I have this scar on my lower right chest. Can I have abdominoplasty? (Photo)

You've posed an excellent and challenging question. Your rib graft was removed using a Kocker-style incision, typically employed for open gallbladder removal. The reason behind this specific incision isn't significant; what matters is the presence of a blood vessel beneath it. This vessel is one of the two major ones that supply blood to the abdominal skin after tummy tuck surgery. In a tummy tuck surgery, 2 of the 4 major blood vessels to the abdominal skin are cut by the incision of the lower abdomen. Therefore, the 2 blood vessels coming in from the upper abdomen provide all the blood supply to the abdominal skin after a tummy tuck.

In your situation, it's possible that a 3rd blood vessel was lost due to the incision under your rib. Hypothetically, this would leave only one functioning blood vessel. However, over time, collateral blood flow typically develops, and other blood vessels compensate for the lost ones. Nonetheless, without performing blood vessel imaging studies, it's impossible to confirm this with absolute certainty. These studies can be costly and invasive, so they're unlikely to be conducted before elective procedures like a tummy tuck.

Throughout my career, I've performed five full tummy tucks on patients with a Kocker incision like yours. All of them required diastasis recti repair. I tailored the surgeries by ensuring the preservation of small collateral vessels from the sides, and minimizing dissection whenever feasible. Fortunately, all five patients experienced smooth recoveries without complications. In one of the patients, I was more concerned before the surgery, and I performed a delay surgery. A delay surgery means that about 4 weeks before the actual tummy tuck, we went to the operating room, and both lower abdominal blood vessels were cut through small incisions. Nothing else was done. By doing so, I created the blood flow conditions of a tummy tuck, without doing anything else to damage blood flow to the abdominal skin. The skin then had 4 weeks to strengthen its collateral blood supply before the actual tummy tuck surgery, further lowering the risks.

This was a very long answer, but I hope you find it helpful.

Dr. B

Thank you for your question. Having an old scar from a previous rib graft doesn’t exclude you from being a good candidate for a tummy tuck. However, as blood vessels are essential for proper healing and tissue viability, there may be concerns during tummy tucks if the rib graft scar is located near where the blood vessels supply the abdominal skin. It is therefore difficult to prove without imaging testing. Patients with comparable scars have been treated with tummy tucks by some surgeons. They limit dissection, maintain collateral vessels, and take preventative measures; reports of successful recoveries have been made. In the end, trust the expertise and judgment of your surgeon and leave him to choose the proper choice for you after his assessment.

Thank you for your question. Having an old scar from a previous rib graft doesn’t exclude you from being a good candidate for a tummy tuck. However, as blood vessels are essential for proper healing and tissue viability, there may be concerns during tummy tucks if the rib graft scar is located near where the blood vessels supply the abdominal skin. It is therefore difficult to prove without imaging testing. Patients with comparable scars have been treated with tummy tucks by some surgeons. They limit dissection, maintain collateral vessels, and take preventative measures; reports of successful recoveries have been made. In the end, trust the expertise and judgment of your surgeon and leave him to choose the proper choice for you after his assessment.