Symptoms of Skin Necrosis After Tummy Tuck?

Its been three weeks since I had a Tummy tuck and I started smoking again but I was wodering what are the signs of skin necrosis?

Doctor Answers 9


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So you've decided to spend all this time and money on a tummy tuck and now decide to risk it all just to smoke. BRILLIANT!! Wow that's about the most foolish thing I've heard in a while. But I guess you didn't smoke the night of surgery. STOP SMOKING PERMANENTLY!! A dead, black skin flap or belly button not to mention heart and lung disease isn't worth it. And don't use nicotine patches or gum because they also cause the vasoconstriction problems that will kill the tissue.

Black dead skin

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Skin necrosis after Tummy Tuck

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My colleagues and I think you are REALLY missing the point.

Nicotine consumption (smoking, inhaling someone else's, chewing, patch efc) causes narrowing of blood vessels providing essential oxygen to the cut areas held together by stitches. Were the flow of oxygen to be reduced or stopped, as is seen with smoking, the healing process begins to derail. In the LEAST, your wound will not heal properly, the scar will widen and be ugly. But in many cases, the tissue which is most distant from the blood supply, in tummy tucks the area over the privates extending to the belly button, begins to die.

This is seen as a bluish discoloration which begins to slowly look mottled and eventually becomes extremely bruised and dark. As noted by one of my colleagues, the whole area will have to be removed surgically because gangrene sets in. With no effective blood flow, bacteria multiply and then can invade the normal skin areas causing a life threatening infection. By the way, none of the subsequent surgeries will be paid by insurance and you will be totally responsible for them.

The cosmetic result is poor.

The reason why most Plastic surgeons feel so passionately about this is that while some complications cannot be prevented, this one is TOTALLY preventable. Don't do it.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Do I have necrosis?

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in general if you have to ask, you don't have it. it is not subtle. having said that even if you "got away ' without complications this time, smoking in general but especially in the perioperative period is simply poor judgement. if your addiction is too powerful, seek professional help. good luck.

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon

Necrosis can be complication following tummy tuck.

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Tissue necrosis is a well known complication of abdominoplasty. This complication occurs when tissue has inadequate blood supply and subsequently dies.The area that’s most vulnerable to this type of problem lies directly above the abdominal incision.This is the point that blood has the furthest to travel.
Skin necrosis initially presents as skin discoloration which progresses from a light pink to a dark purple color.Eventually the tissue turns black and becomes firm with the consistency of leather.In some cases, areas of necrosis can become secondarily infected.
When patients undergo abdominoplasty, the skin and fat are elevated away from the underlying abdominal muscles.This means that blood has to pass through a flap that consist of fat and skin to reach the incision site.Anything that compromises this blood supply can result in tissue necrosis.
Several conditions have been associated with skin necrosis in abdominoplasty patients.These include diabetes, collagen vascular diseases, infection, tension on the wound closure and cigarette smoking.All of these conditions compromise the small blood vessels that flow through the abdominal skin flaps.This poor blood flow can result in tissue necrosis.
Once skin necrosis has occurred, treatment varies from patient to patient depending upon the severity of the problem.Many wounds require debridement, followed by dressing changes and eventual scar revision.In some cases necrotic tissue may become infected and antibiotics may be required as well.
By carefully evaluating patients in the pre-operative period, the incidence of this complication can be minimized but never totally eliminated.It’s important that patients stop smoking six weeks before and after surgery.

Smoking and Tummy Tuck

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Doctors in general do not like smoking due to health reasons. (Everyone knows about the detriment to your lung function, and the increased risk of cancer.) Plastic surgeons have another reason to dislike smoking - the decreased blood flow that it creates interferes with healing and can lead to surgical complications (healing problems, wide scars, fat necrosis, skin loss, etc.) This is partially dependent on your history of smoking (how much you smoke per day and how long you have been smoking), as well as if you are smoking around the time of the operation. If your stomach looks healed from the outside at 3 weeks, you must still consider that healing is going on in the inside. Fat has a less robust blood supply compared to the skin, and fat necrosis is still a possibility. You may end up with hard lumps under the skin near the incision, and sometimes these can even "work their way to the surface" as your body tries to get rid of non-living tissues. This will create a wound that will require some care to heal. With actual skin loss (necrosis) typically the skin becomes dry, firm, non-blanching (if you press on normal skin, the redness of the blood disappears for a second, and then returns. Necrotic skin does not have this color change.)

Don't take the chance! Quit smoking for good... (or as long as you can after surgery...)

Skin necrosis after tummy tuck?

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Necrosis is the medical term for death of tissue. The most common cause of tissue death following surgery is lack of blood supply. All of our bodily tissues require sufficient blood flow to keep it alive. During the course of surgery blood flow to the tissues involved is decreased to some degree. If the blood supply is decreased sufficiently the tissue at the end of the blood supply may die. Necrosis of the skin and fat can occur at the edges of a tummy tuck, breast lift, breast reduction or any other area where the skin and fat layer has been lifted off of the underlying layer. Cigarette smoking is known to decrease the blood supply in the skin and fat layer. If a wound is showing signs of necrosis it is important to stop smoking immediately.
Although it is unlikely at 3 weeks that necrosis would develop, it is possible. You would initially notice areas of redness in the area followed by a darker color to the skin ending with black skin. The skin and some of the underlying tissue would then slowly die leaving a wound that wouldn't need to heal itself over time. This healing process could take up to 3-4 months.

Signs of skin necrosis

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An area of marginal necrosis in the middle is not uncommon.  Blistering is the most common early sign.   This is the area that is the furthest away from the blood supply and under the most tension. These areas generally take about 4 - 6 weeks to fully heal. Many times the scar will look just fine and other times you may require a relatively simple scar revision. Simple wound care is all that is required at this time.

Try to cease from smoking and see your plastic surgeon ASAP!

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Although it is risky to continue to resume smoking following a tummy tuck procedure, I think you need to be honest and open with your plastic surgeon. I would inform he/she immediately as there are some simple steps that can be instituted to avoid poor wound healing, which may lead to skin necrosis and other complication. It is all about you, and you need to optimize your chances. Please make an appointment and discuss this soon as possible.

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.