresses. Occasionally persistent differences in contour are treated by revisional surgery or by liposuction in the office operating room.

Injury or Displacement of Umbilicus

If it were possible to leave the umbilicus untouched during every tummy tuck procedure, that would be ideal. It is not possible to do that since the main goal of the operation is to smooth out the abdomen and remove excess skin. The umbilicus is a tethering point for the wrinkled or excess skin in the upper part of the abdomen, and unless that tethering is released, the esthetic goal will have to be compromised.

If the laxity or wrinkling of the skin of the upper abdomen or just around the umbilicus is minimal, a compromise may be possible. This involves cutting the umbilicus free of its attachment to the abdominal wall and letting it come down or “float” downward with the surrounding skin. As the flap is pulled down, the laxity above the umbilicus is corrected and the umbilicus is sewn back down about an inch lower. This works if the patient has a long waist and with lowering of the umbilicus the abdomen still looks natural. If the umbilicus has to come down too far, so that it does not look natural, then the float should not be done.

To keep the umbilicus in place, the skin around it must be moved. An incision is made around the umbilicus resulting in a vertical defect in the abdominal flap. If the defect comes down far enough when the flap is trimmed, it may be discarded. Otherwise it is repaired and results in a small vertical scar.

The umbilicus is a remnant of the nutritional vessels of the fetus. It is a depression, with a scar at its deepest point and skin pulled down like a funnel into that depression. When the umbilicus is dissected free during the abdominoplasty, its blood supply can be impaired. This can result in skin loss, and the resulting wound healing secondarily. The end result will usually be acceptable, but if not, reconstruction can be done.

Dog-ears

The closing of the end of the incision brings tissue together in a similar manner to the closing of a fan. The closure rotates around the end of the incision or the bottom of the handle of the fan. It is common in plastic surgery for such closures to result in some bunching of tissue at the end of the incision, commonly referred to as a “dog-ear.” If a dog ear occurs, a revisional procedure is required. Usually small dog ears will flatten after several months and require no further surgery. If not, they are removed as an office procedure. Some lengthening of the tummy tuck scar is necessary to do this.

Venous or Fat Emboli

Emboli are uncommon risks which can occur in the post-operative period. Blood clots which may form in the legs can travel to the heart and impair circulation. Small fat particles or metabolic products of fat called free-fatty acids are thought to damage cell membranes in the lungs, causing fluid to accumulate. While there is no specific prevention for these conditions, precautions such as calf-compression devices are usually worn during surgery. Secondary symptoms would be shortness of breath, rapid heart rate, and chest discomfort. Treatment is medical, supportive, and directed at the underlying cause.

For more information on the abdominoplasty procedure, schedule a tummy tuck consultation at our San Jose and Palo Alto area practice. Contact our plastic surgery center today to get started.

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