What could have caused my tummy tuck incision to heal this way and can this be revised? 1 year post op (photos)

Hello and thank you for your question. Wound healing issues are one of the risks of any surgery and are certainly very distressing and frustrating. Small wound healing issues such as spitting sutures can be very common, while larger ones such as yours are more rare but can happen. It is very hard to say based on the limited information but the causes can be multi-factorial including infectious, technical issues/excess tension, pre-existing or undiscovered genetic/medical conditions, and sometimes just bad luck. Revisions are possible and are best considered when the scar tissue is fully mature, or around 1 year after healing. I recommend an in-person consultation with a board certified plastic surgeon. Thank you again for sharing your journey.

Thank you for your question. Sorry to hear that you had some complications after surgery. With that being said it can happen. There are numerous things that could cause this to happen. A few could be infection, a patient that is or was a smoker, rejection of sutures are a few. This area can be revised and yes there is typically some form of a cost that is associated with it. I would suggest speaking with your Surgeon and discussing a plan. Best of luck to you.

Hi Vickilynnp,
I am sorry that you had this problem, and I am glad to see that it has finally healed.
In a tummy tuck, the lower abdominal skin and fat (from bellybutton to with in the pubic hairline) is removed. In order to close that the vertical defect, the remaining upper abdominal skin is undermined to the level of the ribs, and the combination of this undermining, stretch, and bed flexion allows the wound to close primarily. This extent of undermining by definition marginalized is the blood supply to the upper abdominal flap. Unfortunately for you, it appears that a portion of the upper abdominal flap, where it was closed most tightly in the midline, did not survive the transfer. As such, you ended up with an open wound, which healed in on its own.
While it is possible to remake your tummy tuck scar, re undermine the adjacent healthy tissue, and close in a similar fashion to your first surgery, it is unclear whether this would be reliable and whether it would achieve your goals of getting the scar out completely. An exam by a qualified board certified plastic surgeon would help to answer both of these questions.
I am very happy for you that you are completely closed and healed. You may also choose to take some time with her scar as is, expecting that it should fade to a more white scar over time. This scar may be an acceptable alternative to surgery for you, but ultimately you and your surgeon will decide.
Hope this helps.
Best,Christopher Pannucci MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

Dear vickilynnp,
in most cases wound necrosis occurs due to a lack of blood supply. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hi, vickilynnp! Thank you for your question and photos.
Skin necrosis, or skin loss is a complication in tummy-tuck operations and may happen more in patients who have had a liposuction, vaser, j-plasma or other energy based treatments before. Risk of this complication also increases with smoking, diabetes, vascular, rheumatological or autoimmune disorders. Sometimes, it just happens without a known reason. It may happen to any patient and any doctor.
A scar revision, 6months after the total healing of the scar will help you gain a more acceptable appearance.

I am so very sorry about your healing problem. Unfortunately, loosing skin can happen to even the best surgeon. This is common in people who smoke or are around those that do. Your scar can be revised. It may take more than one revision, and different things, including tissue expansion, can be done.

While this is a rare complication, it is possible for anyone who performs abdominoplasty surgery. The skin edge likely died (wound healing or skin necrosis) due to lack of blood supply, over-aggressive liposuction, infection, hematoma or patient related factors such as nicotine use, diabetes, etc.
The resulting scar is after the wound has healed in and the pink immature thin scar can be improved. Your previous surgeon can revise this scar and close it nicely like the rest of the linear incision, often in the office under local anesthesia, however charging you a fee for revision surgery is reasonable and acceptable (but not all surgeons do this, some revisions I will cover complimentary).
If you trust your surgeon and would like him to revise your surgery scar, then do so. If not, then a 2nd opinion can sometimes help to hear. It would be unusual for this to happen again.
Good luck!

I'm sorry to hear of the wound healing issues you had. Your scar looks typical for the size and depth of wound that you had. Scar revision should improve the result. If you're not comfortable with your prior surgeon you can visit with another board certified plastic surgeon near you. I've included a video about scar revision that I hope you find helpful.

Tissue necrosis and wound essence does happen and some individuals after a full tummy tuck.There are certain risk factors that increase this complication.
Individuals to actively smoke cigarettes or use nicotine products are at the top of the list for having this complication. This includes individuals who have a history of tobacco use even though they may have already quit.
The second biggest risk factor is individuals who are obese.
After that it’s in general poor health and age.
From the surgeons perspective there are also variables that can be done to reduce the risk. One is to not remove as much skin and the other is to limit undermining or the separation of tissue layers done during surgery. Both of these are done to improve the aesthetic outcomes so making the operation the safer is done at the cost of a less impressive or attractive results.
Most plastic surgeons are well aware of various risk factors for this operation like a history of tobacco use and obesity. Most will use their best judgment in regards to how aggressive to be during surgery.
In some cases there simply are no significant red flag high risk warning signs and patients still end up having complications. it’s easy to in hindsight say perhaps they should’ve not taken out as much skin or put as much tension on the incision line. most likely your surgeon did what he or she has done it many times before without complications.
Some individuals simply respond to surgery differently and the procedure has the risk of tissue necrosis and wound separation as one of his major known risks that can happen.
I would say the great majority a plastic surgeon has had this complication more than once in their career.
Revision surgery tends to be safer than the primary procedure because the healing from the first procedure has created a new blood supply making it less unlikely to happen a second time.
A lot of patients are apprehensive to have revision surgery because the first experience left him gun shy sometimes almost with PTSD.
I suggest you talk to your surgeon about everything involved with doing the revision surgery and consider getting a few second opinion in person consultations as well.
The complication may have a limited getting a perfect outcome but you should be able to get a fairly good improvement add moderate risk with a Revision as long as you are not an Active smoker or nicotine user.
Smoking (nicotine abuse ) or having had a history of smoking is by far the biggest risk factor for this operation.
Best,
Mats Hagstrom MD

Hi and welcome to our forum!
During the procedure of abdominoplasty, the skin and soft tissues are separated from the underlying musculature from the ribcage to the pubis, creating a flap of tissue with its blood supply arising from the superior and lateral aspects of the flap. If there is impairment of the blood supply as the result of arteriosclerosis, scar, or nicotine inhalation from cigarette smoking, the segment of the flap the longest distance from its blood supply may not survive, resulting in necrosis. This is not an uncommon complication and cannot be predicted. This usually occurs at the middle of the abdominoplasty incision.
Serial scar revision may result in a smaller less obvious scar.
Visit your plastic surgeon for evaluation and discussion.
Best wishes...