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Risk of Necrosis After Tummy Tuck?

What is necrosis and how is it related to the risks of tummy tuck surgery?  I've been trying to read up on all the risks and benefits of this procedure and this topic isn't exactly clear to me.

Doctor Answers 20

Necrosis means dead tissue.

Dead tissue after tummy tuck occurs when there is inadequate blood supply to the healing tissues, causing the affected tissues to die. This requires more healing over longer time, causes more scarring, and can require more surgery, skin grafts, and in rare cases, major reconstructive surgery. This can also, in extremely rare cases, even progress to severe infection and death. This is, when you think about it, true about virtually anything in life, such as a car trip, a slip and fall, etc. What is important is to keep things in proper perspective.

The risk of any kind of skin or umbilical necrosis for most experienced, board-certified plastic surgeons is below 1%, but only if the patient is a non-smoker, avoids all nicotine products (including spray, gum, or patches), and also avoids second-hand smoke. Nicotine is a major vasoconstrictor, and once the skin dies it's too late to say "I won't smoke any more!"

In a smoker, statistics vary, but the risk in some studies is as high as 15-20%. For this reason, I will not perform tummy tucks on smokers, nicotine users, or those exposed to second-hand smoke. It's just not worth the risk, in my opinion. I have cancelled paid-for surgery if I smell smoke on my patient as they report for surgery. They get their money back, minus a cancellation fee.

So, if you are NOT a smoker, this is a minimal risk well-understood by your surgeon. He or she will take all appropriate surgical precautions to minimize this and all the other risks you may or may not be aware of. Trust me, we ARE aware of them, and no surgeon wants or allows complications in their patients; when they occur, they do so despite our best efforts. Our reputation and livelihood depend on your good outcome.

Minneapolis Plastic Surgeon
5.0 out of 5 stars 169 reviews

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Risk of marginal necrosis with an abdominplasty

An area of marginal necrosis in the middle is not uncommon. This is the area that is the furthest away from the blood supply and under the most tension. These areas generally take about 4 - 6 weeks to fully heal. Many times the scar will look just fine and other times you may require a relatively simple scar revision. Simple wound care is all that is required.  A smoker is at greatest risk but it can happen to anyone. 

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 11 reviews

Risk of Necrosis After Tummy Tuck

Necrosis means dead tissue.  This can be caused by external stimuli such as smoking or from surgical technique or postop bandaging or garments.  Diabetics are more prone to this complication.  Sometimes patient s may bend over too far and flex their abdomen when walking causing a kinking of the lower flap and some necrosis with delayed healing.  This can be treated with debridement and/or wet to dry dressings.  Others may use a Wound VAC system that consist of a sponge inserted in the wound and connected to a closed intermittent vacuum system that draws the blood supply towards the wound and removes dead tissue and fluids.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
5.0 out of 5 stars 46 reviews

Tummy tuck risks

Your question refers to a problem that can develop as a result of inadequate blood circulation to the skin that is pulled down in a tummy tuck. Any time skin is undermined (what plastic surgeons call a flap), the blood flow to that area is compromised, and when the skin flap is pulled tight the blood flow is strained further. If it is inadequate the skin dies and can create a significant problem. This is fortunately rare in nonsmokers but the effects of nicotine, which contricts blood vessels, can be enough to trigger it.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 30 reviews

Tummy tuck necrosis

Necrosis is death for the skin. In tummy tuck, it occurs in the lower abdomen near your incision and can occur around the belly button.

If you are a properly selected, healthy, non-smoker with no disease of your blood vessels, and the surgery is done correctly, necrosis should not happen.

Smokers and people with poor blood supply to the skin are at risk. Older people with peripheral vascular disease and those with inflammatory conditions like Lupus and other diseases of the blood vessles do not have adequate blood flowing to the skin, and the lower abdominal skin can necrose after tummy tuck surgery.

Also if the surgeon removes too much skin and has to pull the tummy too tight to close it, then blood supply can be compromised and necrosis can result.

See an experienced board certified plastic surgeon who has a good reputation. Follow his/her advice and you should be fine if you are a good candidate.

This is a wonderful operation which usually creates beautiful results. See before and after pictures.

Necrosis is death

Necrosis associated with tummy tuck surgery is describing skin death that can happen if a tummy tuck is done on a smoker, a patient with multiple abdominal scars, or is perhaps done too tightly. It is caused by inadequate blood flow to keep the skin alive.

If this happens, it can cause very delayed healing for months because the tissue is under tension and wants to pull away from the area of necrosis rather than closing in rapidly as would happen in other wounds. This is a very rare complication in properly chosen tummy tuck patients.

Skin necrosis is a possible but fairly uncommon tummy tuck risk

Skin necrosis is a possible but fairly uncommon risk of having tummy tuck surgery. It occurs when there is not enough circulation to the tissue and the involved skin and fat can die. During tummy tuck surgery, the abdominal tissue is lifted off of the muscle layer and part of the circulation is disrupted. The area that is most at risk is the skin in the lower abdomen, just above the scar, in the midline.

Patients who smoke are at much higher risk for skin necrosis because smoking adversely affects tissue circulation. For this reason, I never perform tummy tucks on patients who are actively smoking. In the routine patient who doesn't smoke, skin necrosis is rare. If it does happen, it may be due to excessive tension on fhe suture line and is usually limited to a small area that can be revised later on for a good result.

I hope this helps you in making an informed decision!

Caroline Min, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 3 reviews

Necrosis after Tummy Tuck unlikely to happen

Hello msmartha,

Necrosis refers to actual loss of tissue due to lack of blood supply. That is extremely unusual and mostly happens in a smoker or a diabetic patient. A major infection would be another reason for necrosis. We ask anyone who smokes to refrain from any form of nicotine for at least one month prior to and after surgery.

It is not uncommon to have some crusting or small open areas, but actual tissue necrosis would be very rare. Bring it up during your consultation and ask your doctor about his/her particular thoughts.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 16 reviews

Rare risk

Necrosis is when tissue of the surgical site dies (become necrotic) following surgery. Tissue may change colour, begin to fall off and become infected. Corrective surgery is necessary to resolve this. Skin or fat (usually when it is transferred) necrosis is more common in people who smoke or are diabetic, when blood circulation.

Diabetes and Tummy Tuck

Thank you for your post. The risk of necrosis of tissue is mainly related to Diabetes, smoking, high blood pressure, as well as problems such as tissue too tight ore problems with the compression garment.  Diabetes is a disease that should demand a healthy respect from both surgeon and patient in plastic surgery. It is a disease that affects the immune system and can increase the risk of infection, a disease that affects the healing potential of a wound and can cause opening of a wound, and is a disease of the circulation that can lower the blood flow to the operated tissue and cause necrosis or tissue death. This needs to be managed as follows:

1. Tight blood glucose control with diet, exercise, and medication. You need to see your internal medicine doctor regularly and make sure your diabetes is well controlled.
2. If you are overweight, then losing weight decreases your risk in tummy tuck surgery or any other surgery for that matter.
3. If you have high blood pressure, this needs to be managed and well controlled by your internal medicine doctor as well.
5. Consider with your surgeon HyperBaric Oxygen therapy pre- and post-op.
6. Make sure you understand from your surgeon and anesthisiologist what medications you should take or not take prior to surgery.

It is very possible to have a great outcome as a diabetic following tummy tuck surgery, but minimizing the risk is the most rational way of accomplishing this.

Best Wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 29 reviews

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.