Risk of Necrosis After Tummy Tuck?

Skin necrosis is a possible but fairly uncommon risk of having tummy tuck surgery. It occurs when there is not enough circulation to the tissue and the involved skin and fat can die. During tummy tuck surgery, the abdominal tissue is lifted off of the muscle layer and part of the circulation is disrupted. The area that is most at risk is the skin in the lower abdomen, just above the scar, in the midline.
Patients who smoke are at much higher risk for skin necrosis because smoking adversely affects tissue circulation. For this reason, I never perform tummy tucks on patients who are actively smoking. In the routine patient who doesn't smoke, skin necrosis is rare. If it does happen, it may be due to excessive tension on fhe suture line and is usually limited to a small area that can be revised later on for a good result.
I hope this helps you in making an informed decision!

Hello, and thank you for your question regarding necrosis after a tummy tuck.

Necrosis refers to the death of cells or tissues in the body. It can occur when there is a lack of blood flow and oxygen to the affected area, leading to tissue damage and cell death. In the context of a tummy tuck (abdominoplasty), necrosis is a potential risk, although it is relatively rare. During a tummy tuck, excess skin and fat are removed, and the abdominal muscles are tightened. This procedure involves creating incisions and lifting the skin, which can potentially affect blood supply to the tissues. When the blood flow to the skin and underlying tissues is compromised, it can lead to necrosis.

Several factors can increase the risk of necrosis after a tummy tuck, including smoking, poor circulation, large amounts of tissue removed, infection, tension on incisions, and obesity. Smoking significantly reduces blood flow and oxygenation to tissues, increasing the risk of complications like necrosis. It is strongly advised to stop smoking at least six weeks before and after surgery. Patients with underlying conditions that affect circulation, such as diabetes or vascular disease, may have a higher risk of necrosis. The more extensive the surgery and the larger the area where tissue is removed, the higher the risk of disrupting blood flow. Post-surgical infections can compromise healing and increase the risk of necrosis. Excessive tension on the surgical incisions can impede blood flow to the surrounding tissues. Excess body weight can negatively impact blood circulation and increase the risk of complications.

To minimize the risk of necrosis, it is crucial to follow your surgeon's preoperative and postoperative instructions carefully. This includes ceasing smoking, maintaining a healthy lifestyle, and following postoperative care. If you smoke, quitting well before surgery is essential to improve blood flow and oxygenation. Proper nutrition, hydration, and managing chronic conditions like diabetes can help support healing. Adhering to wound care instructions, avoiding excessive strain on the surgical area, and attending follow-up appointments with your surgeon can help identify and address any issues early. If necrosis does occur, treatment options may include debridement (removal of dead tissue), antibiotics to prevent or treat infection, and in some cases, additional surgery to repair the affected area.

Necrosis is a potential risk of tummy tuck surgery, but with careful planning, proper surgical techniques, and adherence to postoperative care, the risk can be minimized. Always consult with a board-certified plastic surgeon who has experience performing tummy tucks to discuss your specific risk factors and ensure you receive the best possible care.

I hope this helps to answer your question regarding necrosis after a tummy tuck.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS

Thank you for your question.  Necrosis is literally death of tissue - in this case I believe you are referring to skin and/or fat at the lowest part of the abdominal flap in tummy tuck.  It results from compromise of proper blood supply to the tissue.  If a tummy tuck is closed under too much tension (i.e. too much skin is removed), or significant pressure is applied to the lower portion of the healing abdomen, wound breakdown or skin necrosis can occur.  If performed properly, tummy tuck should never result in true skin necrosis.  Please ensure that you are undergoing surgery with a board-certified plastic surgeon.

Tissue necrosis is a well-known complication of
abdominoplasty.This complication occurs
when tissue has inadequate blood supply and subsequently dies.The area that’s most vulnerable to this type
of problem lies directly above the abdominal incision.This is the point, that blood has the
furthest to travel.When
patients undergo abdominoplasty, the skin and fat are elevated away from the
underlying abdominal muscles.This means
that blood has to pass through a flap that consist of fat and skin to reach the
incision site.Anything that compromises
this blood supply can result in tissue necrosis. Several
conditions have been associated with skin necrosis in abdominoplasty
patients.These include diabetes, collagen
vascular disease, infection, tension on the wound closure and cigarette
smoking.All of these conditions
compromise the small blood vessels that flow through the abdominal skin flap.This poor blood flow can result in tissue
necrosis.By
carefully evaluating patients in the pre-operative period, the incidence of
this complication can be minimized but never totally eliminated.

Necrosis is when tissue of the surgical site dies (become necrotic) following surgery. Tissue may change colour, begin to fall off and become infected. Corrective surgery is necessary to resolve this. Skin or fat (usually when it is transferred) necrosis is more common in people who smoke or are diabetic, when blood circulation.

Hello! Thank you for your question! The issue with nicotine is that it
also acts as a vasoconstrictor, clamping down of blood vessels. Blood
supply is always of great concern during any surgical procedure, but
especially in such a procedure as a breast augmentation where the viability of the
skin/tissue, and nipple-areolar complex is obviously important. Since the vascularity to
the area is already tenuous since it will be raised by cutting around
the area, maximizing blood flow to the tissue is critical. Typically,

we recommend at least 6 weeks of smoking cessation prior to and at
least 6 weeks after any surgical procedure. The longer, the better.
Nicotine always increases the risk for infection, nipple necrosis, poor
scarring, and
wound complications, as well as other health consequences including blood clots. The
anesthesia risk is greater with general anesthesia as well as pulmonary
issues/lung infections postoperatively. I would
discuss this with your surgeon prior to your procedure. Hope that this
helps! Best wishes!

Necrosis means dead tissue.  This can be caused by external stimuli such as smoking or from surgical technique or postop bandaging or garments.  Diabetics are more prone to this complication.  Sometimes patient s may bend over too far and flex their abdomen when walking causing a kinking of the lower flap and some necrosis with delayed healing.  This can be treated with debridement and/or wet to dry dressings.  Others may use a Wound VAC system that consist of a sponge inserted in the wound and connected to a closed intermittent vacuum system that draws the blood supply towards the wound and removes dead tissue and fluids.

Dead tissue after tummy tuck occurs when there is inadequate blood supply to the healing tissues, causing the affected tissues to die. This requires more healing over longer time, causes more scarring, and can require more surgery, skin grafts, and in rare cases, major reconstructive surgery. This can also, in extremely rare cases, even progress to severe infection and death. This is, when you think about it, true about virtually anything in life, such as a car trip, a slip and fall, etc. What is important is to keep things in proper perspective.

The risk of any kind of skin or umbilical necrosis for most experienced, board-certified plastic surgeons is below 1%, but only if the patient is a non-smoker, avoids all nicotine products (including spray, gum, or patches), and also avoids second-hand smoke. Nicotine is a major vasoconstrictor, and once the skin dies it's too late to say "I won't smoke any more!"

In a smoker, statistics vary, but the risk in some studies is as high as 15-20%. For this reason, I will not perform tummy tucks on smokers, nicotine users, or those exposed to second-hand smoke. It's just not worth the risk, in my opinion. I have cancelled paid-for surgery if I smell smoke on my patient as they report for surgery. They get their money back, minus a cancellation fee.

So, if you are NOT a smoker, this is a minimal risk well-understood by your surgeon. He or she will take all appropriate surgical precautions to minimize this and all the other risks you may or may not be aware of. Trust me, we ARE aware of them, and no surgeon wants or allows complications in their patients; when they occur, they do so despite our best efforts. Our reputation and livelihood depend on your good outcome.

Your question refers to a problem that can develop as a result of inadequate blood circulation to the skin that is pulled down in a tummy tuck. Any time skin is undermined (what plastic surgeons call a flap), the blood flow to that area is compromised, and when the skin flap is pulled tight the blood flow is strained further. If it is inadequate the skin dies and can create a significant problem. This is fortunately rare in nonsmokers but the effects of nicotine, which contricts blood vessels, can be enough to trigger it.

Necrosis is a known complication of any plastic surgery procedure. Also, abdominal skin or fat necrosis is one of the known complications of Tummy Tuck. These is however evry infrequent in most people unless for smokers, diabetic patients, immunocompromised patients, and those with certain vascular conditions.

Typically a tummy tuck wound heals without any complications, especially in a mini tummy tuck.  Skin necrosis refers to a complication when some of the skin next to the wound gets inadequate blood supply right after the surgery, turns black and scabby.  This results in a poor scar and prolonged healing.

Make sure your surgeon assesses if you have any risks that would predispose you to this complication, in which case some measures need to be taken, or the surgery might have to be modified to decrease the likelihood of getting this complication.