How likely are the chances of developing skin necrosis after tummy tuck?

Question

I've had 4 c sections and two tummy tucks. After my last baby I now have muscle separation and would like my c section scar revised so I am going to have a mini tummy tuck to repair the muscle separation and scar. After my fourth c section , two of my stitches opened and i developed an infection. The opening took 6 weeks to heal. How likely is this to happen again if I go trough with the tummy tuck? Non smoker, non diabetic, overall good health with only hypertension which is controlled.

Ram Kalus, MD, FACS · Answer

Thank you for your question. From your history the complication you experienced is certainly not routine but also not remarkable unheard of. “Necrosis” can occur for many reasons, the most common being compromised blood supply due to tension in the closure. Your history of two prior “tummy tucks” is a it uncommon and a third even less common. Without an examination in person or viewing photographs it is difficult to comment more specifically.

Please consult with your plastic surgeon or any qualified and expert board certified plastic surgeon who routinely performs abdominoplasty in his or her practice. Best of luck to you.

Please consult with your plastic surgeon or any qualified and expert board certified plastic surgeon who routinely performs abdominoplasty in his or her practice. Best of luck to you.

J. Timothy Katzen, MD, FACS · Answer

It's difficult to precisely quantify the risk of skin necrosis after a tummy tuck as it depends on various factors, including your overall health status, surgical technique, and postoperative care. However, I can say that in the majority of cases, particularly for non-smokers and non-diabetics like yourself, the risk is relatively low.

The prior occurrence of an infection and wound dehiscence (opening) after your C-section does not necessarily mean that you would have the same complication after a tummy tuck. However, it is essential that your plastic surgeon is aware of this history. Also, the management of your hypertension is crucial to ensure optimal healing and minimize potential complications.

Proper preoperative planning, surgical technique, and postoperative care are key to minimizing the risk of complications, including skin necrosis. Please ensure you are working with a board-certified plastic surgeon who has extensive experience in tummy tucks and is well-versed in handling any potential complications.

Sincerely, Dr. Katzen

Daniel Barrett, MD · Answer

Dear Rogonzalez69,
every surgery has a risk of skin necrosis. But with proper preoperative preparation and surgical technique, that risk can be significantly reduced. 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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Dallas Buchanan, MD · Answer

Thank you for your questions. If your procedure is performed by a reputable board certified plastic surgeon with knowledge of the procedure and the anatomy involved, the incidence of true skin necrosis should be very very low. The other important factor is the patient's overall health and post-op care. Patients who are overweight, diabetic, smokers, etc have a much higher incidence of this type of problem so patient selection is key. So if all those things are aligning for you, then you should be good to proceed.
Best of luck!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Connie Hiers, MD, FACS · Answer

You will have less chance of problems not being pregnant or just delivering. C sections open into the uterus which has bacteria. Your plastic surgeon will not go that deep.  Skin necrosis in a nonsmoker with a mini tuck is very rare.  Stay away from smokers before and after surgery.

Douglas Taranow, DO, FACOS · Answer

No one can give you an accurate answer as to the potential for a repeat postoperative necrotic complication with a repeat procedure, however, I can tell you the risks are very low.  With each procedure, your stomach flap develops collateral circulation (alternate smaller blood vessels that form to carry more blood after damage to existing blood vessels).  The most common areas for a separation (diastasis recti) is in the upper abdomen so I guess during your "mini-abdominoplasty" your surgeon will have to open around the belly button and lift the upper flap as well?  If so, this increases the post-operative chances of complications a little bit more.  
Make sure you plastic surgeon knows all of the issues you faced with your previous procedures.
Best wishes,
Dr. Taranow

Camille Cash, MD · Answer

Necrosis is rare, but is a risk of the procedure.  I encourage you to visit with a board certified plastic surgeon to evaluate your skin quality and scar tissue. You will want to carefully select your surgeon as well as closely follow post op instructions.  Your surgeon will cover signs and symptoms for you to look for as you heal.

Mats Hagstrom, MD (license on probation) · Answer

Skin necrosis can happen from a tummy tuck, but is typically limited to those who are at increased risk. Risk is increased, primarily by those who are heavy, smokers, or obese, or generally unhealthy. The risk is also increased if the surgeon puts excessive tension on the incision line.
The degree of undermining or separating the tissue layers also increase the risk of skin necrosis. For that reason, having a mini tummy tuck drastically reduces the chance of skin necrosis in comparison to a full tummy tuck. Having had a previous tummy tuck, creates a “delay affect” which increases the blood supply to the skin, making the chance of skin necrosis during secondary surgery much less.
Muscle tightening typically requires a full tummy tuck to reach the upper abdomen.
Best,
Mats Hagstrom, MD