Infected Incision 3 Weeks Post Op from Tummy Tuck. Should I Worry? (photo)

3 weeks ago I had a breast lift with implant, tummy tuck and lipo of the flanks. Attached is a picture of my tummy tuck incision. Is this something I should worry about?

Doctor Answers 19

Infected incision 3 weeks post-op tummy tuck needs detailed care by your surgeon.

You are right to be concerned about the condition of your incision and umbilicus. I'm a bit worried that you are on-line asking questions, but I will assume that you are getting "unofficial second opinions" regarding what your own surgeon is telling you. Continued follow-up visits, antibiotic therapy, wound care including possible surgical debridement (removing the dead tissue), and particularly examining your breasts to ensure the highest likelihood they do not become infected also are critical to this turning out well.

If you are a smoker or are exposed to second-hand smoke, this could be the CAUSE of the initial wound breakdown, and infection a secondary complication of the loss of blood circulation that nicotine exposure can cause. It's too late now to "bring back to life" the skin and tissue that have died from lack of proper circulation, but it's not too late to limit the amount of additional tissue loss and damage that both poor circulation AND/OR infection can cause.

This is why we constantly are telling our tummy tuck, facelift, and breast lift patients to avoid tobacco or nicotine in ANY form before and after these circulation-critical operations. And YES, even ONE cigarette or exposure to second-hand smoke can cause skin death that leads to precisely the kinds of wound problems your photos show. If you are a non-smoker and were never exposed to the bad effects of nicotine, this kind of wound problem can still occur from inadequate circulation, or when an incisional infection or stitch abscesses develop. The black appearance of your umbilicus and several areas of your central tummy tuck scar look more like circulation impairment first, then infection developing in the dead or ischemic tissues. Fat dies first, then skin, which is why your incision initially looks a little red, then "suddenly" opens up to the wounds that look so terrible!

All that being said, any surgeon who has done several hundred tummy tucks has occasionally seen wounds like this, and careful follow-up visits every few days at first, then at least weekly (more if needed) will get things healed up as quickly as possible, and hopefully avoid problems with your breasts or liposuction areas. This CAN be a big deal if ignored or inadequately treated! When it all heals, a fairly simple scar revision can improve the increased scarring this kind of wound healing problem will cause, though the final scarring will be surprisingly "not as bad" as the appearance of the wound will imply.

See your surgeon ASAP if not already doing so. Good luck and best wishes!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Tummy Tuck - Infected Incision 3 Weeks Post Op from Tummy Tuck. Should I Worry?

What you need is appropriate wound care.

You have more than an "infected incision;" you appear to have (cannot say for sure via this forum) wound separation due to some necrosis.  This is a well-known potential complication of this surgery and the majority of the time it can be treated with local wound care and it will produce a nice result, even though you may need a scar revision at some point in the future in order to achieve that.

However, I'm concerned about your umbilicus (belly button).  That, too, can have problems with wound healing, but it may be more difficult to address that.

You should (of course) be seen by your own plastic surgeon or, in the absence of that being possible, by another plastic surgeon near you who can guide you through the care you'll need, both at this point and going forward.  You should ultimately do well, but you need to be under the care of an experience plastic surgeon.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

Wound Healing After Tummy Tuck

Your pictures suggest wound separation following abdominoplasty surgery.Under these circumstances, it’s not unusual for secondary infection to develop as well.
This complication can be seen following abdominoplasty surgery and occurs for a variety of reasons.It’s often related to poor blood supply to the skin flaps, excess tension on the wound closure, fluid collections, primary infections and patient noncompliance.Each of these factors can significantly increase the potential for this type of problem.
This type of wound separation is frequently seen in cigarette smokers.The nicotine in cigarette smoke causes vasoconstriction in the small blood vessels that supply the skin flaps.This can result in the type of skin necrosis demonstrated in your pictures.For this reason, we request that patients stop smoking six weeks prior to surgery.
In addition, tight wound closures, fluid collections and inappropriate post-operative activity levels can contribute to this problem.Most infections occur secondary to wound separations, but in some cases infection may still be the primary event.
Once this type of problem has developed, aggressive local wound care is indicated.This may require surgical debridement and dressing changes.In some cases, a VAC suction system may be indicated as well.If infection is present, antibiotics may also be necessary.
With appropriate local wound care this type of wound should heal without difficulty.Unfortunately, this wound healing might take several months to occur and a touch up scar revision may be necessary as well.
It’s important that you maintain close contact with your plastic surgeon.Your plastic surgeon should be able to formulate a treatment plan that addresses your concerns.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

You need local wound care

You have local wound infection/dehiscence and should be treated by your surgeon. You will be fine in long run. You may require scar revision in 6-9 months.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 124 reviews

See your surgeon asap

You should see your surgeon as soon as possible. Your incision is infected and requires immediate attention. 

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Wound Separation after Tummy Tuck?

Thanks for the question picture.

What you are experiencing is a known complication after tummy tuck surgery. It is unclear to me whether you infection are skin irritation/redness.  There are a variety of ways to treat this problem but it does usually resolve within a matter of weeks.

I would defer to your plastic surgeon for specific treatment plan.  Please continue regular follow-up with him/her.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,498 reviews

Infected incision 3 weeks postop from tummy tuck

Your open wounds may be infected but it appears by your photographs that the bigger problem is wound separation secondary to tissue necrosis.
Necrosis is the medical term for death of tissue. The most common cause of tissue death following surgery is lack of blood supply. All of our bodily tissues require sufficient blood flow to keep it alive. During the course of surgery blood flow to the tissues involved is decreased to some degree. If the blood supply is decreased sufficiently the tissue at the end of the blood supply may die. Necrosis of the skin and fat can occur at the edges of a tummy tuck, breast lift, breast reduction or any other area where the skin and fat layer has been lifted off of the underlying layer. Cigarette smoking is known to decrease the blood supply in the skin and fat layer. If a wound is showing signs of necrosis it is important to stop smoking immediately. Most areas necrosis in following plastic surgical procedures can be treated by keeping the area clean and preventing an infection in the same area. When areas of necrosis become infected there may be additional tissue loss. By keeping the area clean the tissues often heal from the bottom up. It may be necessary to periodically remove (debride) some of the dead tissue to help enhance and hasten wound healing. If these wounds are kept clean and free of infection healing will occur. This healing process however may take several weeks or a few months to be completed. It is very important to keep in close contact with your surgeon to help monitor and support the healing process.

John J. Edney, MD
Omaha Plastic Surgeon
4.8 out of 5 stars 117 reviews

Wound healing problems...

Unfortunately your wound is having healiing problems. Your wound looks like there are areas of necrosis. You are even having a wound problem at the belly button. It makes me wonder if you are a smoker or if you have a medical problem such as diabetes which makes wound healing problems more common.  Your surgeon will have to make the decisions regarding wound care. Good luck.

Victor Au, MD (retired)
Chapel Hill Plastic Surgeon
4.5 out of 5 stars 7 reviews

Infected Incision 3 Weeks Post Op from Tummy Tuck. Should I Worry? (photo)

Thanks for posting the photo. It shows an infection/dehiscence of the incision in multiple areas. A very unusual occurrence. Are you seeing your PS (if the doctor was a PS) daily or at least 3 times a week for aggressive wound care and debridement? Some thoughts are  collagenase cream to help with debridement, excision of any necrotic areas, possible hyperbaric oxygen therapy, and local wound care. And YES this is something to be worried about if you are not receiving excellent follow up care from the surgeon of record. BTW was it a boarded PS or a cosmetic center hired surgeon, or done out of country? 

Another question because the multiple open areas is were the sutures used non sterile or was there a break in aseptic technique because of the 8 to 10 necrotic dehisced areas. Also I'm concern of the appearance of the umbilicus, as it also appears to have necrosis starting. If you would come to Miami I would be happy to see you or refer you to other boarded Plastic Surgeons here. Good Luck. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Incision post abdominoplasty

You should be seen by your plastic surgeon right away and followed closely by that individual. The surgeon is the best one to treat you.

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 22 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.