Abdominoplasty Surgery Risks and Complications

Anyone considering surgery should approach the decision with a healthy amount of respect and caution especially when the surgery is elective (or planned) and is non essential surgery (as aesthetic or cosmetic surgery generally is). All surgical procedures have limitations in terms achievable outcome and it is important that your expectations match what is possible through surgery. The choice to go ahead with surgery is always (or should always be) taken after due consideration of the risk benefit balance for the procedure. Although the majority of patients do not experience problems, it is important that you fully understand all the potential risks and complications of abdominoplasty surgery. It is important that you take the time to read over them again prior to your next consultation.

Scarring

All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and deeper tissues. Scars may be unattractive and of different color than surrounding skin. Scar appearance may also vary within the same scar, exhibit contour variations or “bunching” due to the amount of excess skin. Scars may be asymmetrical (appear different between right and left side of the body). Scars can appear thick, red and raised all or part of the way along the incision line (a hypertrophic scar) or more rarely can involve tissues beyond the incision itself (and can resemble a badly healed burn). This is known as a keloid scar. Additionally, scars can tether to underlying structures or become abnormally pigmented or can stretch. It is possible that additional treatments, including further surgery, may be required for adverse scarring.

Bleeding

It is possible, though unusual, to experience a bleeding episode during or after surgery. Should post-operative bleeding occur, it may require an emergency treatment to drain the accumulated blood     or transfuse more blood (blood transfusion). Intra-operative blood transfusions may be required. Do not take any aspirin or anti-inflammatory medications for ten days before surgery, as this may increase the risk of bleeding. Non-prescription “herbs” and dietary supplements can increase the risk of surgical bleeding. Hematoma can occur at any time following injury. If blood transfusions are needed to treat blood loss, there is a risk of blood related infections such as hepatitis and the HIV (AIDS). Heparin medications that are used to prevent blood clots in veins can produce bleeding and decreased blood platelets.

Seroma

A seroma can be best thought of a collection of fluid beneath the skin at a surgical site. The composition of a seroma is much the same as that of blood but without the actual blood cells (it contains similar proteins and salts to blood) and is usually the result of lymphatic fluid accumulation (this is the 10% of the fluid that escapes from capillaries within tissues but does not return back to the veins via the small blood vessels but rather by the lymphatic drainage vessels) or by direct production from inflamed tissue (think of the tissues ‘sweating out’ the fluid). If this occurs there is the possibility it will need to be drained (often by simple aspiration with a needle or syringe, though in rarely can require a further operation to remove completely). If a seroma were to become infected it could form an abscess which could require further surgery to washout and drain.

Infection

Infection is unusual after surgery. Should an infection occur, treatment including antibiotics, hospitalization, or additional surgery may be necessary. There is a greater risk of infection when body contouring procedures are performed in conjunction with abdominal surgical procedures. Very rarely significant infections can occur which may be life threatening.

Skin Contour Irregularities

Contour and shape irregularities and depressions may occur after abdominoplasty. Visible and palpable wrinkling of skin can occur. Residual skin irregularities at the ends of the incisions or “dog ears” are always a possibility, as is skin pleating when there is excessive redundant skin. This may improve with time, or it can be surgically corrected. If liposuction is used in conjunction with your abdominoplasty procedure the risks of skin contour irregularities associated with this treatment are applicable.

Major Wound Separation

Wounds may separate after surgery.  Should this occur, additional treatment including surgery may be necessary.

Skin Discoloration / Swelling

Bruising and swelling normally occurs following abdominoplasty. The skin in or near the surgical site can appear either lighter or darker than surrounding skin. Although uncommon, swelling and skin discoloration may persist for long periods of time and, in rare situations, may be permanent.

Change in Sensation

It is common to experience diminished (or loss) of skin sensation in areas that have had surgery, like wise it is possible to develop nerve related pain within the area of surgery (neuropathic pain) and this may be temporary or permanent. It is not unusual for your abdomen to feel tight following an abdominoplasty (indeed the surgery is designed to tighten both the skin and the underlying structures) though some patients may find this sensation uncomfortable and persistent. Diminished (or complete loss of skin sensation) may not totally resolve after an abdominoplasty. The lateral cutaneous nerve of the thigh is a particular nerve that is encountered within the field of the surgery (it supplies sensation to the outer aspect of the thigh) and it can be subject to the problems described above.

Skin Sensitivity

Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually this resolve during healing, but in rare situations it may be chronic.

Sutures

Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation that requires removal.

Skin Necrosis

If the blood supply to the skin is insufficient following surgery (which can be for a variety of reasons) the skin, particularly at the incision site, can necrose (die). If this happens the skin will form an eschar (scab) which may need to be removed surgically. Dressings are likely to be required for a period of time and further surgery including skin grafting may be needed.

Delayed Healing

Wounds can break down following surgery (wound dehiscence) or after suture removal or may be slow to heal. If this occurs dressings may be required for a prolonged period of time (weeks to months) prior to wound healing and in occasional cases a further operation may be needed. Scar revision may be necessary in cases of delayed wound healing. Smokers have a greater risk of skin loss and wound healing complications.

Fat Necrosis

Fatty tissue found deep in the skin might die. This may produce areas of firmness within the skin. Additional surgery to remove areas of fat necrosis may be necessary. There is the possibility of contour irregularities in the skin that may result from fat necrosis.

Asymmetry

Everyone has a degree of asymmetry between right and left halves of the body. Sometimes certain asymmetries that were present, but less noticeable pre-operatively are revealed after abdominoplasty surgery. It is important to be aware of this possibility prior to undergoing surgery. Factors such as skin tone, fatty deposits, skeletal prominence, and muscle tone may contribute to normal asymmetry in body features. Regarding the scar, although every effort is taken to make the scar as symmetrical as possible, the scar is often slightly different each side. This too must be appreciated prior to undergoing surgery.

Umbilicus

Asymmetry of the position of the umbilicus on the abdominal wall may occur following surgery. Adverse scarring (as described above) can occur around the around the umbilicus following surgery. The blood supply to the umbilicus may be insufficient following lifting of the tummy skin off the abdominal wall during the procedure and if this were to occur the umbilicus could die and form a scab which may need to be removed under local anaesthetic. If, at the time of operation it is obvious that the blood supply to the umbilicus is insufficient it will be necessary to remove it from the abdominal wall and sew it in as a skin graft (this can only be determined at the time of the operation).

Abdominal Shape

Although abdominoplasty surgery will remove the excess skin from the abdominal region and tighten the abdominal muscles there is no guarantee that it will give you a flat tummy. Overall abdominal shape is governed not only by the skin but also by underlying muscle tone (for which you can do exercise to improve) and the amount of fat stored by the body inside the abdomen. At the suture line there may be a step off between the thin skin of the groin region (which has little in the way of subcutaneous fat) and the skin of the upper portion of the abdomen which has been moved down. This skin has a much greater thickness of underlying fat and whilst if liposuction has been included in the surgery it will help to reduce any mis-match there is no guarantee that a step off will not be present after surgery.

Mons Pubis

The mons pubis is the area covered by pubic hair, and often can sag following weight gain (and especially with subsequent weight loss). Mons position and shape can be improved by surgery but there is a limitation on what can be achieved both in terms of tissue tightness (as there is a risk of distortion of the labia) and tissue thinning (relating to degree of fullness of the mons area).

Pubic Distortion

It is possible, though unusual, for women to develop distortion of their labia and pubic area. Should this occur, additional treatment including surgery may be necessary.

Damage to Deeper Structures

There is the potential for injury to deeper structures including nerves, blood vessels, muscles, and bowel during abdominoplasty.  Injury to deeper structures may be temporary or permanent and may require further surgery.

Shock

In rare circumstances, your surgical procedure can cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even death. If surgical shock occurs, hospitalization and additional treatment would be necessary.

Persistent Swelling (Lymphedema)

Swelling in the lower portion of the abdomen or more rarely the legs can occur following abdominoplasty. This usually temporary and resolves with time and massage but it can be persistent and in some cases permanent.

Pain

You will experience pain after your surgery. Pain of varying intensity and duration may occur and persist after abdominoplasty. Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue after abdominoplasty.

Surgical Anaesthesia

 Both local and general anaesthesia involve risk. There is the possibility of complications, injury, and even death from all forms of surgical anesthesia or sedation

Unsatisfactory Result

Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained.  You may be disappointed with the results of abdominoplasty surgery.  This would include risks such as asymmetry, unsatisfactory or highly visible surgical scar location, unacceptable visible deformities, bunching and rippling in the skin near the suture lines or at the ends of the incisions (dog ears), poor healing, wound disruption, and loss of sensation. It may not be possible to correct or improve the effects of surgical scars. In some situations, it may not be possible to achieve optimal results with a single surgical procedure.  Additional surgery may be required to improve results.

Deep Venous Thrombosis, Cardiac and Pulmonary Complications

Surgery, especially longer procedures, may be associated with the formation of, or increase in, blood clots in the venous system. Pulmonary complications may occur secondarily to both blood clots (pulmonary emboli), fat deposits (fat emboli) or partial collapse of the lungs after general anesthesia. Pulmonary and fat emboli can be life- threatening or fatal in some circumstances. Air travel, inactivity and other conditions may increase the incidence of blood clots traveling to the lungs causing a major blood clot that may result in death. It is important to discuss with your physician any past history of blood clots, swollen legs or the use of estrogen or birth control pills that may contribute to this condition. Cardiac complications are a risk with any surgery and anesthesia, even in patients without symptoms. Should any of these complications occur, you may require hospitalization and additional treatment. If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately.

Recommendations around the time of surgery

  • Before surgery please shave pubic hair to a lower level if possible – this will help with the pre-operative markings as well as be needed for the surgery itself.
  • The night before surgery, and the morning of surgery, thoroughly clean your belly button, using cotton buds if necessary. This will reduce the risk of wound infections arising from your belly button.
  • Clothing to wear to hospital – we recommend you wear a button or zip top for ease and comfort (such as a tracksuit top).
  • Keeping your skin clean – we recommend regular washing before and after surgery with tea tree wash.
  • Post-operative garment – a supportive (but not tight) garment is highly recommended after surgery to speed up the resolution of any swelling. This should be worn for 6-weeks.
  • Abdominal discomfort – your abdomen will feel tight, and it may be uncomfortable to laugh, cough or sneeze initially. Therefore, support your abdomen with a pillow or your hand when laughing, coughing or sneezing to make it more comfortable.
  • Opening your bowels – we suggest taking a mild laxative for a week or two after surgery. This will ensure you do not have to strain when opening your bowels, which can be uncomfortable.
  • Sleeping – you will feel tight and will not be able to lie completely flat for 1-2 weeks after surgery. Therefore, we suggest putting a pillow under your knees and a couple of pillows under your head. Alternatively, a wedge (triangular) pillow can be very helpful in supporting your back and keeping your upper body at an angle whilst you sleep.
  • Sexual intercourse – please refrain from sexual intercourse for 2-3 weeks after surgery to minimise risks to your healing wound.
  • Looking after your dressings – your wounds will be dressed in brown tape that stays on for two weeks. You can shower with the dressings on, but please have your back to the shower hose, so the tapes don’t come off. It is essential that the dressings are dry prior to getting dressed – dab of excess water with a towel, then use a hair dryer on a cold setting to dry the tapes.
  • Post-operative follow-up – you will have a check up with the nurse one week after surgery, and then a further appointment for the removal of tapes at 2-weeks, as well as the trimming of any suture ends. Further follow-up appointments will be arranged subsequently.
  • Take things easy & slowly after surgery. Gentle pottering about, no heavy lifting.
  • You will be able to stand up straight by 2-weeks. Don’t try and push things before hand – it will gradually become easier.
  • After 6 weeks you can get back to normal exercise.
  • Scar management – this will be discussed with you at your 2-week post-operative appointment. Regular moisturizing and massage of your scars is important, and silicone gel can help ensure your scars settle down as quickly as possible.
  • Arnica – some people find using arnica cream or tablets very helpful for their bruising and swelling.

Further Reading about Abdominoplasty with Consultant Plastic Surgeon Anthony MacQuillan