Skin Necrosis after a Tummy Tuck (TT)

I answer a lot of questions on Realself.com and a question I have seen many times concerns tummy tuck necrosis which is the dying of live skin cells, following a tummy tuck. It is very important to know that this complication occurs occasionally to every plastic surgeon, no matter how careful he is. As I was once taught and it is very true: the only surgeons who do not get complications with this don’t operate or they lie (courtesy of Dr. John Guy, one of the better surgeons that I trained with many years ago).

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What causes skin necrosis after a TT ?

This is always due to an insufficient blood supply. It is much more common in smokers or nicotine users. I insist all of my patients refrain from all nicotine products (including cigarettes, patches, gum etc) for 3 weeks before and after surgery. Diabetics are also more likely to have decreased circulation after a TT to the distal flaps of tissue. An extremely tight garment that interferes with the blood supply can contribute to this.

However, most of the time when it occurs, it just happens, and there is no obvious reason. I had a female patients many years ago who placed a very hot pad on her abdomen for menstrual cramps and gave herself a 3rd degree burn, which caused skin loss – but this is a very unusual case.

Where does the skin loss occur?

Almost always, the skin loss occurs at the farthest point of the flap, where the blood supply is the weakest. This is at the lower abdominal incision, usually close to the middle of the incision or at the T-junction if there is a small vertical part of the scar.

Skin Necrosis Treatment

This will depend on the size of the area and how it looks. This will require frequent visits to the plastic surgeon or a wound healing center. If the area is fairly small, local wound care is usually all that is needed, plus lots of patience. The area will usually go black, lift off and then heal fine. Sometimes the scar will need to be revised in the office at a much later date. The final result is usually excellent but you need to have a lot of patience since you cannot rush the process.

In some cases, you may need to pack the wound or use special vacuum suction to speed up the healing.

Have more questions or concerns about the tummy tuck procedure? Please call my office at 703-406-2444 to schedule a complimentary, private consultation with me.