I had a tummy tuck 6 months ago and not satisfied with the results. I will be having a revision (more lipo and taking off remaining loose skin). Is there a higher risk of necrosis? If so, what can be done to help prevent it?
Is There a Higher Rick of Necrosis when a Revising a Tummy Tuck?
Doctor Answers 12
Tummy Tuck Revision Usually Has Lower Chance of Healing Problems
Thank you for your question.
When the first Tummy Tuck is done the skin of the abdomen is removed from much of its blood supply. After surgery, as you heal, new blood vessels grow into the abdominal skin actually increasing circulation-this phenomena is called a "delay" and is used to improve survival of skin flaps in Plastic Surgery.
I would expect this delay phenomena to have occurred after your original Tummy Tuck and would expect that the chances of necrosis or wound healing problems would be less after a second procedure for Tummy Tuck Revision.
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There are always exceptions but in general well-planned repeat surgery is less risky than first time surgery. This is something to discuss with your surgeon as it depends upon other issues as well. The amount of surgery planned and your overall health are quite important.
John Di Saia MD
Tummy tuck revision
I don't believe, assuming no risk factors such as nicotine use etc. and the use of appropriate technique and judgment, that you are at increased risks with your planned revisionary surgery. I'm also assuming that you're working with a well-trained/experienced board-certified plastic surgeon.
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Revision tummy tuck and skin necrosis.
In general, the revision is less likely to have issues with necrosis because of whats known as a "delay phenomenon." When tissue is elevated and a portion of the blood supply is cut, it will respond by dilating and increasing the number of blood vessels which remain. What this means for a tummy tuck is that the skin is more resilient to elevation and tightening after it has had time to heal than it did from the first operation. Of course, there is a limit to the amount of tension which can be placed. But in general, the risk is generally lower for skin necrosis in revision tummy tucks.
Revision Of Tummy Tuck Shouldn't Increase Risk Of Necrosis
Revising your tummy tuck 6 months after the original surgery should not be accompanied by an increased risk of skin necrosis, especially if it involves only lipo and some additional skin excision. The one thing which would change this is smoking which always leads to a significantly increased risk of skin necrosis as well as necrosis of deeper tissues.
Higher Rick of Tissue Death when a Revising a Tummy Tuck?
Your question : "I had a tummy tuck 6 months ago and not satisfied with the results. I will be having a revision (more lipo and taking off remaining loose skin). Is there a higher risk of necrosis? If so, what can be done to help prevent it?" is very general and without examining you and knowing how your original tummy tuck was done, where the areas of unhappiness reside and what is being proposed by way of revision, it is impossible to assure you that no complications, including tissue death, will happen.
The cutting of the blood supply to the tummy skin from below the groin and from underneath the skin which is necessary to lift and pull the tummy skin leaves only the blood supply from above as the major blood supply of the tummy skin. With time, through a surgical phenomenon called DELAY, this supply becomes reliable and is joined by a newly formed network of vessels from the formerly undermined areas. This should make the lower tummy skin less apt to die in a revision procedure. However, it does not make it impossible to do so especially if very aggressive liposuction disrupts the majority of blood supply to the operated area.
The truth is in the details of your particular operation. Give yourself time to heal (and create new blood vessels) to increase the odds of success of a future revision.
Dr. Peter A Aldea
Is There a Higher Rick of Necrosis when a Revising a Tummy Tuck?
The correct answer per text book is yes but there are so many variables to consider it is not fair to ask such a general question for your specific issues. I believe you are only having a minor excision with minor lipo so the necrosis risak SHOULD be low.
Revision tummy tuck risks are increased with the addition of liposuction.
Revision of the tummy tuck alone carries LESS risk of necrosis (tissue death), which is the loss of some of the abdominal skin and fat due to inadequate circulation. When this occurs, the dead skin and fat is typically centered just above the pubic area, as these tissues are farthest from the blood supply. When the skin incision is made and the skin/fat layer is elevated from the abdominal wall, the only way for any circulation to get to the skin farthest from the attachment point (and blood supply) is through the capillaries in the dermis and fewer capillaries in the fat. (This is also why fat necrosis occurs more commonly than skin necrosis.)
This is also why smoking even one cigarette, or exposure to second-hand smoke, or use of nicotine gum are all absolutely contraindicated in patients undergoing tummy tuck, facelift, breast lifts, etc. Any type of skin lifting and tightening that can compromise the blood supply makes those tissues much more susceptible to the vasoconstriction (narrowing of the vessels, choking off of the blood supply) caused by any form of nicotine!
This is also why liposuction (of any area in the blood supply region for the abdominal tissues, such as the upper abdomen, flanks, or mid-back, can damage part of the blood supply to the distal tissues and increase the risk of skin/fat necrosis. Liposuction of other areas, such as the hips or thighs, has no adverse effect on the abdominal skin blood supply.
So, in the absence of liposuction of the upper abdomen, flanks, or back this time, your previous tummy tuck actually strengthened the blood supply, making more skin excision safe(r), and allowing careful and judicious liposuction of the upper abdomen, flanks, or back. But this is not a "free ride" nor is there ever a guarantee of safety and adequate blood supply with initial or secondary surgery. If your plastic surgeon is ABPS-certified, he or she already knows how to be as safe as possible. Perhaps this is even part of the reason you are not as tight as you hoped--your surgeon made a judgment of the amount of skin to remove based on safety and adequate circulation to heal uneventfully. Perhaps you already know that, which is why you are going ahead with another surgery by the same surgeon.
Please realize that your surgeon has to make the same assessment of circulation and safe and proper amount of additional skin and fat to remove again this time so that you have the highest likelihood of healing without wound dehiscience or circulation impairment causing necrosis. If you have any doubts, see one or more plastic surgeons (American Board of Plastic Surgery-certified) who can provide experienced opinions. Best wishes!
Risks revising tummy tuck
Generally, there are fewer risks revising a tummy tuck, less risk of healing problems or skin necrosis. Smoking is the most controllable factor in avoiding problems altogether.
Best of luck,
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.