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The following list of potential complications is not all-inclusive; however, it does include all the general and specific key issues that should be considered and understood.
Whenever someone is having an anaesthetic, no matter what it’s for, then things can potentially go wrong. That is why no surgery should be considered “minor”. Of course, whilst the chances of the following potential problems occurring are extremely small, you still need to know about then:
All these potential problems are standard for any operation, although some operations and some patients have an increased risk of developing them.
It is essential that you discuss your medical and surgical history, which includes your allergies, medications, lifestyle, physical and mental health, motivations and smoking history with your surgeon. These considerations can impact your surgery, anaesthetic and post-operative care. Failing to disclose your full medical history could potentially increase your risk of complications.
Tummy Tucks are invasive surgeries that involve long scars and a large raw surface area under the skin that must heal.
Every operation has the potential for wound healing problems. The larger the wounds, the larger the potential for problems. This includes wound bleeding, infections, wound breakdown and tissue necrosis. Tissue necrosis is where healthy tissue dies. These issues vary in severity and can warrant further surgery or hospital treatment.
With a Tummy Tuck, the wounds are obviously very large, so these risks are much greater compared to surgery with smaller wounds.
The patients at greatest risk of potential complications are:
For people who are otherwise healthy and are taking the correct precautions, the risk of wound issues is very small.
People often think that with a Tummy Tuck the surgeon creates a new belly button. This is not the case, you keep your original belly button! However, you do end up with a scar around and within your belly button.
However, like all wound healing, the belly button needs a healthy blood supply to ensure it stays alive!
During the surgery, the original belly button remains attached to the underlying abdominal wall muscles via a stalk of connective tissue. It is through this stalk that the delicate blood supply to the belly button is keeping the skin alive. If the surgery results in too much tension, then the belly button blood supply could be cut off and it will die off. This will result in a belly button that ulcerates, and you end up with a scar where the belly button should be.
Patients at high risk of developing this problem include:
Seroma is a well-known potential complication of Tummy Tucks. Dr Dona would generally quote an incidence of 5% of people may experience a seroma. Seromas refers to a collection of fluid under the abdominal wall skin. This typically manifests during one of your regular early follow up appointments where your belly essentially feels like a water bottle with a slushy feel. However, in some cases when the fluid is under tension it feels tight and firm.
These are not considered a major complication but more of a hassle to you. If it occurs, we will organise for you to undergo an ultrasound and the doctor doing it will insert a needle and drain the fluid.
The need to undergo an ultrasound and have the fluid drained often requires repeating, sometimes multiple times, until it eventually dries up.
On the rare occasion, further surgery may be required to remove a chronic seroma.
It does not compromise long term results, although it can be a slight inconvenience.
Swelling after Tummy Tuck is to be expected, especially since the surgery is very extensive. The most obvious swelling is experienced in the weeks after the Tummy Tuck and typically subsides after a couple of months. Although mild swelling in the abdominal region is common, for a while after the procedure as the body continues to heal. The swelling will also fluctuate in severity, with some days more noticeable than others.
Swelling is a completely normal response to an injury, which is why most swelling will be located near the incision sites. When you undergo the Tummy Tuck procedure, the blood supply of the surgical area and the lymphatic system (responsible for the draining of fluid) are affected. As the body repairs these, swelling begins to gradually resolve.
A compression garment will be provided during the first six weeks to assist with the swelling. We also recommend you perform gentle daily massage to these areas starting a few weeks after surgery to help control the swelling and facilitate the settling process.
Abdominal wall numbness will happen after a Tummy Tuck (Abdominoplasty).
All women that have had a caesarean will notice that the belly above the scar, typically has a dull or numb feeling. The scar from a Tummy Tuck is much larger than that of a caesarean, so the numbness covers a much greater area – above the full length of the scar and often extending above the level of the belly button. This odd feeling is quite noticeable initially, but over time it does improve, but never completely. So, expect permanently reduced sensation in this area.
This is not a clinically significant area. However, with the reduced sensation it is possible that you could injure that skin without knowing about it – such as burning your skin with a hot water bottle.
The reason why loss of sensation occurs is that the surgery involves lifting the skin and fatty tissue from the muscles to allow it to be moved down for the excess to be removed. In doing so, the small nerves that run from the muscle to the skin are by necessity divided to allow this to happen.
In addition to this, some people may experience some numbness or even pain down the front and outer aspect of their thighs. This will occur in small percentage of people as the nerve that supplies this area runs immediately deep to the outer aspect of the wounds on each side. So, any possible irritation or disturbance to this nerve (often due to the sutures used to close the wound), can cause this sensory disturbance. This typically resolves after a few months, but on the rare occasion it can be permanent.
The Tummy Tuck procedure is designed to comprehensively tighten the abdominal area by eliminating excess skin and addressing abdominal muscle issues. However, in cases where patients have extensive skin laxity in other regions of the trunk, lingering looseness may persist post-Tummy Tuck.
This occurrence is often observed in individuals who have undergone massive weight loss, leading to excess skin and residual fatty tissue extending around to the back. During the Tummy Tuck, the segment of skin requiring excision is determined, resulting in a surgical scar. Since this scar must terminate somewhere, it typically extends along the sides towards the back. Consequently, areas beyond the scar may retain some degree of looseness. With the front aspect improved, attention may naturally shift to the sides and back, prompting consideration for additional surgery to address excess skin in these regions, often necessitating a two-stage lower body lift.
Another cause for loose skin after a Tummy Tuck, is when a surgeon has removed a wedge-shaped segment of skin and at the end of the scar on either side, the skin and fatty tissue can sometimes bulge out – this is often referred to as a ‘dog ear’. While this can be somewhat inevitable and occasionally dramatic, if the issue persists significantly, further contouring surgery may be recommended.
Lastly, there are individuals who aspire to have absolutely no skin sagging post-Tummy Tuck, viewing even the slightest excess as a setback. However, it’s important to note that even individuals with a slender physique exhibit some degree of skin gathering in the abdominal area when bending forward, making complete elimination of skin sagging an unrealistic expectation.
Irregular scars at the end of Tummy Tuck incisions are referred to as ‘dog ears’. They are raised areas of skin which abnormally bulges out and creates an unusual contour. This scar abnormality can largely be avoided at the time of surgery by careful incision planning.
A dog ear typically occurs when the surgeon has not made the scar long enough, therefore, the angle of the segment of excised tissue is too large. In other words, the surgeon has tried to make the scar too short, so when they stitch you back up, the apex of the scar area bulges forward. This is the classical dog ear.
These irregular folds often settle after several months, however they sometimes don’t. If the abnormality is very small and minor, it can often be removed with a minor surgical procedure under local anaesthetic. However, for a large dog ear the correction is more involved and will require revisional surgery.
Dr Dona believes that contours and aesthetics should not be sacrificed in attempting to make the scar a little shorter. Not only does this potentially cause ‘dog ears’, but it may also cause unsightly creases along the lower abdominal wall. This is because the length of skin of the upper abdominal skin flap will be much longer than the lower length of skin and will require significant ‘pleating’ to make it fit. Small creases seen immediately after surgery almost always resolve but large creases along the lower abdomen often don’t.
It’s not uncommon for a Tummy Tuck (Abdominoplasty) patient to require further surgery to “fine tune” the results.
Dr Dona often uses dressmaking as an analogy for many surgical procedures following massive weight loss. This simplistic analogy of a complex operation is used to help the patient understand the relevant scars required for these operations and the potential for further ‘revision’ surgery.
Of course, a Tummy Tuck surgery many times more complex than any dressmaking. The skin and tissues are not static and rigid objects. They swell, they stretch, they shrink, they sag etc. In addition to this, the underlying body is also changing.
So as a surgeon Dr Dona needs to reconstruct and reshape everything that’s 3D and not static, whilst at the same time making sure that he does not push things too far and make it too tight. The risk of wounds not healing and complications arising is always the major concern and dictates what can and can’t (or shouldn’t) be done.
So, with all this in mind, after everything settles and swelling starts to settle and things “relax” into position, it’s normal for things to be nowhere near as tight as they initially were. Given this, it’s not uncommon for patients to require further surgery to “fine tune” the results, just like you would for a second fitting of a tailor-made dress.
Therefore, you should not undertake any surgery if you’re not prepared or willing to have further surgery, and the potential time off and costs involved.
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1300 DR DONA (1300 37 3662) – ((02) 8805 7600)
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