Risk of Necrosis After Tummy Tuck?

What is necrosis and how is it related to the risks of tummy tuck surgery?  

Doctor Answers 22

Risk of marginal necrosis with an abdominplasty

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An area of marginal necrosis in the middle is not uncommon. This is the area that is the furthest away from the blood supply and under the most tension. These areas generally take about 4 - 6 weeks to fully heal. Many times the scar will look just fine and other times you may require a relatively simple scar revision. Simple wound care is all that is required.  A smoker is at greatest risk but it can happen to anyone. 

Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Tummy tuck necrosis

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Necrosis is death for the skin. In tummy tuck, it occurs in the lower abdomen near your incision and can occur around the belly button.

If you are a properly selected, healthy, non-smoker with no disease of your blood vessels, and the surgery is done correctly, necrosis should not happen.

Smokers and people with poor blood supply to the skin are at risk. Older people with peripheral vascular disease and those with inflammatory conditions like Lupus and other diseases of the blood vessles do not have adequate blood flowing to the skin, and the lower abdominal skin can necrose after tummy tuck surgery.

Also if the surgeon removes too much skin and has to pull the tummy too tight to close it, then blood supply can be compromised and necrosis can result.

See an experienced board certified plastic surgeon who has a good reputation. Follow his/her advice and you should be fine if you are a good candidate.

This is a wonderful operation which usually creates beautiful results. See before and after pictures.

Skin necrosis is a possible but fairly uncommon tummy tuck risk

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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!

Caroline Min, MD
Los Angeles Plastic Surgeon

Necrosis means dead tissue.

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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.

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

Lack of blood supply is the culprit...

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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.

Risk of necrosis after tummy tuck

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Necrosis is loosing part or all layers of abdominal skin flap. It is a very uncommon complication of tummy tuck if it is not done cautiously. Chronic and heavy smokers are more prone to have this complication if extensive undermining is performed and undue tension is applied  at the time of flap closure. If recognized early enough, tension needs to be released immediately to rescue the flap.

Tummy tuck risks

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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.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Risk of necrosis after a tummy tuck

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Like every surgery, a tummy tuck also carries known risks and publications. One possible risk is known as necrosis or death of the overlying skin or skin and fat at the edge of the incision. Necrosis can occur if the flap has been damaged or too aggressively manipulated or if a wound has been closed with excess tension. To avoid this serious public, your best bet is to work with a board-certified plastic surgeon was great deal of experience in Mini tummy tucks, regular tummy tucks, and flap surgery. In our practice, we cannot close these ones with excess tension so that we can avoid the risk of necrosis and so that we do not create a distorted appearance of the abdomen.


Necrosis is death

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Necrosis associated with tummy tuck surgery is describing skin death that can happen if a tummy tuck is done on a smoker, a patient with multiple abdominal scars, or is perhaps done too tightly. It is caused by inadequate blood flow to keep the skin alive.

If this happens, it can cause very delayed healing for months because the tissue is under tension and wants to pull away from the area of necrosis rather than closing in rapidly as would happen in other wounds. This is a very rare complication in properly chosen tummy tuck patients.

Necrosis after Tummy Tuck unlikely to happen

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Hello msmartha,

Necrosis refers to actual loss of tissue due to lack of blood supply. That is extremely unusual and mostly happens in a smoker or a diabetic patient. A major infection would be another reason for necrosis. We ask anyone who smokes to refrain from any form of nicotine for at least one month prior to and after surgery.

It is not uncommon to have some crusting or small open areas, but actual tissue necrosis would be very rare. Bring it up during your consultation and ask your doctor about his/her particular thoughts.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 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.