Can necrosis after a tummy tuck occur because to much skin was removed above the belly button pulling skin too tight? (Photos)

Question

During my tummy tuck I feel too much skin was, removed, too aggressive lipo in the abdominal area was done. Necrosis has occurred above my pubic line. When I removed the tape that was, on the incision line right above the pubic line my skin just came off with it. Now I'm having fluid leaking out my belly button when my doctor just checked me for fluid a day and a half ago and said I had none.

Frank Agullo, MD · Answer

Necrosis can occur after a tummy tuck due to the factors you mentioned and a few others:- Too much skin was removed resulting in tightness- Too much liposuction at the same time- Aggressive undermining- Poor circulation due to previous scars or liposuction

Ven Erella, MD · Answer

Thank you for your question. Sorry for the complication.  Necrosis can happen after TT because of vascular compromise and especially with upper abdomen Lipo if it is done aggressively. Now you need good local wound care and it will heal with time. Please continue to follow with your PS

Erika Sato, MD, FACS · Answer

Necrosis is always a possibility with a tummy tuck especially if there is aggressive liposuction above the umbilicus. It is very popular and has become the standard to do liposculpture during a tummy tuck. Necrosis occurs because there is a low blood flow state to that area of skin, and that skin dies. Other things that increase the risk of necrosis is smoking or nicotine use and other co-morbidities. Once there is necrosis the tissue can get infected and leak fluid. This does not mean there is a fluid collection that needs drained. It means the tissue is producing the fluid. You will eventually need that area debrided. Stay in close contact with your PS and all things will heal up just fine.  Any scar tissue present can be cut out after one year when you have given everything time to fully heal and remodel.

Tom J. Pousti, MD · Answer

I am sorry that you are experiencing this complication. Although you are asking a good question, the answer is likely more complicated than what can be communicated here. Generally speaking, there may be many different reasons why a patient will develop tissue necrosis,  not necessarily related to either surgeon or patient "fault".  On the other hand, there are some causes of necrosis that may be "surgeon related" (for example excessive excision or tension upon closure and/or excessive liposuction)  or patient related (for example use of nicotine products).In my opinion, the most important “factor” involved  with successful treatment of the complication will be close follow-up with your plastic surgeon (or seek to follow with another surgeon in your area).   He/she will be able to monitor for signs of infection and decide whether or not removal of unhealthy tissue and/or removal of exposed sutures is indicated.
 You will likely find that  dressing changes may be necessary for a period of time. The open wound  should go on to heal over the course of  several weeks.  However, sometimes, depending on the final appearance of the scar, scar revision surgery may be helpful. Also, concentrate on a well-balanced ( good protein source) diet  and avoid nicotine in all its forms.  Best wishes.For more specific/relevant information best to address your question directly to your plastic surgeon. Best wishes.

David E. Berman, MD (retired) · Answer

The most important factor is nicotine. Nicotine use definitely increases the risk of skin necrosis by a huge amount. All smokers should stop smoking (any nicotine use such as patches etc) for at least 3 weeks before and after surgery, ideally 6 weeks. if you are a non-smoker, you can still get skin necrosis. any plastic surgeon, who does a lot of TT is going to occasionally have problems like this. it is impossible to always know why it happened. it takes a lot of time and good wound care to get you healed, so you need to be patient. your final result will be good, but you may need a scar revision. however, the priority now is to get healed. He may refer you to a wound healing clinic.david berman md

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