Fat Necrosis After Tummy Tuck?

I am looking to get a tummy tuck in the next several months. A friend of mine had one several years ago, and had necrosis of her fat at the incision line. Eventually it healed on its own and she was left with a flat stomach. Is necrosis after a tummy tuck common? If so, how severe are most cases? Thank you. 

LadyMaryland

F, 44, Maryland

Fat necrosis is a known complication that can arise after abdominoplasty. Risks and side effects can occur as a result of any type of surgery, and should you decide to proceed with a tummy tuck your surgeon will explain the benefits and risks to you in detail so you’re well-informed prior to the procedure. And remember, you are always far less likely to experience any adverse side effects when you choose a plastic surgeon who is board-certified, and better, specializes in tummy tuck surgery.

Fat necrosis is the death of fat cells due to ischemia, a disruption of blood flow to the abdominal fat and skin. The risk of fat necrosis is elevated in patients who are smokers, diabetics, obese, or who have previous abdominal scars, as these can all diminish blood flow to the wound. If you identify with any of the above characteristics your surgeon can help you evaluate the risk and advise you on any necessary measures you need to take, such as ceasing smoking for four weeks both prior to surgery and postoperatively as well.

Fat necrosis can also occur after a tummy tuck surgery if the flap has been damaged, manipulated too aggressively,  or closed with excessive tension. This is one more reason why it’s so essential to seek a board-certified surgeon to perform your procedure.

Patients who experience fat necrosis following abdominoplasty will witness their skin next to the incision site turn black and scabby, with a lumpy or firm appearance beneath it. The symptoms often appear to be similar to those of an infection. In most cases of fat necrosis, the issue will clear up on its own so long as the overlying skin is alive and healthy, you maintain a healthy lifestyle, and the incision site is kept clean and protected.

The swelling and hard lumps should subside over a period of several months, although for some patients it can sometimes take up to a year for the condition to completely resolve. Some individuals require a small second surgical procedure to excise any remaining lumps. In rare but more serious cases where fat necrosis has delayed the healing of the wound and there is scar tissue, scar revision surgery may be required.

Fat necrosis can occur after a tummy tuck or any surgical procedure where fat is removed from the body or rearranged. It occurs because the blood supply to the fat cells is insufficient, causing the death of those fat cells and the subsequent release of fatty acids and chemicals. As these acids and chemicals are released, they provoke inflammation, swelling and in some cases, pain.

Fat necrosis presents as an area of darkness or blood-stained blister around the incision line, and is followed by a firmness or lump beneath the subcutaneous tissues of the lower abdomen. The lumpy texture beneath the skin feels doughy, but is seldom painful or tender. Many patients notice it and perceive to be a wound infection. It usually appears the 2nd-4th day after surgery, and can sometimes be followed by wound dehiscence (separation) or other issues which may delay the healing of the wound.

Most cases of fat necrosis do not pose any medical danger or threaten your results, but the complication can be an unpleasant experience and slow your rate of healing. The area will gradually soften over time, and usually doesn’t require revision surgery to address the issue as it will further delay your recovery. Patience is the best treatment for this particular complication, which usually subsides on its own over a period of several months. Some surgeons recommend their patients wait for 6-9 months to allow as much of the necrotic tissue to soften and decrease in size before they carry out an excision of any remaining lumps.

It’s highly unlikely you will experience fat necrosis if you observe all of your surgeon's pre and post-op recommendations, such as ceasing smoking prior to surgery. The risk posed by smoking is real and well documented in medical literature. It can increase the likelihood of fat necrosis occurring because nicotine is a vasoconstrictor which inhibits oxygen from reaching the wound site. Wounds require oxygen for fast healing. The risk of fat necrosis can also be elevated in people who have diabetes.

If you’re still interested in undergoing a tummy tuck, ensure you find a board-certified plastic surgeon. A highly experienced surgeon can help you achieve beautiful results and decrease the possibility of any complications such as fat necrosis from occurring.

Necrosis after a tummy tuck does happen, but fortunately it is not common when performed by an experienced surgeon.  It is more common in diabetics and smokers.  When it does happen, it usually heals with proper wound care.  On some occasions, a secondary procedure is necessary to revise the affected area.

Dr. Gary Breslow has 16 Tummytuck before & afters:

Tummytuck before image performed by Dr. Gary D. BreslowTummytuck after image performed by Dr. Gary D. BreslowTummytuck before image performed by Dr. Gary D. BreslowTummytuck after image performed by Dr. Gary D. BreslowTummytuck before image performed by Dr. Gary D. BreslowTummytuck after image performed by Dr. Gary D. BreslowTummytuck before image performed by Dr. Gary D. BreslowTummytuck after image performed by Dr. Gary D. Breslow

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