I have a scar from gall bladder surgery in the middle of my stomach. I wanted a tummy tuck but two doctors have told me that part of my scar might develop into dead skin because their is not going to be blood flow in that area. I'm very dissapointed one doctor suggested i have lypo instead another suggested i do a vertical tummy tuck.
Vertical Tummy Tuck vs. Lipo for Scar Removal
Doctor Answers (8)
GB scar and tummy tuck
Certainly there is a small risk of skin death when elevating the abdominal flap during a tummy tuck, but the risk can be minimized by limiting elevation in certain areas.
Tummy Tuck With An Oblique Surgical Scar
Your surgeon's concerns are valid ones about an oblique surgical scar potentially affecting a traditionally oriented tummy tuck's skin healing. That being said, I have done such tummy tucks successfully without any skin healing problems by making sure that area is not excessively undermined and the closure is not under too much tension. While a vertical tummy tuck is safer, it is not a scar that can be hidden. Liposuction is always an option but depending upon your excess skin amount may not produce a very satisfying result.These scar concerns are gradually disappearing in tummy tuck candidates as laparascopic abdominal surgery has been mainstream now for well over a decade.
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Tummy tuck with prior abdominal scars
At least your surgeons have been honest about the risks, and if you are lax enough to consider tummy tuck then skin shrinkage from liposuction may be the best compromise. Vertical scars in the abdomen can be very hard to hide.
Gallbladder scar--tummy tuck vs. lipo?
If you have a vertical (upper midline) scar, you are still an appropriate candidate for tummy tuck surgery with a bikini-line scar. Blood supply comes from the back towards the front, and a scar in your mid-abdomen does not interrupt circulation to the upper abdominal skin. Even a well-healed subcostal (ribcage) scar does not usually prevent a successful horizontal-scar tummy tuck, even though there is some degree of potential circulation impairment that could lead to skin death. I say "potential" since I have performed many tummy tucks on such patients over the past 25 years, each with the same risks discussed and accepted, and have never had a problem (thus far--that sound you hear is me knocking on wood).
If your cutaneous excess is best dealt with via vertical excision (vertical abdominoplasty), then proceed with that. Most of the time the skin excess is in the other direction, leading to the much-more-common horizontal tummy tuck scar. Liposuction only EMPTIES out your skin, and unless you have good elasticity and skin tone, liposuction will cause loose, wrinkled, "prune-belly" skin. This is NOT a good result!
SmartLipo cannot tighten skin sufficiently to eliminate the need for traditional skin excision operations. This is proved with the second operation (abdominoplasty) to remove the deflated skin. For an example of one of my patients who underwent liposuction and then needed tummy tuck to "fix" the wrinkled skin, click on the link below!
I'd recommend consultation with a couple more ABPS-certified plastic surgeons. You seem to be getting advice that most of us would consider peripheral options, not mainstream. Good luck!
Surgery with gallbladder scar
In patients with existing gallbladder scars we have performed many successful tummy tucks.
The blood supply is finished, so the surgeon must be skillful in avoiding depriving the tissues of blood supply.
An experienced plastic surgeon can guide you based on your anatomy and expectations.
Lipo Will Help
Liposuction will help sculpt and remove the fat. Smartlipo will also remove fat and help tighten the skin. Tummy tuck with a horizontal scar is risky due to the previous gall bladder surgery. Vertical tummy tuck will reduce the risk of the gall bladder surgery but the vertical scar is not well hidden. Tummy tuck will be necessary if you have a hernia or loose abdominal muscles.You might consider doing liposuction first, and then considering your options for tummy tuck second. Especially if your problem is more due to diet resistant fat in the outer abdominal wall. Lipo and Smartlipo do not help with any muscle problems underneath, but Smartlipo will help skin tightening.
Liposuctio or vertical scar approach
Unfortunately I don't have your pictures to see your abdomen and the scar from your previous surgery. I can give you a couple of general thoughts relating to your question.
Liposuction is very useful for removing fat beneath your skin. It will reduce the thickness of the "Pinch", but it will not tighten your skin.
A Tummy Tuck will reduce the redundant skin but requires a long skin incision, either vertical or, more commonly, transverse. We always must be aware of previous scars because of a concern for blood supply. You should probably listen to the advise your plastic surgeon has given you.
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.