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There have been several comments recently on one of my previous blog posts about swelling after a tummy tuck. Swelling is only one of the possible complications that can occur following a tummy tuck procedure. Other post-op abdominoplasty complications can be subdivided into a few major classifications: Infection, Wound Separation, and Fluid Collections (Hematoma and Seromas).
Infection after a tummy tuck
Most surgeons give patients pre-operative antibiotics so wound infection is not as big a problem as it used to be. Ask your surgeon if he will be giving you preoperative antibiotics and make sure you are not allergic!
Infections can be minor, such as a suture abscess. However, they can also be life threatening, like those of MRSA.
A suture abscess is typically not dangerous, and it’s caused by the body trying to dissolve away some of the absorbable sutures that are placed in the deep layers of tissue to hold the tissue together. It is easily taken care of by lancing the area under a local anesthetic, and packing the small puncture with a medicated gauze. Usually additional antibiotics are not needed unless the patient has fever and redness over an extended area.
With respect to MRSA, as a precaution I routinely ask patients if they, or anyone in their family, has had an episode of MRSA (Methcillin Resistant Staph Aureus). This can be a very dangerous infection after surgery. If the patient has a history of MRSA or exposure, we will do a swab culture of the nose (where MRSA frequently resides), and will give specific antibiotics against MRSA at the time of surgery.
Remedy: Taking active steps to prevent infection is the best remedy.
Wound separation after a tummy tuck
This looks dramatic to the patient, because the patient thinks that the separation is very deep. However, it is not, as the separation only goes to the muscle wall. Wounds can separate for the following reasons:
1) Excess skin tension if too much skin was taken out during the procedure. The best way to prevent this is for the surgeon to excise the skin in surgery not according to ‘the pre drawn pattern’, but by making sure the closure will be more than adequate well before the actual cutting is made!
2) The wound edge heals poorly because of poor blood supply. This is more common with techniques that elevate the skin all the way up to the skin margins.
The Lockwood technique that I use for the tummy tuck dissection is excellent because it does less undermining and preserves most of the blood supply.
Remedy: Small wound separations are easily taken care of by packing the wound with medicated gauze. Slightly larger wound separations, or those caused by tension, can be taken care of by a suction device called a “Vac Dressing” manufactured by KCI. Large wound separations caused by poor blood supply may need revision and re-approximation of the wound edges in a procedure room.
Fluid collections after a tummy tuck
Fluid collections are more common when there is a lot of space created between the abdominal skin and the underlying muscle. Fluid can easily accumulate in this space and complicate the healing process. For more detailed information, see my blog post about post operative tummy tuck swelling and seromas, Tummy Tucks and How To Reduce Swelling and Eliminate Fluid Collections.
In summary, the different type of fluid collections associated with tummy tucks are seroma and hematoma.
Seroma
A Seroma is a collection of wound fluid. It is mostly seen when the patient has a lot of activity in the post operative period or there is inadequate compression, and rarely happens when the Lockwood technique is used. It can easily be treated with a needle aspiration, but it is not unusual to have to do a series of aspirations spaced over a few days to take care of the problem.
Hematoma
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. It is usually caused by a small blood vessel that opens up in the recovery period, and can happen up to a few days after surgery. Most of the time it can be evacuated with a needle, but sometimes it may need a small intervention in a procedure room.
Remedy: The best remedy against fluid collections is prevention. I am a firm believer in the right kind of compression garment with shoulder straps to keep the garment well placed. Foam pads over areas of potential fluid accumulation also help a lot.
All in all, the Tummy Tuck is a very safe operation. However, you need to be aware of the risks and potential complications prior to any surgery. When you go into your pre-operative tummy tuck consultation be sure to ask your plastic surgeon about these possible complications and how he or she handles them when they occur. Most importantly, get a commitment that the surgeon will be available after surgery within a short time period should you experience any problems. I give all of my post op patients my cell phone number so I can communicate immediately if any problems or concerns arise. Be sure you know how to get answers to post op questions prior to your surgery.
Have a great Thanksgiving!
Ricardo L Rodriguez, MD
Board-Certified Plastic Surgeon
© Cosmeticsurg.net (permission to copy article or part of article provided this notice is included and proper attribution is given, including a link to the original source URL)
16 Comments
March 16, 2012 at 1:58 pm
Ethel:
I have answered your posts in the other places you posted questions. If you think we can help you contact us at kelly@cosmeticsurg.net
Hope this helps!
March 16, 2012 at 10:39 am
i have had smart lipo 8 months ago. have had burning, and pain every since. i thought i may have an ucler but was check. no i dont . the burning gets so bad some times it wakes me up. if i eat more than i should it feels like i am riping apart… whats the problem ????
January 19, 2012 at 6:51 pm
June:
Could be any number of things. The most common could be a retained suture.
You need to talk to your surgeon or a Plastic Surgeon where you live who can examine you.
January 18, 2012 at 11:55 pm
I had a tummy tuck in 2009 but in 2012 the insion site started to re open what’s going on?
January 8, 2012 at 3:42 pm
Lu:
Hope Jan 6 went well.
If you check out the girl on this blogpost she had a repair of the rectus diastasis going thru the umbilicus.
This procedure can be very useful for bodybuilders that had separated muscles after pregnancy without too much skin excess. That way they have NO SCAR except for the small scar around the belly button.
BTW, saw your pictures, and you are fantastic. You should be very proud of your accomplishments, with a family and profession in addition! Super Mom indeed!
December 26, 2011 at 3:50 pm
Dr. Rodriguez thank you again for all your help.
It’s funny you should say that because I already mentioned you to a few friends of mine that are fellow bodybuilding competitors. I’m sure you’ll be hearing from a few of them soon as they have a lot of questions before they dive in… Most of them are for breast augmentation and 2 regarding stretch marks along their thighs. I compete in the bikini as well as figure bodybuilding categories – this past october I qualified for the nationals in Canada. I will be competing in June 2012 at that level. That’s one of the reasons why I wanted to get my tummy tuck done. Bodybuilding and competing is really a hobby. My profession is Creative Director & Marketing Consultant in the field of advertising. Now that my husband and I have our two kids and no plans of having anymore, it was time to hit the stage and compete… but I did need to get my tummy taken care of. Both kids were 9 pounders and I’m really small so you can imagine the shape my tummy was in. After I had my daughter I went up to 165 lbs – my pre-baby weight was 120 lbs. So I decided to take a year to get rid of of the body fat and get back in shape. At my last show I was 117lbs and my transformation from the day I started has been amazing. Through clean eating, a strategic workout regimen and a lot of dedication even on days when I didn’t feel like it, I managed to get back into shape. I’m hoping I can compete this coming June. Hopefully this recovery doesn’t take more than it should so I can get back to my 300 plus lb leg presses etc LOL! I need at least 5 months to gain some more muscle and then lean out. But here I am December 26th 5 weeks post surgery and I can tell I still have fluids in my abdomen and feeling very tights on the lower part of my tummy —- I’m hoping he drains the remainder on Jan 6th even though he said last time there was not much in there…. Last time I asked him if I was on track to be released fully to exercise — he first said yes… and then I told him “By the way doc, you do realize I leg press 300-400 lbs and bench press 80-100 lbs right? because when you release me that’s the training I’ll be going back to..” He then paused and said wow I can’t leg press that much. Mrs. Diaz you’ll have to wait until I’m comfortable releasing you to do that.” —- Which indicates to me that he may not release me as scheduled…. Oh well — no turning back now. Recovery comes first. Thanks again Dr. Rodriguez. I will spread the word of your site to my friends. Check out this link of my competition pics on my facebook: https://www.facebook.com/media/set/?set=a.10150324540561643.346131.690686642&type=1&l=1b1619c831
December 25, 2011 at 11:50 am
Lu:
Closing it now would be a mistake. It needs to drain.
And yes, you need to see him again soon.
He is handling it right.
BTW Lu, if you appreciate what I have done just spread the word about my site to other people online and to your friends.
Merry Christmas!
December 20, 2011 at 11:12 am
Hello again Dr. Rodriguez. I visited my PS yesterday and he extracted 3 more syringes of old blood. My tummy looks flat now but it still feels tight. I noticed redness along one spot on my incision. I asked him about it and he put me back on antibiotics for a week. I woke up this morning to find yellowish liquid coming out of one small spot. I’m hoping I can see him again today. I spoke to his nurse and she said it was probably the infection coming out and to just wipe the area and keep it dry. I’m hoping I can see him so he can have a look at it. I’m wondering if he should be closing that particular spot later on by stitching it… it’s only about 3 cm. I’ll let you know what happens. Thank you for all your help.
December 20, 2011 at 9:27 am
Lu:
You need to get on the phone and call your Doctor and you need to talk to see him. Tell him you still have fluid and you want it aspirated. You do not want to wait until Jan 6 to see him.
You also need to be wearing compression 24/7.
Let me know what happens after you see him.
December 20, 2011 at 12:26 am
Thank you Doctor Rodriguez. To be honest with you, I failed myself by not digging deeper before my surgery. I’ve read a lot about the Lockwood technique and kick myself for not getting a surgeon that uses it. I would recommend to anyone that’s thinking about getting a TT to ensure they get a physician that practices it. I’m going to see my PS January 6th – hopefully I don’t need many more sessions. I’m hoping once the swelling goes down I will be able to stand up straight like before the surgery. My back is killing me and my PS told me to just stand up straight but I feel like my obliques are going to rip. I’m considering Lymphatic massages and stretching. I just don’t want to do any damage inside. Is there anything you can recommend that I could do at home to help? It’s been 4 weeks today since my surgery. Thanks again Dr. Rodriguez
December 19, 2011 at 10:21 pm
Lu:
It seems he is handling it appropriately. It may take several sessions to drain the hematoma completely. I would continue to wear a compression girdle continuously (day and night) until the problem is resolved.
I have not had this problem since I started using the Lockwood technique for abdominoplasty.
December 16, 2011 at 6:58 pm
Like all surgeries, there are dangers of complication afterwards even thought surgeons do their best in the OR to prevent this. Still, it is difficult to predict how a human’s body will react to certain types of surgeries, even when all the possibilities have been explored first.
December 16, 2011 at 11:57 am
Dr. Rodriguez –
Thank you for post above. I’ve been trying to find out if extracting hematoma fluids after a tummy tuck may require a few visits. I recently had a tummy tuck. I have a hematoma. My doctor told me to wait a few days for the liquid to soften up. I’ve been to see him 3 times now and the first time he extracted a little bit of fluids. The other two times he’s extracted a couple of larger syringes worth. My abdomen looks smaller but it seems like the fluids move down on the abdomen. He’s having me come in again… I’m wondering up to how many visits it may take to extract all fluids and is that safe… I’m worried the hematoma will get infected. I had surgery November 22 2011 and today is December 16th. So I’m 3 weeks post-op. Is there any information or recommendation you can give me regarding this? I can’t seem to find information regarding how “normal” it is for various sessions to be required to extract a hematoma via needle… your help would be greatly greatly appreciated. Thank you.
December 2, 2011 at 7:44 pm
I am so scared to any complications. I want a healthy body that’s why I manage to eat healthy foods and do daily exercises. Anyway, thanks for sharing those info above I have learned enough about the subject.
December 1, 2011 at 7:35 pm
Yolanda:
You should be getting an email from Kelly pretty soon.
As far as where the fat comes from it really depends on the individual patient. On some cases the patient benefits more from a tummy tuck, on others, liposuction only will do.
If you have a lot of stretch marks and a split muscle from pregnancy then a tummy tuck may be indicated.
I’m looking forward to seeing you!
November 26, 2011 at 4:51 pm
When getting a Brazilian Butt Lift i understand they take fat from one area and then purify it and then its distributed accordingly to the buttocks. However, if fat is taken from back all the way up to bra line and love handles, plus upper and lower abs can this fat be taken by liposuction? or do u have to get a tummy tuck? and actually be cut and have that lower abdominal scar? what is better? i left a vm message and am interested in procedure please contact me thanks!!