Abdominal hematoma - will it ruin my tummy tuck results?

Question

I had a TT with muscle repair 11/2021 that I was very happy about. I had to have preventative laparoscopic procedure by my ob/gyn that went smoothly, but I developed a 7cm hematoma on my left side immediately after. The doctor prefers not to intervene and said to wait for it to reabsorb. It is painful, not growing, but not shrinking quickly. Is waiting for it to go away on its own the best approach and will it ruin the TT results I am happy with? IDK if an OB cares about long term appearances

Emmanuel De La Cruz, MD · Answer

The presence of an abdominal hematoma (a collection of blood outside of blood vessels) after a tummy tuck surgery can potentially impact your results, but its effect will depend on several factors, including the size of the hematoma, how it's managed, and your body's healing response. Here's what you need to know:

Potential Impact on Results:
Swelling and Discomfort:

A hematoma can cause increased swelling, discomfort, and possibly pain in the abdominal area. This can temporarily distort the appearance of your abdomen, making it difficult to assess the final results of the tummy tuck surgery.
Delayed Healing:

Hematomas can interfere with the normal healing process by creating pressure on surrounding tissues and potentially causing tissue damage. This may lead to delayed wound healing and prolong the recovery period.
Asymmetry and Irregularities:

In some cases, the presence of a hematoma can lead to asymmetry or irregularities in the abdominal contour, particularly if the hematoma resolves unevenly or causes tissue displacement during the healing process.
Scar Formation:

Depending on the severity of the hematoma and how it's managed, there may be an increased risk of scar formation or changes in scar appearance. This could affect the overall aesthetic outcome of the tummy tuck.
Revision Surgery:

In rare cases where the hematoma is large or causes significant complications, additional surgical intervention may be necessary to address the issue. This could potentially impact the final results of the tummy tuck surgery and require further revisions.
Management and Prevention:
Early Detection:

Prompt recognition and management of a hematoma are crucial for minimizing its impact on the surgical outcome. Notify your surgeon immediately if you experience unusual swelling, pain, or other symptoms after surgery.
Drainage and Monitoring:

Your surgeon may need to drain the hematoma using a needle or surgical drainage tube to relieve pressure and prevent complications. Regular monitoring of the hematoma's size and resolution is important to ensure proper healing.
Compliance with Post-Operative Instructions:

Follow your surgeon's post-operative instructions carefully, including activity restrictions, wound care, and medication use. Avoid activities that may increase the risk of bleeding or hematoma formation during the initial recovery period.
Patient Education:

Be aware of the signs and symptoms of complications, such as excessive swelling, increasing pain, or changes in skin color or temperature. Contact your surgeon immediately if you have any concerns.
Long-Term Outlook:
Most hematomas resolve spontaneously:

In many cases, small to moderate-sized hematomas will resolve on their own with appropriate management and do not have a significant long-term impact on the tummy tuck results.
Patience and Follow-Up:

It's important to be patient during the recovery process and attend all scheduled follow-up appointments with your surgeon. They can assess your progress, address any concerns, and determine if any additional interventions are needed.
Summary:
While an abdominal hematoma after a tummy tuck surgery can potentially impact your results, its effect will vary depending on various factors. Prompt detection, proper management, and adherence to post-operative instructions are essential for minimizing complications and achieving the best possible outcome. Communication with your surgeon and close monitoring of your recovery are key to addressing any issues that may arise and ensuring optimal long-term results from your tummy tuck surgery.

Semih Yildiz, MD, FEPOBRAS · Answer

A 7 cm hematoma after a laparoscopic procedure can be painful and slow to resolve. If it is not enlarging and your exam and labs are reassuring, observation with serial exams and sometimes ultrasound or CT is a common approach, because many hematomas gradually liquefy and reabsorb over weeks to a few months. That said, the best approach depends on the size, exact location, symptoms, skin changes, infection signs, blood thinners, and whether it is changing.

It should be monitored closely. Contact your OB/GYN promptly, and seek urgent evaluation if you develop increasing swelling, worsening pain, redness, warmth, fever, drainage, dizziness, shortness of breath, rapid expansion, or skin darkening. If the collection enlarges, becomes infected, threatens the skin, causes significant anemia, or stays persistent and liquefied, drainage or aspiration may be considered. Early drainage of a clotted hematoma is not always simple and can sometimes create more bleeding or introduce infection, which is why doctors often watch stable collections.

For your tummy tuck result, a resolving hematoma usually does not permanently ruin an otherwise healed abdominoplasty. It can temporarily distort the contour and leave firmness, discoloration, or tenderness while it heals. Less commonly, it can contribute to scar tissue, fat necrosis, a persistent lump, or localized contour irregularity, especially if it is large or slow to resolve.

Because you are specifically worried about the prior tummy tuck appearance, I would ask your OB/GYN to share the imaging or report with your plastic surgeon, or see a board-certified plastic surgeon for an exam. That second set of eyes can help judge whether the collection is likely to settle on its own, whether it is affecting the abdominal flap or scar tissue, and when intervention would help more than hurt. In the meantime, avoid massage, compression changes, exercise, or heat unless your treating doctor specifically clears them.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question about your hematoma and concerns for your tummy tuck results. A hematoma, especially one that’s stable and not growing, often will reabsorb gradually over time. However, larger hematomas, like the one you’re experiencing, can take weeks or even months to dissipate fully. While this waiting approach is common, especially if there’s no sign of infection or worsening symptoms, the main focus is on monitoring for changes.

If the hematoma does not shrink over time or causes discomfort, some plastic surgeons may recommend aspiration (draining) or other treatments to encourage absorption and reduce pressure on surrounding tissues. This can also help prevent potential issues, like scar tissue formation, which could impact the contour of the tummy area. However, many cases do resolve on their own without intervention.

As for your tummy tuck results, minor hematomas typically don’t lead to long-term aesthetic concerns, but larger ones can sometimes affect the smoothness of the abdominal area. It’s best to keep in touch with your plastic surgeon to discuss any persistent concerns. They can assess if intervention might benefit you and help preserve the results you’re happy with.

Sincerely,
Dr. Katzen

Daniel Barrett, MD · Answer

Dear karas_l,
in most cases hematoma will absorb and reduce with time. I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Matthew C. Camp, MD · Answer

The hematoma should be evacuated. In addition to having an unpredictable effect on shape, a large blood collection is susceptible to infection, and abscess formation. Hematoma also results in thick scar as the tissue is walled off from the rest of the body. This scar can distort shape, requiring secondary surgery to extirpate the scar tissue. If your OB/GYN doctor is unable/unwilling to help, see a general surgeon or plastic surgeon for help.

Jeffrey M. Darrow, MD · Answer

Your simplest way forward is to allow the hematoma to resolve on its own. This may take some time and can leave the area initially, slightly puckered and firm due to the process of the hematoma resolving. Over time, however, this should gradually resolve.  Another option is to have the hematoma drained by ultrasound guidance,  so the majority of it is removed, and there is less to resorb. This should speed up the time to full resolution but does involve having a small minimally invasive procedure. Check back with your plastic surgeon about what they feel is the best way forward. Best wishes.

Connie Hiers, MD, FACS · Answer

If need, ask your OB to send you to radiology and let the radiologist drain the hematoma under Xray. this would best be done at 2 weeks so that the blood is liquified.

Scott C. Lindsay, DO · Answer

Thank you for your question.
This should not ruin your tummy tuck. It should reabsorb and cause no issues. Reach out to your surgeon with your concerns. Best wishes!

Camille Cash, MD · Answer

The hematoma may result in distorted contours initially but should soften and improve as time goes on.  It is important to follow up regularly with your OB/Gyn to ensure the hematoma is resolving.

Mats Hagstrom, MD (license on probation) · Answer

If a patient is actively bleeding during or after surgery, then it is the surgeons obligation to first and foremost make sure the bleeding stops and to deal with the consequences.
A small blood collection can be left alone, but a large blood collection can lead to some problems if not properly drained.
Depending on the circumstances draining a hematoma can sometimes be very easy.
Surgeons can usually suction out and hematoma using a Liposuction cannula in just a few minutes.
This can save the patient from months of being bruised and ending up with a massive layer of contractile scar tissue And months of inflammation.
There is no right or wrong answer. It simply depends on the circumstances and what’s involved.
You also find very different opinions among different providers, especially those of different backgrounds.
There is also a certain timeframe when a blood collection should be drained.Follow up with your providers and schedule second opinion consultations if indicated.
Without any more information, we can’t begin to make a good assessment or recommendations.
Best,
Mats Hagstrom MD

Abdominal hematoma - will it ruin my tummy tuck results?

Answers (10)

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