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.

Yes you would be at extra risk of tissue necrosis. Your scar may be more favorable from what other patients have, but necrosis would be hard to predict. you may consider other procedures perhaps using upper full abdominal liposuction and lower abdominal skin excision.

Most often this situation is from a gallbladder removal when the did them open. I’ve done tummy tucks in several of these and never had a problem. I think the surgeon is playing it safe and informing you properly but the chance of necrosis is small

Since the scar is somewhat high and somewhat short, I think it would be safe to do a limited full tuck on you. The mini tuck would not be a problem and could tighten the lower abdomen well.

Hello; unfortunately, your scar is located quite poorly. If it was done by entering under the breast; it wouldn't cause any problems. This type of located scar is used in Classic Abdominoplasty; it has the potential to induce necrosis problems. In lipoabdominoplasty; since the subcutaneous tissue is loosened by liposuction; for diastasis repair; it is not a large skin elevation like in the Classic Tummy Tuck; it is sufficient to open up a tunnel about 6-7 cm. Therefore, I think you can have a surgery with Lipoabdominoplasty.

The scar that you have could put you at greater risk of healing complications as the blood supply to the abdomen may be more compromised due to your previous surgery (assuming an open gall bladder surgery). All of the surgeons it seems acknowledged the risk, it's just that there was a variety of opinions on if the risk was too great.

Hi, this is a great question! Any longer abdominal scars make an abdominoplasty more risky/ put skin at risk for necrosis. The scar is high and somewhat centrally located which are positive attributes. Based on this picture I would not absolutely deny you. A physical exam and discussion of risks and benefits with your surgeon is needed. Both you and your surgeon will need to outline and accept higher risk. There are also a couple precautions a surgeon can take to mitigate your risk, such as not performing abdominal liposuction simultaneously and not lifting the flap as much as usual. Hope this helps!

Will a scar cause problems with a TT.

There are studies now that show it should not be an issue relating to a TT. Older thinking suggested a problem. In some cases with a lower scar some dissection adjustments should be made.

In short, trust your surgeon with experience.