Onset of necrosis after TT - timeline?

Question

Hello. How soon after a TT will a patient start seeing signs of necrosis (if there is one developing)? Would it be within days after TT? How long after TT is there no more risk of necrosis?

Ronald J. Edelson, MD · Answer

If you are going to experience skin necrosis after a tummy tuck it would likely be obvious just one day after surgery

Semih Yildiz, MD, FEPOBRAS · Answer

Skin or tissue necrosis after a tummy tuck most often declares itself in the first several days to first 1 to 2 weeks, when blood supply problems show up as increasing dusky, purple, gray, or black skin, blistering, wound separation, drainage, odor, or pain that is worsening instead of improving. Some skin may look bruised early, so the trend and an exam by the surgeon matter.

The risk is never zero at a fixed day, but if the incision and skin have good color, warmth, capillary refill, and are healing normally through the early postoperative period, the chance of new necrosis becomes much lower. If you see darkening skin, spreading redness, fever, bad odor, increasing swelling, drainage, or severe pain, contact your operating surgeon promptly or seek same-day care.

Ira H. Rex III, MD · Answer

Recognizing poor blood flow usually happens at the end of the tummy tuck or hours thereafter.  Necrosis technically would start later that day but often the severity and extent of necrosis is not obvious for 5-10 days, or even a bit longer.  If everything looks healthy within hours of the operation, then usually there is no concern about necrosis unless something else happens, like a hematoma or too much pressure from the binder, or putting ice on the flap, or starting to smoke.

Donovan Rosas, MD · Answer

Skin necrosis can occur after abdominoplasty if the blood supply to the skin flap is compromised. This can occur with over-dissection or aggressive upper abdominal liposuction.

Evidence of necrosis will become apparent in the early post operative period. Discoloration is an early sign which can eventually progress to tissue loss. Outside of the first few weeks, new onset skin necrosis is unlikely without outside insult (i.e. compression).

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Steve Laverson, MD, FACS · Answer

Hopefully, one does not see or experience skin necrosis after tummy tuck.  If one does, yes, it becomes apparent over the early post-surgical course, days and progressively by one to two weeks after surgery becomes more well defined.  By two weeks after abdominoplasty, if wound edges well approximated, pink, and alive, necrosis is unlikely.  Still, numbness of the abdominoplasty flap is important to be aware of.  Patients may not feel injurious stimuli, such as heat.  Avoid burning or otherwise injuring the numb skin which may result in necrosis later after abdominoplasty.

Matthew S. Kilgo, MD · Answer

Hello and thank you for your question.
Skin necrosis is a gradual process that occurs shortly after surgery. Initial signs include mottling of the skin that progresses over the following days to a deep purple hue. Eventually, with full thickness necrosis, the tissue becomes black and leathery consistent with an  eschar.  These changes typically occur within the first week or two after surgery.

Ram Kalus, MD, FACS · Answer

Thanks for your question. Usually we would see signs of necrosis within the first week. Occasionally, it may be a bit delayed and closer to two weeks, especially if the patient is a smoker or straightening and standing tall too soon. Hope that helps. Good luck.

James Knoetgen, III, MD · Answer

Hi! Great question — tissue necrosis is a known, though relatively uncommon, complication after a tummy tuck (TT) (abdominoplasty). Here's a breakdown of the typical timeline and risk period for necrosis:
When Does Necrosis Typically Start to Show?
•	Initial Signs of necrosis often become apparent within the first 3–7 days after surgery.
•	In some cases, it might take up to 2 weeks for full-thickness skin necrosis to declare itself.
•	Early clues may include:
o	Dusky or dark discoloration of the skin
o	Delayed wound healing or wound separation (dehiscence)
o	Foul odor or drainage from the incision
o	Hardened or cool tissue that doesn’t “pink up” with pressure
o	Increased pain, swelling, or redness around the incision (although these can also be normal early post-op)
When Is the Risk of Necrosis Mostly Past?
•	The critical window is the first 2–3 weeks post-op. Most cases of necrosis that are going to happen will occur in that window.
•	After about 3 weeks, if healing is progressing well and there's no compromised tissue, the risk of new-onset necrosis drops significantly.
•	Minor wound healing issues can still occur later (e.g., suture spitting, delayed wound closure), but true necrosis after the first month is extremely rare.
Higher Risk Factors Include:
•	Smoking (even 2–4 weeks pre/post-op)
•	Poor circulation or diabetes
•	Extensive tissue undermining
•	High tension on closures
•	Infection or hematoma formation
•	Large BMI or pre-existing skin compromise
•	High BMI or pre-existing skin compromise
Yes — if necrosis is going to occur, it almost always begins to show within the first 1–2 weeks after surgery. After the 3-week mark, the risk becomes very low, especially if the wound looks healthy and is healing well.

Camille Cash, MD · Answer

Necrosis can begin to appear as early as the first few days to weeks after surgery.  The risk goes down after the first six weeks.  In order to keep your risk low be sure to closely follow your surgeon's post op instructions and report any concerns as they are noticed.

Mark Eberbach, MD · Answer

Necrosis is caused by a lack of blood supply. The cause of this can be injury to blood vessels or more commonly excessive pressure or tension. The excessive tension can be caused by swelling or by inappropriate positioning, such as standing fully erect in the first several days to week. Pressure can be caused by a compression garment.

Nicotine is the greatest overall danger since even in a low tension well vascularized flap, nicotine can kill the tissue. Ice can as well.

The longest delay in necrosis developing I’ve seen is after a week of perfect healing when a patient decided to smoke a cigarette. It was devastating tissue turned dark overnight and took months to heal.

Good luck

Onset of necrosis after TT - timeline?

Answers (10)

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