Potential Post-Operative Abdominoplasty Risks and Complications

According to the American Society of Plastic Surgeons (ASPS), more than 129,000 abdominoplasty procedures were performed in the US last year. This figure represents an increase of more than 2,000 abdominoplasties since 2016. Abdominoplasty ( ) made the 5th place in the 2017 top 5 cosmetic surgical procedures in America (1). Abdominoplasty is very popular following pregnancy and massive weight loss because it significantly improves the appearance of saggy skin. It is typically recommended for patients who want to get rid of the excess skin, fat around the abdomen and having their belly button fixed all in one procedure. When performed by an experienced and highly trained plastic surgeon, the abdominoplasty will result in flatter, firmer abdominal contour with narrower waistline that wouldn’t be achieved by liposuction procedures only.

As with every surgery, there are some risks associated with abdominoplasty such as swelling, infection, wound separation and fluid collections (seromas and hematomas), among others (2). Long term complications after abdominoplasty might include: scarring (since the incision scar from a tummy tuck is permanent and some patients scar more than others); tissue necrosis (depending on the size of the area, tissue might heal on its own within weeks or require a surgical touch-up procedure); and changes in skin sensation. During a tummy tuck, the repositioning of your abdominal tissues can affect superficial sensory nerves in the abdominal area, and infrequently, in the upper thighs. Patients will likely feel some reduced sensation or numbness. This usually diminishes in the months after the procedure, but it might be also permanent. However, most complications can be treated appropriately by a highly trained and skilled plastic surgeon, following the current standards, with satisfactory and aesthetically pleasing results.

Common side effects experienced by abdominoplasty patients include redness, bruising, and swelling. These effects usually subside in one to three weeks as your body adjusts to the new contours and the incisions heal. When walking or standing, keep in a bent position. You may start increasing your movements and straighten up gradually, but there should be no strenuous activity for three weeks after your tummy tuck surgery. Wearing your compression garment as directed reduces the likelihood of loose or sagging skin after an abdominoplasty, and also helps to control swelling, resulting in a shorter recovery period (3).

Infection is another possible complication that can occur after abdominoplasty. Usually, plastic surgeons prescribe patients antibiotics during their final pre-operative visit to prevent wound infection. It is important that patients make sure they are not allergic to the antibiotics prescribed by their surgeons. Oral temperature over 100.4 degrees, yellowish or greenish drainage from the incisions and/or foul odor are among the indicators of a possible infection. Abdominoplasty patients should avoid tub soaking while sutures or drains are in place. It's typically recommended to avoid swimming or being in a bath tub when patients have wounds that are still open since these wounds can get infected caused by Vibrio bacteria. A suture abscess is typically not dangerous and it’s easily taken care of by lancing the area under a local anesthetic, and packing the small puncture with a medicated gauze. However, infections can also be life threatening, like those of MRSA (Methicillin Resistant Staph Aureus). Medical conditions like diabetes and/or obesity (with a Body Mass Index higher than 30) increase the risk of complications such as infections, if the diabetes is not controlled adequately. It’s always best for patients to contact their plastic surgeon promptly if they have any sign of infection.

Wound separation can also be a possible complication after an abdominoplasty. Excess skin tension if too much skin was taking out during the procedure can cause the wound to separate. Small wound separations are easily taken care of by packing the wound with medicated gauze. Large wound separations caused by poor blood supply may need revision and re-approximation of the wound edges in a procedure room. In any case, it is highly recommended for patients to schedule an in-person visit to get the wound treated promptly and prevent further complications such as getting the wound infected or extending the recovery period. For procedures that involve long incisions, such as abdominoplasty, it is ideal to achieve a Body Mass Index of less than 30 to minimize the risks of complications, such as wound dehiscence and infection.

Seromas and hematomas are also among the possible complications after a tummy tuck procedure. A seroma is a collection of wound fluid. Sometimes it occurs when patients do not wear the compression garment adequately or he/she has a lot of activity in the post-operative period. These complications can cause swelling, pain and bruising after surgery. Most seromas heal naturally since they are usually reabsorbed into the body within a month. In more severe cases, it can take up to a year for them to be reabsorbed, or they can form a capsule and remain until they are removed surgically. Depending on the severity, a seroma may have to be drained more than once. Heat can be applied to the area to help the seromas heal more quickly. A heating pad or hot compress can be applied for about 15 minutes every few hours. Doing so would help with fluid drainage while providing additional comfort to the incision area. However, if the area is sore, warm, red, or swollen, it is highly recommended consulting with your plastic surgeon promptly. Seromas can increase the chances of a surgical site infection, so it is important to monitor them carefully. For its part, a hematoma is a collection of blood in the dead space. It usually needs to be evacuated because it can be painful, can lead to infection or cause excessive scarring. Although seromas and hematomas can be easily treated with a needle aspiration, the best remedy against fluid collections is prevention. The proper use of compression garments and foam pads (Topifoam pads) over areas of potential fluid accumulation are significantly beneficial to prevent these post-operative complications.

References:

(1) “2017 Plastic Surgery Statistics Report” American Society of Plastic Surgeons. www.plasticsurgery.org/documents/News/Statistics/2017/plastic-surgery-statistics-full-report-2017.pdf

(2) “What are the risks of tummy tuck surgery?” American Society of Plastic Surgeons. www.plasticsurgery.org/

(3) Managing Complications in Abdominoplasty: A Literature Review. National Center for Biotechnology Information, US National Library of Medicine. www.ncbi.nlm.nih.gov/pmc/articles/PMC5621815/