Tummy Tuck Complications
Most of today’s pitfalls in plastic surgery are a result of prospective patients not doing their homework to select the right facility or plastic surgeon. Serious complications in cosmetic surgery are rare in the hands of competent board certified plastic surgeons because plastic surgery does not have anything to do with the internal organs; it just deals with the skin and the supporting muscles. Most serious complications are a result of anesthesia or infections, the latter which are usually curable with antibiotics. However, the greatest problems with results of a tummy tuck are that the results are not what the patient expected mostly because of the resulting scar, its location, or its appearance. This section will help you avoid the most common pitfalls associated with a tummy tuck.
The Diagnosis: Select A Qualified Surgeon to Obtain an Accurate Diagnosis
If you visit a physician who does not routinely do all the procedures surrounding a tummy tuck, the diagnosis will usually be one of the procedures that they know. A double board certified plastic surgeon with board certifications in general surgery and plastic surgery is usually the most qualified surgeon for tummy tuck surgery. The reason is because sometimes this surgery involves the unexpected repair of a hernia which is not commonly performed by plastic surgeons that do not also have experience or board certification in general surgery. Any medical doctor is allowed to do a tummy tuck whether they are board certified in preventive medicine, dermatology, or emergency medicine. Today, many doctors performing surgery have no board certifications in any type of surgery. This phenomenon is a consequence of doctor incomes dropping because insurance companies and HMO’s have dramatically reduced reimbursements. The most common pitfall in this area is with liposuction. Laser companies are advertising their products with misleading names like slim laser, cool laser, or smart laser and selling these to any physician who wants to buy one. If you have a liposuction procedure instead of a tummy tuck, when a tummy tuck is needed, you will be highly disappointed because after the procedure, your skin will be even looser than before surgery.
Select the Correct Procedure
In the section, Are You a Candidate, we describe the 6 different variations in this procedure. If you select the wrong one, you will not be happy with the results. Oftentimes, patients will select a less expensive option in order to save money but to do something to solve part of the problem. For example, if you need a full abdominoplasty with muscle repair and you select a mini tuck instead, you are wasting your money. You are better off doing nothing and waiting until you have saved up for the procedure. Furthermore, there are great variances in recuperation based upon the procedure you select. Don’t expect to be attending your Yoga classes after a week if you have a major muscle repair. There are more complications with tummy tucks than in other plastic surgery procedure because when a muscle repair or hernia is included, it is the most invasive cosmetic surgery procedure. In these extreme cases, you should consider having the procedure done in a hospital rather than in an outpatient facility, particularly if you have any kind of health related problems.
Select an Accredited Surgical Facility
Most problems in surgery have to do with infections and emergencies related to anesthesia. Both of these possible problems are highly regulated by accreditation organizations that control the safety of outpatient facilities. An office surgery center that does not have checks and monitoring on infection control and emergency situations is a surgery center with an accident waiting to happen. Every year, patients die in unaccredited surgery centers because of deficient standards. Finally, you need to know who will be responsible for your anesthesia. Will it be a board certified anestheologist or a nurse anesthesist. Either one can do the job, but in the case of a problem, it’s better to have two doctors on the scene rather than a doctor and a nurse. If you feel uncomfortable with a nurse anesthesist, you should ask your surgeon if you could pay extra to have a board certified anestheologist put you under. In no circumstances should you ever have a tummy tuck without at least a board certified nurse anesthesist or anestheologist present.
Know Who Pays for Revisional Surgery
Generally, a surgeon will cover required corrections for approximately six months. However, that doesn’t normally include anesthesia or OR expenses. It’s Important for you to know exactly what is covered in a follow up procedure and how long this warranty will last. Some patients expect surgeons to cover them for two years or more but this is unrealistic because any necessary corrections will usually be obvious within 6-12 months. When it comes to scar revision, this cannot be done until the scar has healed completely.
Possible Risks & Complications
Results are never guaranteed. We all heal differently and a surgeon cannot predict exactly how you will heal. Surgeons are taught to perform surgeries in certain ways that normally produce certain results. That doesn’t mean that the results are always predictable!
There are risks and complications, some fairly common and others very rare, that you need to understand. Since tummyt tuck results are very personal, you need to weigh both sides, the benefits and the possible complications, and determine if a tummy tuck is in your best interest. Below are short explanations of these different risks. This list does not include less than optimal esthetic results or the possibility of revisional surgery. You need to discuss all these possible complications with the surgeon you select, knowing also that you will have to sign consent forms explaining that you understand all these risks.
You will have a scar following this procedure. The appearance, as well as the location of this scar is important. If you have a history of keloids in scarring (thick protruding scars), there is a high probability that your scar will not look nice following surgery. If your scars are smooth and fade to white after many years, you more than likely will not have a problem. After the scar has healed, a few surgeons suggest treatments with a fractional NdYag, CO2, or Erbium laser, in order to help blend the scar’s color in the surrounding skin. Some women have a vine tattooed around the scar in order to camouflage it.
Hematoma is bleeding under the skin after surgery. Just before and during surgery, a chemical called epinephrine is used to control your bleeding in the surgical area. By necessity, many small blood vessels will be cut during this procedure and following surgery, after your abdomen has been sewn back together, some of these capillaries will continue to bleed. Generally, they stop bleeding within 12 hours following surgery and this blood is either removed naturally from your body or through drains that your surgeon inserted during surgery. If it accumulates and begins to swell in an area, this is called a hematoma and your surgeon will have to intervene and drain this blood in a small secondary operation.
These happen rarely and when they happen they can be treated with antibiotics. However, untreated infections, especially those involving a hernia can be very dangerous and life threatening if not treated in time. Should you have swelling and or redness around the surgical area accompanied by a fever of over 100 degrees, contact your surgeon immediately.
It’s fairly common to have some accumulation of fluids in the surgical area underneath the skin following surgery. Your lymphatic system will usually drain this fluid over time. The time required for this to happen varies. Should there be pockets of fluid that do not drain naturally, your surgeon may either aspirate this fluid with a syringe or in the worst case scenario, be obliged to open the wound in a revisional procedure.
Poor Wound Healing or Separation
This can happen particularly to people who smoke, but otherwise is not so common. Wound separation in healthy people is usually caused by physical activity. In the recovery section of this site we address the limitations of physical activity to avoid wound separation.
Other than the skin that must be cut and removed (dermal excisions), there is also a possibility of additional skin loss around the wound if you smoke, are in poor health, or if the skin does not reattach itself properly to the tissue below that is supplying blood.
Blood clots are very uncommon but dangerous if they occur in larger blood vessels
Numbness or Tingling of the Skin
This also happens infrequently and usually goes away with time. This is caused by small nerves severed during the operation.
These are also less common, particularly if you have had anesthesia before without complications and you are being monitored in an accredited facility by a board certified anestheologist. Accredited facilities have the necessary emergency equipment to handle emergency situations effectively. If you have had allergic reactions to any kinds of anesthetic drugs in the past, you must explain this to your surgeon.
This involves fat that “dies” inside your body because it lost its blood supply. Usually this fat is absorbed by the body and discharged through the lymphatic system. Sometimes, it needs to be surgically removed.
This is an esthetic problem that is rare unless you have certain skin conditions that affect the melanin in your skin. Or, if you have darker skin, you will have a greater risk of discoloration as compared to someone with very pale skin.
The most common problem is the placement of the belly button in a full tummy tuck. If one side of the body heals differently than the other, it could pull the belly button away from the center line of your body. Asymmetry is also more common just above or below the scar when comparing the tissue on both sides of the body.
Cardiac and Pulmonary Complications & Deep Vein Thrombosis
These are very rare complications that can be fatal, particularly if the surgery is not in a hospital or an accredited outpatient facility where they have the necessary emergency equipment to handle these kinds of situations. If you have a history of heart problems your surgeon will either not operate on you or require that it be in a hospital.
There are just a few other possible risks and complications that you need to discuss with your surgeon. These are looseness of skin, pain, persistent swelling in the legs, and nerve damage.