How Will a Second Pregnancy Affect Scar from Previous C-section?

Question

What will happen to my vertical scar during pregnancy and can I have an abdominoplasty during my next c-section? I had a child by c-section at 21 years old. Three months later I was diagnosed with ovarian cancer which left me with a vertical scar from the top of my pubic bone up past my belly button.
I am now 26 and my husband and I are now cleared to try for another baby. I have two questions.   Will the scar stretch and hurt? And two, can an abdominoplasty be performed during my c-section?

J. Timothy Katzen, MD, FACS · Answer

Hello sbw518. Congratulations on being cleared to try for another baby, and thank you for your questions regarding the impact of pregnancy on your existing vertical C-section scar, as well as the feasibility of having abdominoplasty during a future C-section.

Impact of Pregnancy on Existing Scar:

Stretching of the Scar: During pregnancy, your abdomen will stretch to accommodate the growing fetus. This stretching can affect your existing scar. While the scar tissue itself does not stretch in the same way as normal skin due to its less elastic nature, the surrounding skin will stretch, which might make the scar more pronounced or slightly altered in appearance.
Discomfort and Pain: Some women experience discomfort or pain around their C-section scars during subsequent pregnancies. This is due to the stretching and hormonal changes that affect skin sensitivity. However, the degree of discomfort varies from person to person.
Abdominoplasty During C-Section:

Feasibility: Generally, performing abdominoplasty (tummy tuck) at the time of a C-section is not recommended. Abdominoplasty is a major surgery that involves tightening the abdominal muscles and removing excess skin and fat. Combining it with a C-section significantly increases the risk of complications such as bleeding, infection, and prolonged recovery time.
Safety Concerns: The postpartum period is already demanding on your body, and the added stress of recovery from abdominoplasty could complicate or hinder your ability to recover and care for your newborn.
Timing: Most surgeons recommend waiting at least six months after delivery, or until after you’ve finished having children, to perform abdominoplasty. This waiting period allows your body to stabilize hormonally and physically, ensuring that the results of the abdominoplasty are more permanent and satisfying.
Recommendations:

Consult with Your OB/GYN and a Plastic Surgeon: Discuss your concerns and desires with both your obstetrician and a qualified plastic surgeon. They can provide personalized advice based on your health, previous surgical history, and your plans for future pregnancies.

Plan for Future: If you are considering abdominoplasty, planning the procedure after completing your family is advisable. This approach minimizes the need for potential revision surgeries due to further pregnancies.

Care for Your Scar: As you plan for another pregnancy, consider consulting a dermatologist or your surgeon for advice on managing your scar, possibly using topical treatments or silicone sheets to keep the skin as supple as possible.

It's wonderful to hear that you are moving forward with expanding your family, and taking these proactive steps will help you manage your health and expectations regarding your existing scar and future surgical options.

Best wishes for a healthy and joyful pregnancy ahead.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

Richard J. Bruneteau, MD · Answer

A lower
abdominal incision wouldn’t impact expansion of the abdomen during
pregnancy.Conversely the lower
abdominal scar wouldn’t be impacted by the pregnancy, unless the scar was immature.Under these circumstances, slight spread of
the scar might occur during pregnancy.Abdominoplasty isn’t recommended
immediately following a C-section for a variety of reasons.These include the inability to make aesthetic
judgements immediately following pregnancy, the mothers overall health status
and the demands of a newborn child on the mother.The timing of the surgery following
pregnancy is important and several issues should be considered before
proceeding with surgery.It takes time for
a new post pregnancy body to reach its new baseline following pregnancy and
during this transition it’s impossible to make aesthetic judgements.During this period, stretched skin may
contract, a swollen uterus may shrink and the weight gained during pregnancy
may gradually disappear.This process
takes 3-6 months and needs to occur before abdominoplasty is performed.Ideally, patients should be within
10% of their ideal body weight and in good health otherwise.The majority of women who have undergone C-sections
aren’t in good physical shape and are therefore not optimal candidates for
surgery for a variety of reasons.These
may include severe fatigue, a depressed immune system, possible blood loss, an
increased potential for infection, and elevated estrogen levels which can
increase the risk of blood clots.Finally, the demands of a newborn
would make the recovery from these combined procedures very difficult.For instance, the use of post-operative pain
medications would prevent breast feeding. In other words, the abdominoplasty might
impact your developing relationship with your newborn child.For all these reasons, it’s obvious
that C-section and abdominoplasty shouldn’t be performed together.If you’re considering abdominoplasty it’s
important to give yourself time to fully recover from your C-section.Once this has occurred it’s appropriate to
consult a board certified plastic surgeon.

Otto Joseph Placik, MD · Answer

This is controversial and while some surgeons may be willing to perform this, the vast majority, in my opinion would prefer to defer this for a minimum of 4 months following successful healing and cessation of nursing.

David Shafer, MD, FACS · Answer

During your pregnancy, your scar may stretch or widen, but will not lengthen. You look like a great candidate for abdominoplasty which will likely be able to remove almost, if not all, of your vertical scar. It would be best to do your abdominoplasty at a seperate time from your c-section. I just feel that you will acheive much better results that way. Good luck.

Jeffrey Zwiren, MD · Answer

Looking at you photos you would be a good candidate for an abdominoplasty. Liposuction alone will not get rid of the excess skin and fat.  A complete examination would be needed to determine if you are a good candidate for this elective procedure.

Kris M. Reddy, MD, FACS · Answer

As you are actively considering having another child, it would be wise to wait 6 months to a year post  pregnancy or post breast feeding (if you breast feed).

Pat Pazmino, MD, FACS · Answer

A woman's body undergoes significant changes with pregnancy. If you have had a vertical section scar, a second pregnancy should not alter significantly. After your pregnancies, you would be an excellent candidate for a tummy to answer the complete removal of this vertical scar. During your tummy tux surgery, this vertical scar will be replaced by a horizontal scar that is positioned very low underneath your panty line.

	To learn more about tummy tucks, see photos, and help you decide which one is best for you, please visit us at the link below:

Steven Wallach, MD · Answer

The scar may stretch a bit. Performing a tummy tuck at the same time as a c-section is not indicated and could be dangerous. You want to wait for the body to "go back to normal" after the pregnancy. You should allow the tissues to heal and the baby weight to come off before performing a tummy tuck. Usually 6 months to a year later.

Bahram Ghaderi, MD · Answer

Your scar will not change due to the pregnancy. You appear to be a great candidate for a tummy tuck after you are done having children. The tummy tuck should remove most if not all of your vertical scar. However, I would not do the tummy tuck at the time of your c-section. It is not advisable due to the risks involved for you and also your attention should be solely on your new baby. I do agree with the other surgeon who advised you to avoid your OB doing any kind of cosmetic procedure at the time of your c-section. That may sound attractive but allow your body to heal from the delivery for 6mo or longer - specially if you breast feed. Once all your tissues have return to a stable state, then seek out a board certified plastic surgeon for a consultation regarding a tummy tuck. That will give you the safest, and best outcome possible.

Richard P. Rand, MD, FACS (retired) · Answer

Your scars won't change significantly from being pregnant again. It would not be wise to do a tummy tuck at the time of delivering a child.  First of all, it increases the risks to your life unnecessarily.  Secondly, your tissues need to shrink after delivery to know exactly how much should be removed during a tummy tuck.  I would wait at least 6-9 months after delivery and make sure this is your last child before proceeding.
You have an excellent abdomen for a great result when the time is right!  Make sure you go to an excellent Board Certified Plastic Surgeon for your care.  To my amazement, there are OB-Gyn doctors who try to do tummy tucks on their patients rather than referring them to a plastic surgeon.  They should never do this as they have no training in this surgery and the results are never as good.

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