What could be causing incision pain over 1 year post op?

Question

Hello! Had ETT with MR 4/15/22. My left side of my incision constantly hurts in a small area. Ive been on to see my ps because I swear I thought I had opened internally in that spot. He doesn't think so and gave me a shot in my incision at that area of steroid and nerve block in which I almost came off the table screaming in pain. He said that its a nerve or its scar tissue the nerve is stuck in/around. What else could it be?!! Does this sound accurate of what Im experiencing? Im so over it

J. Timothy Katzen, MD, FACS · Answer

Hello Polite3981,

I'm sorry to hear about the ongoing discomfort you're experiencing at your incision site more than a year after your extended tummy tuck with muscle repair (ETT with MR). Persistent pain in a specific area of an incision can indeed be distressing and warrants a thorough understanding.

Based on your description, it seems your plastic surgeon has considered two common causes of such pain: nerve-related issues or scar tissue entrapment. Both of these are plausible explanations for the pain you're experiencing.

Nerve-Related Pain: After any surgery, especially one as extensive as an ETT with MR, nerves in the area can be affected. Sometimes, a nerve may become irritated or entrapped in the healing process, leading to pain, tingling, or sensitivity. The fact that you experienced intense pain during the injection could indicate a hypersensitive nerve response.

Scar Tissue Entrapment: As your body heals from surgery, scar tissue forms, which is a normal part of the healing process. However, sometimes, scar tissue can entangle nearby nerves, leading to pain or discomfort, particularly when certain movements stretch or pull on the scarred area.

It's worth exploring if there's any specific movement, posture, or activity that exacerbates the pain, as this information can be helpful in diagnosing and treating the issue.

Given the duration and intensity of your pain, and if the initial interventions haven't provided relief, I would recommend seeking a second opinion. Sometimes, a fresh set of eyes and additional diagnostic tools, like an ultrasound or MRI, can offer more insights. You might also benefit from consulting a pain management specialist, especially one experienced in post-surgical pain.

In some cases, targeted physical therapy, specialized massages (like scar tissue massage), or other non-surgical treatments can offer relief. If the pain is indeed due to nerve entrapment, certain medications can help manage nerve pain effectively.

Persistent pain after surgery should not be the norm, and exploring all avenues to address it is important for your quality of life. Please don't hesitate to reach out for further support or to seek additional opinions.

Sincerely, 
Dr. Katzen

Emmanuel De La Cruz, MD · Answer

Persistent incision pain over a year after surgery is not typical and may warrant further investigation by a healthcare professional. While it's not possible to diagnose the specific cause without a thorough examination and additional information, here are some potential reasons for persistent incision pain:

Scar Tissue Formation:

Scar tissue can sometimes cause discomfort or pain, especially if it becomes thick or adheres to surrounding tissues. Massage and scar management techniques may help alleviate discomfort.
Nerve Sensitivity or Neuroma:

Nerves in the area of the incision may become irritated or sensitive, leading to persistent pain. This can be caused by nerve damage during surgery or other factors. Nerve-related pain may be sharp, shooting, or burning.
Infection or Inflammation:

Infections, even delayed ones, can cause pain and discomfort. Inflammation in the tissues around the incision site may also contribute to ongoing pain.
Hernia or Tissue Damage:

Occasionally, a hernia or damage to underlying tissues may not become apparent immediately after surgery. Persistent pain could be related to these issues.
Suture Reaction:

Some individuals may experience a reaction to sutures or surgical materials, leading to prolonged discomfort.
Muscle or Tendon Issues:

Discomfort may be related to issues with muscles or tendons in the area, especially if the surgical procedure involved these structures.
Foreign Body Reaction:

In rare cases, the body may react to a foreign body, such as a suture, that wasn't fully absorbed or a retained surgical instrument.
If you're experiencing persistent incision pain, it's crucial to consult with the surgeon who performed the procedure or another healthcare professional. They may recommend diagnostic tests, imaging studies, or a physical examination to identify the cause of the pain. Treatment options will depend on the underlying issue and may include medications, physical therapy, or, in some cases, additional surgical intervention.

Ignoring persistent pain is not advisable, as it may be a sign of an underlying issue that requires attention. Always seek guidance from a healthcare professional for an accurate diagnosis and appropriate management.

Camille Cash, MD · Answer

From your description it sounds like a nerve has become trapped in the tissue.  It doesn't sound like there is anything that opened internally. You may want to consider scar revision if the pain does not improve.

Mats Hagstrom, MD (license on probation) · Answer

Chronic pain at the incision site after a full tummy tuck is fairly unusual. When it happens, we it’s often not possible to find an ideology unless there’s an obvious explanation such as an infection or other problems.
You could conceivably ask to get a radio logical evaluation to see if there’s anything unusual know most likely if there isn’t anything unusual on exam, it’s unlikely an MRI or ultrasound will show any abnormalities other than scar tissue. Depending on how severe the pain is and the thoughts of you and your surgeon a scar revision could be considered, though there’s no guarantee that this will relieve the discomfort.
There is no simple answer to your question. Continue to follow up with your provider or consider getting an in person second opinion consultation from another provider.
 In the end, there’s a good chance you will not find anything wrong, nor will you find simple treatments that relieve your discomfort.
Without an examination or having further information, it’s hard to give you. Good answers or recommendations.
Best,
Mats Hagstrom, MD

What could be causing incision pain over 1 year post op?

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What could be causing incision pain over 1 year post op?

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Answer: Tammy tuck incision pain

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