Complications with Tummy Tucks

Complications with Tummy Tucks

As part of my responsibility to maintain my medical licenses, memberships in the ASPS (American Society of Plastic Surgeons) and ASAPS (American Society for Aesthetic Plastic Surgery) and to remain a board-certified plastic surgeon with special interest in cosmetic surgery (Diplomat of The American Board of Plastic Surgery), I have to take a number of continuing medical education courses. Recently, I took a course about abdominoplasty that summarized the latest information the cosmetic plastic surgery field has developed about tummy tuck procedures.
Some of the innovations I am already using, some I have moved forward from and others I will be implementing into my practice following a large number of surgical studies that point the way. In general, obesity, diabetes, hypertension, smoking and a history of blood clots or other medical problems will lead to more complications after a tummy tuck. Make sure you discuss these with your cosmetic plastic surgeon. Life-threatening complications are very rare but do occur.

Complications in tummy tucks patients

Seroma
A fluid buildup under the skin occurs in 6% to 14% of patients.
Drains placed at the time of surgery should be used to remove this fluid, unless the plastic surgeon uses the more recent technique of tension sutures.

Infection

Infection occurs in 2% to 7% of abdominoplasty patients and is usually minor and limited.
The risk for skin infection is increased by:

  • Having a BMI over 30 (obesity) – decreasing weight naturally by dieting before surgery decreases your risk; weight loss surgery actually leads to an increased complication rate
  • Smoking
  • An operating time greater than 2.5 hours
  • A vertical and horizontal incision (Fleur-de-Lis incision)

One dose of antibiotics is now recommended just before surgery. There is no further need for antibiotics for a week after surgery.

 

 

Deep vein thrombosis (DVT), clots in the leg veins/Pulmonary embolism (PE), clots in the lungs

 

These occur in less than 2% of patients but can be serious, life-threatening complications.
Tummy tuck patients at greatest risk may have to be treated with Lovenox (a blood thinner) prophylactically, at the risk of increased bleeding from the wound. Compression of the legs by using pneumatic machines during surgery can help prevent DVT and PE.
Patients at risk are those:

  • With obesity
  • With a previous history of DVT
  • Aged over 60
  • On oral contraceptives
  • Not walking after surgery

Pain

Though not a complication but rather a side effect of tummy tuck surgery, there are new advances in discomfort management.

Injecting long-acting anesthetic medications (such as Bupivicaine) at the time of surgery decreases pain. Taking anti-inflammatory meds, such as Celebrex  (but NOT ibuprofen, etc.), also helps and leads to faster recovery and less stomach upset. Taking Valium along with other medications also leads to faster recovery in my experience. Using pain pumps using constant local anesthesia has not been shown to be better than other techniques.

Satisfaction and scars

Patients who have abdominoplasty and liposuction at the same time are happy with their results more often.
A low horizontal scar over the pubic area is better than a W-shaped scar as it can be better hidden.
Revisions of abdominoplasty scars occur in 13% to 40% of patients.
Discussing the risks of abdominoplasty and your previous medical history with your plastic surgeon is important for your understanding of tummy tuck surgery and to allow your surgeon to plan the best technique for you.