Hysterectomy 6 years after tummy tuck - will a vertical incision increase my likelihood of needing a revision?

Question

I am 6 years post-tummy tuck and have recently found out I need a hysterectomy. Unfortunately my uterus is quite enlarged into abdomen due to a fibroid and my doctor is concerned they may have to do a vertical incision. What is the likelihood I may need an abdominoplasty revision. My diastasis was very bad and the plastic surgeon performed a miracle fixing it. I’ve been very happy with the results and aghast at the thought they’ll be ruined.

Emmanuel De La Cruz, MD · Answer

The relationship between a hysterectomy and a previous tummy tuck can be complex, and the decision to perform a vertical incision during a hysterectomy depends on various factors. While I can provide general information, it's important to discuss your specific case with your surgeon for personalized advice.

Here are some considerations:

Previous Tummy Tuck:

The presence of a previous tummy tuck can affect the approach to a hysterectomy. If a horizontal incision (transverse or "bikini" incision) was made during the tummy tuck, it may influence the surgical planning for the hysterectomy.
Vertical Incision:

A vertical incision (up and down) during a hysterectomy may be required for specific medical reasons, such as the need for better access to the uterus or surrounding structures. The decision to use a vertical incision is typically based on the surgeon's assessment of the individual case.
Potential Impact on Tummy Tuck Results:

If a vertical incision is made during the hysterectomy, it may impact the aesthetic results of the previous tummy tuck. The vertical scar could potentially alter the appearance of the abdominal area, and revision surgery may be considered to address aesthetic concerns.
Consultation with a Plastic Surgeon:

If you are concerned about the impact of a hysterectomy on your previous tummy tuck results, consider scheduling a consultation with a board-certified plastic surgeon. They can assess your case, discuss potential implications, and provide guidance on whether a revision may be needed.
Timing of Procedures:

The timing of the hysterectomy in relation to the tummy tuck can also influence the potential need for revision. Scar maturation and tissue healing play a role in the overall aesthetic outcome.
It's crucial to communicate openly with both your gynecological surgeon and your plastic surgeon. Discuss your aesthetic goals, concerns, and any potential impact on the tummy tuck results. Collaboration between the two surgeons can help optimize outcomes and address both medical and aesthetic considerations.

Remember that individual cases can vary, and the best course of action will depend on the specifics of your situation. Always consult with your healthcare providers for personalized advice based on your medical history and goals.

Daniel Barrett, MD · Answer

Dear Momakover2017,
in case of hysterectomy, you will need to have abdominal wall incision so there is a chance that you'll have muscle separation again. I would suggest you to discuss your concerns with your surgeon. 
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

Your tummy tuck results should not be significantly impacted by your hysterectomy.  Be sure to follow your surgeon's advice post operatively including lifting restrictions.  Wear supportive garments as recommended.  I encourage you to discuss your concerns with your surgeon.

Connie Hiers, MD, FACS · Answer

If your abdomen is not stretched out, you should do well and not undo any work your plastic surgeon did.

Mats Hagstrom, MD (license on probation) · Answer

I suggest you get a few different OB/GYN opinions. Since I don’t perform hysterectomies, I’m not in a position to say what is or is not possible. You should absolutely confirm that a transvaginal laparoscopic hysterectomy is completely out of the question. There may be other OB/GYN’s who feel comfortable doing it a laparoscopic transvaginal hysterectomy. It seems to me a good surgeon should be able to divide the uterus laparoscopically and deliver it in sections if they can’t do it as a entire unit. I would hate to see you undergo a vertical incision after a tummy tuck. If you end up with a full length, abdominal incision, you’ll have that scar for life.
I suggest having at least a couple more OB/GYN consultations. Consider consulting at an academic center if there’s one close to you.
Ending up with a vertical scar on your abdomen is not necessarily an indication to redo your tummy tuck. You probably don’t have much skin laxity anymore so you’ll probably be stuck with the scar unless the procedure can be done as a laparoscopic operation.
Best,
Mats Hagstrom, MD

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