Am I a Candidate for Tummy Tuck, If I had Radiation Treatments 6 Years Ago?

Question

I am a 51 yr old female and have undergone a hysterectomy and pelvic radiation & chemo for cervical cancer. That was 6 yrs ago. One surgeon I consulted said he would not perform surgery on me because of the radiation's effect on area. Should I give up hope of tummy tuck? Any other treatment options for loose skin and stretch marks? Thank you.

Darryl J. Blinski, MD · Answer

Great question! In my experience (having done a few radiated tummy tucks in over 34 years of practice) my advise is consider the risk/benefit ratio. The increase risk of necrosis due to the micro fibrosis caused by radiation to the small blood vessels can not be understated. I would only attempt your operation in a hospital in staged procedures. Stage I - would be an incision in the groins to ligate the inferior epigastric vascular bundles bilaterally. This allows to skin flap to become dependent upon the blood supply from the superior vessels. I recommend a 2 month wait. Than Stage II - in hospital do the tummy tuck, just before deep closure, do a dye test to check on the blood flow to the most dependent part of the abdominal flap. Seek boarded PSs in your area and good luck.

Peter A. Aldea, MD · Answer

The choice to have or not to have a surgical procedure should be based on your being educated on the potential risks you are risking by having the operation contrasted to the risks you are taking by NOT having the operation. Cosmetic surgery, by definition, is "I want" surgery NOT "I need" surgery; It is surgery which only improves appearance, not surgery which saves lives or improves function the way Reconstructive Plastic surgery is. You risk NOTHING by not having Cosmetic Surgery and you DO take on risks by having it.

	When the risks taken are great, many ethical Plastic surgeons would refuse to perform operations even though the patients would like to have them done. Sometimes it is MUCH harder to say "No" to a patient than to go along, be paid and perform the operation but expose the patients to such risks. Unlike surgeons who have seen and treated complications, our patients often view them as abstract and unreal until they affect them.

	Radiation is used to prevent local re-growth of cancer. Unfortunately, it permanently damages the skin by causing severe scarring and stiffness of the skin with loss of the normal blood supply. Operating on radiated skin results in very slow to heal wounds which may die for lack of blood supply. In addition, due to the scarring around blood vessels and lymphatics, drainage continues for a very long time and seromas are very common.

	I would strongly advise you to think about this long and hard before proceeding with a Tummy Tuck.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Whether a tummy tuck operation can be done safely after radiation to the pelvic area will depend on the presence of radiation damage to the abdominal wall skin and tissues. This can only be determined on physical examination.

	I would suggest meeting with a few  well experienced board-certified plastic surgeons for direct examination.

	Best wishes.

Robert L. Kraft, MD, FACS · Answer

Radiation therapy would not be a complete bar to undergoing abdominoplasty but it does mean that the risk of complications, including necrosis of the flaps would be higher. This certainly should be discussed at great length with your plastic surgeon and a determination made as to what surgery would be appropriate under these special circumstances. I do not want to be completely pessimistic but please assess all of the risks before making a decision. Depending on the extent of skin laxity, you may be a candidate for Thermage as a skin tightening procedure if your condition precludes abdominoplasty. Congratulations on being a survivor, which is truly the most important thing!

Vasdev Rai, MD · Answer

It will be unsafe to do abdominoplasty after abdominal radiation. Your plastic surgeon has wisely declined. You owe him a thank you note. Now don't start looking for someone who will operate on you, because if you do, you are surely able to find a fool who will operate on you to your deteriment.

Remus Repta, MD · Answer

Hello,

	The blood supply that surgeons depend on when a traditional tummy tuck is performed is based on the vessels that come from the rib cage. The other two sources of blood supply to the abdominal skin is the vessels that come directly through the muscles (6 pack muscles) and the vesssels that come from below near the thight-abdomen crease.  If radiation therapy was performed on the uterus I would imagine that would be relatively low on the abdomen and not adversely affect the rib cage vessels.  If additional concern is still present the tummy tuck can be delayed, that is performed in two stages where the bottom vessels are eliminated thereby allowing the rib cage vessels to be more robust.  Dont lose hope yet!

	All the best,

	Dr. Remus Repta

Talmage J. Raine, MD, FACS (retired) · Answer

Radiation to the pelvis does not preclude having a tummy tuck.  Your risk for complications would be higher and the procedure might have to be modified.  If you are a smoke, stop now.  Hyperbaric treatments after the surgery, prophylactically, might also be considered.

	There is hope.  However, a more definitive discussion would require a physical exam and a discussion with your radiation oncologist.

	All the best,

	Talmage J. Raine MD FACS

John Whitt, MD (retired) · Answer

Having undergone previous radiation therapy in the pelvis would most definitely increase your potential for complications if you were to have a tummy tuck performed. The radiation causes long term effects on the blood vessels. This, in turn, would lead to a much higher rate of wound healing problems and flap necrosis. You may well have difficulty fonding a plastic surgeon willing to accept these risks even if you are.

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