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

Hi there

This is a minor but annoying problem.  I've seen it many times in my practice.  The problem is not that it will compromise your result, but that it just takes a long time to settle down so it gets a bit frustrating.

The wound will heal, but it will take it's time.  Just use local wound cleaning measures to keep it clean and avoid infection.  Talk to the practice nurse at your surgeons office for advice about this.

Once healed, there will be a thick hard lump under the scar for up to a year.  Sometimes it is better after a few months for the surgeon to excise the scar itself in a few months, just to get rid of the hard lump underneath it.

The lump will not give you a poor result, it just feels like an annoying lump that's all.  It's easily fixed if it doesn't seem to be going away.

Any surgeon doing a large volume of abdominoplasty (tt) surgery will see this reasonably often. Don't feel too bad about it, it's easily dealt with.

Good luck!

Hello,

Its possible that it may be fat necrosis.  The overlying skin is alive and appears healthy so we know that there is some blood supply that is getting to that area.  The second issue is that there is no way to tell how much fat necrosis there is if any.  It might only be a few percent and the body may be able to clean this up on its own.  What you are likely feeling is essentially the extra edema that the body is creating in that area to help clean up the fat issue.  At this time I would continue doing what you are doing.  Stay well hydrated, avoid smoking or nicotine, and keep the area protected.  It will continue to get smaller and better on its own.

All the best,

Dr Repta

Sounds like your chosen PSs is treating you correctly. It takes time to heal this area, about 2 months on average. 

Thank you for the question and picture.

Fat necrosis will usually resolve by liquefaction ( will liquefy and drain or be absorbed). You may find that the area of firmness will gradually decrease in size and soft you may find that you will have drainage for a period of time from the incision line.

You should follow up closely with your plastic surgeon to look for signs of infection in the area given that the blood supply is (by definition) limited in this area.

I hope this helps.

The good news is that fat necrosis will generally improve over time. What should happen is that the area of firmness will slowly get smaller and softer. At about 6 months postop you will be able to see what is left. At that point, if the area is still large, a revision/excision may be necessary. Good Luck!

Upsetting as this may sound, I think it is probably quite common and I wouldn't be surprised if there weren't always some fat necrosis after a tummy tuck. Your pictures look like you are actually having a relatively normal healing process and it sounds like your surgeon is working with you to speed your healing as much as possible. It will be slower than you would like, but I would expect that the area will gradually soften. Surgery now will just delay the healing process and I woud not recommend any revisionary surgery to my patients if they were in a similar situation until at least 6-9 months after the surgery. Patience is your best option at the moment, difficult though it may be. Good luck to you.
 

You are early in your recovery and things will improve with time.  You may require scar revision at a latter date.  Discuss with your surgeon your concerns and give your body time to heal before further surgery.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Most likely, this will heal on its own, without additional surgery, and with a nice result.

Of course, there's no way to guarantee that and you must remain under the care of your own plastic surgery.  But based on what this looks like I suspect that you'll have a period of drainage and need to have some wound care (not as bad as it sounds), after which the wound may even open up a bit more than it is, and then, finally, the wound edges will contract and you will heal reasonably well, and possibly very well.  A lot depends on the extent of the tissue loss that you're having, and I cannot tell from this photo. 

Again, the specifics of this process need to be discussed with your plastic surgeon, and you need to stay in touch with him or her, and follow the directions carefully.  Overall, though, I think you have a high liklihood of getting the result you wanted.

I hope that this helps, and good luck,

Dr. E

I agree that in many cases this will resolve without surgery. It does take time and I have found that waiting for the body to heal as much as possible has been a better solution rather than diving in early. You need to continue to follow up with your surgeon