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

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

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.

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.