Fat Necrosis After Tummy Tuck What to Do? Update (photo)

Thank you for the answers to a question about fat necrosis after TT I posted 15 days ago. Now I am worry again. My PS cut part of a scar making one big wound instead 2 smaller; cleaned the wound with instruments, and told me to wet a gauze with tap water and pack a wound twice a day. A couple of days ago I noticed bad odor from a would. I have no fever or pain. Is it a new complication or a normal step in treatment?

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Doctor Answers 11

Fat Necrosis Treatment?

Thank you for the question and updated photos.

I think you and your plastic surgeon are treating the fat process appropriately. It may be that, given the new onset odor,  that further debridement will be beneficial. Your plastic surgeon will be in the best position to determine the need for debridement once he examines you.

Generally speaking, it is best to allow for the unhealthy tissues to “declare themselves” ( as yours has done). This will prevent unnecessary debridement of potentially healthy tissue.

You will find that after the debridement wet to dry dressings may be beneficial. The open won't will gradually heal. I would suggest paying attention to the protein in your diet as well.

I hope this helps.

Necrosis after tummy tuck

Time and local care are what you need right now. Frequent moist to dry dressings are beneficial. You can use either saline or Dakin's solution ( roughly 1 part Chlorox to 19 parts sterile water). Oral antibiotics are not necessary unless you are running a hig fever, have increased redness or a positive culture.Then at least 6 months after the wound has filled in the widened scar can be reexcised and closed.

I know this looks very bad to you. Stick with your surgeon and he or she will help you get through this complication and ultimately to a pleasing result.

Ann F. Reilley, MD (retired)
Baton Rouge Plastic Surgeon
5.0 out of 5 stars 7 reviews

Abdominoplasty wound from fat necrosis now smells. What to do?

Odor relates to bacteria residing in warm, wet, dead tissue. Better cleansing will eliminate this. To accomplish better wound care, you should perform more dressing changes per day, let the dried "stuff" stick to the gauze as you pull it away (in other words, do not moisten the dressing so it comes out easily), and feel free to gently scrub the wound with a soft-bristle toothbrush! This accomplishes what your surgeon did when he "cleaned the wound with instruments." Remember, if light bleeding occurs, healthy tissues bleed, whereas dead tissue does not, so don't let a little red ooze scare you!

Your instruments are a bit less metallic and sharp, but you can (and should) accomplish the same goal with daily wound toothbrush scrubs in the shower, more frequent wet-dry dressing changes, and follow-up with your surgeon as recommended. Please verify that your surgeon is in agreement with any recommendation from someone who has not seen your wound in person (all of us), but rest assured that this will continue to heal and leave a remarkably smaller scar than you now suspect.

BTW, hydrogen peroxide is sometimes recommended for an infected or contaminated wound. It is OK for once or twice, but chronic use can actually slow healing, so stick with soap, water, scrubbing, and bandage changes per your surgeon's advice. Good luck!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 238 reviews

Odor is likely the residual fat necrosis


With an open wound and with the dressing changes you describe your body will be able to get rid of the dead fat/tissue and form healing tissue (granulation) behind it, essentially filling the wound in from the inside out.  What you are likely detecting in terms of odor is residual fat necrosis and the bacteria that wants to grow in it.  Sometimes when this happens changing your dressing regiment to add a solution that kills some of the bacteria may be helpful.  Acetic acid or Daikins solution are both option.  This is done until the odor goes away and tap water is resumed.

All the best,

Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 153 reviews

Necrosis of skin of lower abdomen following a tummy tuck

Your healing issue is not a rare phenomenon with tummy tucks and should ultimately heal. You may need more aggressive treatment of the wound such as debridements by your plastic surgeon who may need to follow you twice a week. An antibacterial dressing may be more effect such as silvadene.

Make sure that you are on a well balanced but high protein diet. Finally, if you are smoking or exposed to smoke: STOP! This is very detrimental to healing.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 27 reviews

Wound Healing Problem

You need to see the doctor and get either more debridement or change your dressing routine.  Usually a bad odor reflects dead tissue.

Fat necrosis after tt

When there is fat necrosis it means a strip of fat is dead. Your ps has debrided or cleaned the dead fat out which is good. But there is always still a little patchy bit of fat necrosis left which will take time to separate and come out on the dressings. This is the reason for the packing. If you change the packs often it will lessen the odor which will diminish over time anyway. You are being well and appropriately managed all the right things are happening but it's a slow and frustrating period fo you. The wound will close and it will be a nice result when that happens. You will be surprised how the scar looks thin once the defect shrinks down and closes. This might take up to 2 months. Good luck.

Marginal necrosis and blood supply

Marginal necrosis at the wound edge especially in the midline is not unusual following an abdominoplasty. With conservative management it will get better. Your plastic surgeon will help you get this area healed.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 16 reviews

Fat Necrosis After Tummy Tuck What to Do? Update (photo)

Thanks for the photos. Aggressive deep wound care is the initial course to proceed. Are you following with your surgeon on a 3 times a week visits? Other options are operative debridement, oxygen therapy, wound vac. The odor is due to the necrofication and bacteria of the necrotic tissue. 

You will be ok

This is a rare complication of the tummy tuck that will heal. You will to follow your surgeons recommendations. The wound looks bad now,but it will heal fine and you will need local scar revision in 6 months. The other option to expedite the healing is wound vac. This may cost you extra ,but will shorten the healing time.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 110 reviews

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.