I have a Cholesycstectomy scar (kocher) and would love to have an abdominoplasty, as I have lost 10 stones in weight and have lots of excess skin. I realize that this scar may cause problems, although it is 19 years old and never caused me any trouble. Please, could you tell me what my options might be? Many thanks.
Abdominoplasty for Old Cholesystectomy Scar and Excess Skin?
Doctor Answers 4
How would an old-fashioned Gall Bladder (Kocher) Scar influence Tummy Tuck Choices?
Congratulations on the 140 pound weight loss.
You bring up a very vexing question. One with which you are obviously familiar but many of the others reading these posts are not. For their benefit, I will first explain how scar placements affect subsequent abdominal contouring procedures, especially abdominoplasties.
The blood (and with it the oxygen) flow to the tummy skin normally come from three discrete sources. First, from branches of the groin (Femoral) arteries. From perforating artery branches going up through the tummy muscles that look like a tree or chad (from the superior and inferior epigastric arteries) and fin-all the continuing branches of the arteries thatt run under our lower ribs (subcostal arteries).
When a traditional tummy tuck incision is made across the lower tummy, we routinely see and cauterize the superficial branches of the groin (Femoral) arteries. As the process continues and the skin is lifted all the way up to the rib cage, all the perforating branches are cauterized. This leaves ONLY the terminal branches of the subcostal vessels to supply the raised tummy skin.
ANY hindrance to the blood flow through the tummy skin at this point MAY result in death of the most distant part of the elevated tummy skin. A gallbladder removal scar (Subcostal aka Kocher scar) has divided some of the branches that would go to supply the right side of the flap. While the vessels MAY HAVE created a bypass around the scar in 19 years, I personally would not bet on it. A similar scenario is seen with smokers in whom these vessels are chronically in spasm and as a result the blood flow distally is compromised. Poor results with tummy tucks in smokers are therefore common.
In addition, in your case, we need to consider if you may require a Fleur de Lis (IE a VERTICAL) scar as well to remove as much tummy skin as possible. Such a scar would, in turn, remove the negligible amount of blood flow across the midline further assuring healing issues with the distal tummy skin and incision.
YOUR OPTIONS are:
1. A REVERSE abdominoplasty - the scar is placed across the upper torso under the breasts. It WILL remove the old Kocher scar and the flow through it is based on the branches from the groin arteries.
2. A Standard abdominoplasty with a high scar - The transverse scar is placed high enough that the Old Kocher scar (and the scar blockage to blood flow distally) is removed. But the scar will be visible.
3. Limited undermining Abdominoplasty - A tummy tuck is done with limited undermining trying to preserve as many perforators as possible. However, in patients who lost 140 pounds, this procedure is less likely to give great flat results, in my opinion.
Depending on your actual exam and your preference, either of the first two choices may be applicable.
Peter A Aldea, MD, FACS
Abdominoplasty and cholecsytectomy scar
Congratulations on your weight loss.
The scar from your gall bladder surgery does change the blood supply in the area. An abdominoplasty may still be possible with some modifications of the "typical" technique.
It may be possible to still do an abdominoplasty with the trade-off of a higher scar than is typical.
There is an operation called a "reverse abdominoplasty" which may be an option.
With the amount of weight you have lost please seek a consultation with a member of ASAPS or ASPS who is experienced in surgery after weight loss. There are a number of factors to consider to optimize your results and safety.
Abdominoplasty with Old Abdominal Scarring
Congratulations on your fantastic weight loss Although there is some interference with normal blood supply with your scar, it was long enough ago that you can probably undergo a TT relatively safely, sinc there should be a far amount of collateral circulation at this time.
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