I Would Like a Full TT However I Have an Existing Kocher Gallbladder Scar...

I have never had a problem with either. I don't smoke and I'm pretty fit. I have met with several board certified plastic surgeons to mixed reviews. 2 said they could do the procedure, 1 said he would only recommend a mini tuck and one recommended a Fleur de lis (sp). I really want this but not at the risk of my health or life. Is there a board certified surgeon out there who has done this procedure with extensive experience and before and after photos? If so pls send link.

Doctor Answers 10

Gall bladder scar and tummy tuck. Is it safe?

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You know, we tend to be thoughtful about this kind of scar before proceding because it obviously interrupts blood supply on the right side to some extent.  But interestingly, the patients I have operated on with this scar, healed normally without any trouble.

I think that if the undermining is done carefully, preserving as much of the perforating blood supply below the ribs on each side as possible, and the tension is adjusted conservatively, it should work out well.

Mountain View Plastic Surgeon
5.0 out of 5 stars 54 reviews

Tummy Tuck And GB Scar

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I am glad to hear you are not a smoker. What is your height and weight? Yes I have done tummy tucks on several people with GB scars. There are increased risks of wound healing problems and the surgical scars might be a little higher with a small T. Lipo suction can be helpful to avoid undermining to preserve blood supply. An experienced surgeon would need to examine you and look at your GB scar but I would not give up hope.

Richard Linderman, MD
Indianapolis Plastic Surgeon

Tummy tuck after Kocher gallbladder incision is safe.

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With 24 years of cosmetic surgery experience and hundreds of tummy tuck procedures, I have done many with this scar (and other scars). All have done well, as the skin develops collateral circulation in the months and years after the cholecystectomy scar cuts some of the skin circulation.

So, while the concern is a legitimate one, and one I still discuss with my patients, I have no reservations about proceeding with a full tummy tuck in a patient with this scar. If they smoke, I will not do this surgery (scar or not) unless they quit, do not use nicotine patch, spray, gum, or even if they have exposure to second-hand smoke.

If the tummy tuck is a very "tight" one, this is one more "relative" risk factor that needs to be taken into account, but will not prevent me from doing the operation I feel is best for my patient. Those surgeons who offer other options as a way of avoiding the circulation concern are not wrong, but rather they are understandably wary, and perhaps have not had experience with enough of these incision issues to feel comfortable with this. Consider consultation with several ABPS-certified plastic surgeons until you find those senior enough (experienced) who do lots of tummy tucks to give you the same definitive answer several of us here have. Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Concerns about an old and large gallbladder scar and the performance of a tummy tuck

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Though it is often preached that these large scars used in the removal of gallbladders can compromise the blood flow to the tissues as relates to tummy tuck surgery, with proper precautions and the right patient, the risks can be kept low. Smoking does present a high risk for problems (though you are not a smoker).

I have performed many tummy tucks in selected patients with these pre-existing incisions and have not experienced tissue loss. Given your history and with the proper precautions, you should be able to have a full tummy tuck performed (if indicated) with a reasonably low risk of some tissue loss.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

Tummy tuck, gall bladder scar

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I have probably done 30 or more tummy tucks on people with the scar you mentioned with no complications in the wound healing. BUT I do require the patient to be a non-smoker and to have 5 years or more since the gallbladder surgery. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Tummy tucks after previous abdominal surgery

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You pose a very good question.  Part of your surgeon's job is to examine your body, specifically looking for signs of possible problems. Previous abdominal surgery can result in abdimonal scars being located in areas that can cause increased risks following tummy tuck surgery, The "old fashioned" Kocher (named after a famous German surgeon) is one of those areas. It is typically located below the right side of the ribcage and can extend across the entire right side of the abdomen. Tummy tucks can certainly be performed but must be a little more conservative in order to maintain the blood circulation to the rest of the skin. Depending on how much extra skin you have, you might be able to get a great result with a modified tummy tuck (which would include aggressive liposuction, lower abdominal muscle tightening and removal of mid to lower abdominal skin. A Fleur de Lis will probably not work unless you have a tremendous amount of extra upper abdominal skin, and even then, you will still probably have asome of your subcostal scar remain. You could also plan on a "two step" plan where first you would have a modified abdominoplasty and then have an upper tummy lift. The upper tummy lift will be able to tighten what is left over and conceal the scars beneath your breasts. Keep asking questions and proceed carefully. Good luck.

Can a Tummy Tuck be performed on someone with a large gallbladder incision?

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  Great question, and for those of you reading this who don't know, before laparoscopy was invented we used to take out gallbladders by cutting a large diagonal scar on the right upper abdomen just under the rib margin.  Very rarely, general surgeons still have to do this type of procedure even these days for very difficult cases of gallbladder or liver disease.

   The problem is that this incision cuts some of the major vessels that feed the abdominal skin and are essential for proper healing during a tummy tuck procedure.  However, in the proper candidate (non-smoker, excellent health, fairly fit) a tummy tuck could still be performed but I would wait at least two years after the extended gallbladder procedure.

    I just performed one of these last month on a lady who had her gallbladder surgery more than 10 years prior and she did great.  Loves her new flat stomach.  There is one problem though, the diagonal gallbladder scar is now at the middle of her right side after pulling down all the skin.  She is really happy, but this is something to consider because now the scar will be visible with a bathing suit on.  I can't post pictures because I don't have her consent.  Hope this helps.

Erez Sternberg, MD
Jacksonville Plastic Surgeon
4.9 out of 5 stars 33 reviews

An old Kocher scar from gall bladder surgery merits special consideration in doing a tummy tuck.

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There is a saying among plastic surgeons that if you meet with 10 plastic surgeons you will get 15 different opinions!  The fleur-de-lis scar is not a good option and a mini-tummy tuck is usually inadequate.  Your old abdominal scar is a problem.  It cuts off the blood supply just below the scar so that if you have a normal full tummy tuck, you are likely to have a complication with skin loss just below this scar.  I had one patient who elected to go ahead with the surgery and developed an area of skin loss about the size of a silver dollar that healed on its own and she was happy.  The important point is that she was prepared for this complication and accepted the risk.  The results of a tummy tuck can be so dramatic that it can still be worthwhile even if you have to put up with an area of skin loss and a little more scarring.  Another option may be including that old scar in the skin removed by the tummy tuck if it is low enough and you have enough skin laxity (a big if).  The disadvantage is that the scar will end up a little higher than we would like.  I've attached a link in case you would like to view the scars.  I actually have photos of that patient showing her complication and then the healed result.  If you want to see them, just contact me and I'll email them to you.

Eric Swanson, MD
Kansas City Plastic Surgeon
4.7 out of 5 stars 62 reviews

Full Tummy Tuck and Previous Scar?

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Thank you for the question.

You are correct to be concerned regarding your current scar, however, with limited undermining of the area, you can have a successful tummy tuck surgery.

Yes, it is very important to consult with very experienced plastic surgeons who have taken care of complicated cases so that you feel confident that he/she is able to get you through the surgery successfully.

Best Wishes! 

No problem

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I'm old enough to have don many tummy tucks with this incision. You should do well and have no problems with a well done tummy tuck.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 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.