Symptoms of Skin Necrosis After Tummy Tuck?

Tissue necrosis is a well known complication of
abdominoplasty. This complication occurs
when tissue has inadequate blood supply and subsequently dies.The area that’s most vulnerable to this type
of problem lies directly above the abdominal incision.This is the point that blood has the furthest
to travel.Skin necrosis initially presents as
skin discoloration which progresses from a light pink to a dark purple
color.Eventually the tissue turns black
and becomes firm with the consistency of leather.In some cases, areas of necrosis can become
secondarily infected.When patients undergo abdominoplasty, the skin and fat are
elevated away from the underlying abdominal muscles.This means that blood has to pass through a
flap that consist of fat and skin to reach the incision site.Anything that compromises this blood supply
can result in tissue necrosis.Several
conditions have been associated with skin necrosis in abdominoplasty
patients.These include diabetes,
collagen vascular diseases, infection, tension on the wound closure and
cigarette smoking.All of these
conditions compromise the small blood vessels that flow through the abdominal
skin flaps.This poor blood flow can
result in tissue necrosis.Once skin
necrosis has occurred, treatment varies from patient to patient depending upon
the severity of the problem.Many wounds
require debridement, followed by dressing changes and eventual scar revision.In some cases necrotic tissue may become
infected and antibiotics may be required as well.By carefully
evaluating patients in the pre-operative period, the incidence of this
complication can be minimized but never totally eliminated.It’s important that patients stop smoking six
weeks before and after surgery.

Necrosis is the medical term for death of tissue. The most common cause of tissue death following surgery is lack of blood supply. All of our bodily tissues require sufficient blood flow to keep it alive. During the course of surgery blood flow to the tissues involved is decreased to some degree. If the blood supply is decreased sufficiently the tissue at the end of the blood supply may die. Necrosis of the skin and fat can occur at the edges of a tummy tuck, breast lift, breast reduction or any other area where the skin and fat layer has been lifted off of the underlying layer. Cigarette smoking is known to decrease the blood supply in the skin and fat layer. If a wound is showing signs of necrosis it is important to stop smoking immediately.
Although it is unlikely at 3 weeks that necrosis would develop, it is possible. You would initially notice areas of redness in the area followed by a darker color to the skin ending with black skin. The skin and some of the underlying tissue would then slowly die leaving a wound that wouldn't need to heal itself over time. This healing process could take up to 3-4 months.

Doctors in general do not like smoking due to health reasons. (Everyone knows about the detriment to your lung function, and the increased risk of cancer.) Plastic surgeons have another reason to dislike smoking - the decreased blood flow that it creates interferes with healing and can lead to surgical complications (healing problems, wide scars, fat necrosis, skin loss, etc.) This is partially dependent on your history of smoking (how much you smoke per day and how long you have been smoking), as well as if you are smoking around the time of the operation. If your stomach looks healed from the outside at 3 weeks, you must still consider that healing is going on in the inside. Fat has a less robust blood supply compared to the skin, and fat necrosis is still a possibility. You may end up with hard lumps under the skin near the incision, and sometimes these can even "work their way to the surface" as your body tries to get rid of non-living tissues. This will create a wound that will require some care to heal. With actual skin loss (necrosis) typically the skin becomes dry, firm, non-blanching (if you press on normal skin, the redness of the blood disappears for a second, and then returns. Necrotic skin does not have this color change.)
Don't take the chance! Quit smoking for good... (or as long as you can after surgery...)