Abdominoplasty is considered a very effective plastic surgery for achieving an aesthetic ideal in the abdominal area. But along with a beautiful belly, the patient also receives scars remaining after the operation. Unfortunately, it is not possible to completely avoid scarring, since this type of intervention requires fairly large incisions and removal of a large amount of tissue. But it is within the power of the doctor and the patient to make postoperative marks as less noticeable as possible.
After abdominoplasty, tightening tissue, drainage, and muscle contractions lead to scars not healing under the most favorable conditions. To minimize the consequences, during abdominoplasty the sutures are made of specialized material. The surgeon also uses special suturing techniques.
How seams are formed
The formation of scar tissue is a natural reaction of the body to damage caused during surgery. Since abdominoplasty is an abdominal operation, it is impossible to avoid damage during surgical work. Tissues injured during the intervention force the body to launch an inflammatory response and begin producing collagen in the damaged areas.
At the moment of intense collagen production, a red, clearly visible mark is formed on the skin, rising above the level of the rest of the skin. Once the destroyed tissue begins to heal, the excess collagen gradually disappears over time. The formation of a new, normal scar begins, which will remain at the site of the incisions. If the abdominoplasty scar left a noticeable one, it means that the scarring process was disrupted for some reason (suppuration, strong tissue tension, hereditary predisposition, etc.).
Complications after breast reduction
Early complications of reduction mammoplasty
- Inflammation of the edges of the wound
- Abscess
- Generalized breast infection (fat necrosis)
- Dehiscence of wound edges
- Skin necrosis
- Bleeding/hematoma/seroma
- Necrosis of the nipple-areolar complex
- Thrombophlebitis
- Galactorrhea
- Mammary cancer
Early systemic complications (anesthesia complications)
- Atelectasis
- Pneumonia
- Heart problems
- Deep vein thrombosis (DVT)
- Pulmonary embolism (PE)
- Urinary retention/bladder infection
Late complications of reduction mammoplasty
- Changes in skin pigmentation
- Problematic scars (hypertrophic, keloid, wide normotrophic)
- Cysts
- Breast asymmetry
- Problems with the size, shape, contour or position of the nipple/areola
- Periodic breast enlargement
- Need for reoperation
- Dissatisfied patient
With all operations there can be complications, but with breast reduction the risk of complications is slightly higher, and this is due to the fact that in addition to the gland, in a large breast there is also a lot of fat, and during the operation the nipple-areolar complex moves over a long distance.
An overweight woman also has a higher risk of developing complications.
In any case, most complications that occur are minor and can be resolved without further surgery or hospitalization.
This article will review the most common potential early complications, both local (related to the surgical site) and systemic (affecting the body as a whole, and which can develop after any major surgery performed under general anesthesia).
I will also talk about late complications, which are serious problems that affect the appearance of the breasts in the long term.
Early complications of reduction mammoplasty
Inflammation of the edges of the wound
Any surgical incision can become infected. A wound infection is identified by the presence of redness, swelling, increased pain, and sometimes the leakage of pus from the incision site.
True wound infections are usually treated with oral antibiotics and sometimes require suture removal.
Redness and mild irritation in the area immediately around the stitches usually represents a skin reaction to the suture material rather than an infection. Antibiotic ointments can also cause redness and rash, and should be discontinued or replaced with a different ointment if a rash occurs.
True wound infections are rare in breast reduction surgery. More often we see an isolated area of wound dehiscence, which may occur as a result of infection around the internal suture or at the site of tension on the wound edges. This type of problem is almost always successfully treated with topical wound care. I recommend treating the skin with antibacterial soap twice a day, followed by antibiotic ointment and covering with a sterile towel.
Abscess
An abscess is a collection of infected fluid (pus) and dead tissue at the site of surgery. In the breast, an abscess usually manifests as redness, swelling, and increased pain. The patient often has a fever. The key to treating an abscess is opening it up and draining it, which in some cases can be done in a surgeon's office.
Draining a deep abscess is a more extensive operation that usually requires work in the operating room. Sometimes the abscess goes away on its own. After drainage, antibiotics are prescribed to treat any remaining infection.
Breasts are particularly susceptible to another problem called fat necrosis, which can resemble an abscess.
Generalized breast infection (fat necrosis)
General redness of the breast, increasing swelling, increasing pain and fever may indicate a serious infection of the entire breast. This is an extremely rare but very serious problem and you should seek immediate medical attention.
The term “fat necrosis” refers to the melting of fatty tissue that occurs after injury (for example, surgery).
Some women have a lot of fat in their breasts, while others have relatively little. Women with “fat breasts” have a higher likelihood of fat necrosis after breast surgery.
Fat necrosis is a particular problem in breast reduction surgery because large incisions are made through fatty tissue that already has a poor blood supply compared to other body tissues.
Fat with a borderline blood supply will appear normal to the surgeon during surgery, but after the breast incisions are closed and swelling increases, the borderline blood supply deteriorates. The affected fat tissue becomes inflamed and eventually dies. The fat cells themselves turn into a yellow, fatty liquid. The liquefied fat irritates the surrounding tissue, causing increased inflammation and setting the stage for dead tissue to become infected.
A patient with fat necrosis will experience local pain, redness, and swelling in the chest. Often only one breast is affected. Sometimes liquefied fat may leak out through the suture line.
Spontaneous wound drainage may be sudden and dramatic, but it also signals the beginning of improvement. Once the drainage process begins, pain and inflammation usually begin to subside. The discharge is most often a cloudy, fatty yellow fluid, but it can also be green or brown, especially if it is accompanied by an infection or blood.
The discharge may go away over several days or even weeks, but over time it tends to decrease.
I recommend that patients who have an area of fat necrosis insert absorbent pads with a waterproof backing (such as menstrual pads) into their bras.
In rare cases, the liquefied fat cannot escape through the line and appears as a soft red spot in the middle of the breast. In this situation, the surgeon may need to make a hole in the skin to allow the liquefied fat to escape.
Fat necrosis may present with fever, which usually resolves once the liquefied fat drains. Antibiotics are always prescribed for fat necrosis.
Small areas of fat necrosis may sometimes not drain, leaving hard areas inside the breast instead, especially in the nipple area. These hard areas eventually soften over a long period, usually many months.
If significant fat necrosis occurs in one breast and not in the other, permanent visible breast asymmetry may occur. Additional surgery may be required to restore symmetry.
Fat necrosis can also cause abnormalities seen on mammograms. Most of the time, these changes can be monitored with serial X-rays, but in rare cases, it is recommended to perform a breast biopsy of the problem area to rule out cancer.
Wound dehiscence
If breast incisions are sutured under tension, the edges of the skin may pull apart as breast swelling increases in the first few days. Dehiscence most often occurs under the breast at the T-junction.
Infection, fluid and blood accumulation, and fat necrosis can also create holes in the suture line. Small areas of wound dehiscence can be treated with dressing changes and wound care. Larger areas may require additional corrective surgery.
Fortunately, minor degrees of skin dehiscence usually heal well without any negative impact on the final appearance of the scar.
Skin necrosis
Skin necrosis refers to the loss of an area of skin due to poor blood supply or severe infection. Major skin loss after breast reduction surgery is rare.
Factors that may be responsible for significant skin necrosis include
- surgical intervention in a patient with a long history of smoking or a history of breast radiation (for example, for breast cancer);
- development of a large accumulation of blood (hematoma) inside the mammary gland after surgery;
- technical aspects of the surgical procedure (such as creating thin skin flaps or closing the wound under high tension).
Bleeding/hematoma/seroma
Excessive bleeding is rare after breast reduction. If bleeding does occur, it may be the result of a leaky blood vessel or two or a previously undiagnosed clotting problem.
Many methods have been developed to reduce bleeding during breast reduction surgery. However, the operation creates large wound surfaces inside the chest, and these surfaces ooze blood.
Most patients may have some minor bruising on the chest after surgery. Some patients may develop a buildup of blood inside the breast, which can lead to long-term swelling, pain, and hardness. This collection of blood is called a hematoma.
Small hematomas resolve over time and do not require treatment. Large hematomas require emptying in the operating room. Hematomas can appear both in patients who have drains installed during breast reduction surgery, and in those who do not have drains.
Some patients develop seromas, which are collections of fluid (serum) that ooze from cuts inside the breast after bleeding has stopped. Seromas are often absorbed by the body without requiring treatment, but sometimes they need to be drained. This can often be done in a dressing room.
Generalized, continuous bleeding after surgery may indicate a bleeding disorder. Surgeons strive to identify patients with potential bleeding disorders before surgery, but if bleeding is suspected during or after surgery, it must be evaluated and treated promptly.
Some medications impair blood clotting, so they should be avoided before surgery. Pregnancy and breastfeeding dramatically increase the blood supply to the mammary glands, so after giving birth and finishing breastfeeding, women should postpone elective breast surgery for several months.
Necrosis of the nipple-areolar complex
Fortunately, this is a very rare complication after breast reduction surgery. The risk of this complication increases with the length of the feeding pedicle of the nipple-areolar complex (NAC), i.e., the distance by which the NAC must be moved upward.
Nipple loss can also be the result of post-operative vascular obstruction in the breast, for example due to an overly tight bra. SAH necrosis might never occur if all patients had a free SAH graft, but a SAH left attached to the feeding pedicle appears more natural.
Marginal necrosis (loss limited to the edge) of the skin of the areola is quite common and can be treated locally.
Free SAH grafts and SAH grafts with a borderline blood supply may peel off. This is called superficial flaking, which means the top few layers of skin cells are lost. Ultimately, these nipple-areolar complexes heal very well and quickly.
If the nipple-areolar complex is excessively red after surgery, even purple in color, it can be saved by treating it locally with nitroglycerin ointment to increase blood flow. Nitroglycerin is a good vasodilator that improves blood flow. This medication may also be used by patients who have pain in the heart area (angina).
The amount of nitroglycerin ointment needed to improve blood flow to the nipple-areolar area is small, but even when used this medicine may cause headaches in some women. If survival of SAH remains in doubt despite the use of nitroglycerin, emergency surgery may be required.
In some cases, the surgeon will have to remove the SAH and replace it with a free graft, but sometimes releasing the sutures can relieve the compression on the SAH and keep it viable. After a while, stitches are applied.
If the blood supply to the NAC is inadequate for too long, the nipple tissues suffer irreversible damage and cannot be salvaged even after conversion to a free nipple graft. Therefore, it is critical that you notify your surgeon immediately if you notice a darkening or purple discoloration of the entire SAH or if you notice a loss of capillary refill.
If the nipple and areola cannot be saved, part of the underlying feeding pedicle is also likely to be lost. Dead (necrotic) tissue can be removed in the dressing room or operating room. The end result is slightly smaller breasts without SAH. Nipple reconstruction can be done after the scars have matured, which takes many months. Some breast asymmetry is likely.
Thrombophlebitis
Some patients develop a painful cord under the skin in the lower chest after surgery (superficial phlebitis). This cord represents an inflamed vein that may have a blood clot.
The cause of the formation may be a surgical bra or the operation itself. In any case, treatment consists of prescribing warm compresses and painkillers. Treatment may take weeks or months until the cord-like lump is completely resolved.
Galactorrhea
Women who were pregnant or breastfeeding for a year before breast reduction surgery may have residual breast milk inside their breasts.
These patients may experience a milky discharge from the nipple or through the suture line for a short time after surgery.
Mammary cancer
I think this could be a nightmare for every woman whose plastic surgeon discovers breast cancer during surgery. In fact, such a development of events is almost impossible.
I am not aware of any cases of breast reduction patients being diagnosed with breast cancer during surgery. All breast reduction patients undergo a comprehensive examination in advance.
Before surgery, a breast examination is performed, which includes checking for signs of cancer, and most women have a mammogram or breast ultrasound before surgery. However, it is very rare that breast cancer may be found during breast reduction.
If the surgeon finds a suspicious area, a piece of tissue will be sent to the laboratory for immediate examination. If cancer is diagnosed, the incisions will be sutured and surgery will be stopped.
The patient will be referred to appropriate specialists for further examination and treatment.
Sometimes cancer is not obvious to the plastic surgeon and is discovered by a pathologist when examining removed breast tissue. In this case, the patient will also be referred to appropriate specialists.
Early systemic complications (anesthesia complications)
General anesthesia and local anesthesia with sedation are performed millions of times a year without incident to help patients undergo surgery comfortably.
General anesthesia should only be administered by well-trained doctors (anesthesiologists) and nurses (anesthetists). Some plastic surgeons use local anesthesia with intravenous sedation during breast reduction surgery.
Anesthetic complications are rare and are rare in healthy patients. Complications that can occur range from minor (nausea or sore throat from the breathing tube) to serious (heart attack or seizures) and devastating (stroke or death).
This article does not cover every possible complication of surgery, but it does discuss the most common ones.
I have no hesitation in recommending surgery under general anesthesia to any patient.
Lung problems
Atelectasis
Atelectasis refers to the collapse of the alveoli in the lungs and is quite common in patients undergoing general anesthesia. Atelectasis is one of the common causes of fever in the first days after general anesthesia, but is much less common in young healthy patients. Prevention and treatment include deep breathing and early physical activity after surgery.
Pneumonia
Untreated atelectasis or pre-existing breathing problems can lead to pneumonia, which is a lung infection. Pneumonia rarely occurs after breast reduction surgery.
Heart problems
Cardiac complications during surgery are extremely rare in healthy patients, and women with heart disease can often have surgery under general anesthesia if they have been properly assessed and prepared.
During anesthesia, abnormal heart rhythms (arrhythmias) or insufficient blood flow to the heart (ischemia) may occur.
Anesthesiologists are trained to deal with these problems. A patient who has a serious cardiac “event” during surgery may subsequently be transferred to the cardiac care unit and evaluated by a cardiologist.
Problems with blood vessels and clotting
deep vein thrombosis (DVT)
A blood clot in a deep vein of the leg is a serious problem, and if you have a history of DVT, you are at risk of recurrence.
Deep vein clots cause swelling in the legs, but more importantly, they can break off and remain in the lungs. Other factors that increase the risk of DVT and pulmonary embolism (see below) include the use of contraception, hormone replacement therapy, a family history of thrombosis or embolism, a genetic predisposition to bleeding disorders, and any swelling or other signs of insufficient function of the veins in the legs .
pulmonary embolism (PE)
Blood clots that travel to the heart and become lodged in the blood vessels of the lungs are called pulmonary emboli.
Pulmonary embolism can be fatal. If you have a history of DVT or PE, you should notify your surgeon before surgery. Preventive measures can be taken to minimize the risk of any of the complications.
Treatment for DVT and PE usually includes blood thinners, but in general, patients taking blood thinners should not undergo major elective surgery such as breast reduction unless they temporarily stop taking blood thinners.
A patient with a history of DVT or PE who cannot take anticoagulants or must stop taking them may be a candidate to have a filter placed in the large vein leading to the heart (inferior vena cava), which prevents blood clots from traveling to the lungs.
Urinary retention/bladder infection
Some patients have difficulty emptying their bladder after general anesthesia, especially when large volumes of fluid are given intravenously.
Temporary urinary retention is treated by installing a urinary catheter for a short time. In rare cases, women with persistent problems will need a catheter installed for a longer period of time.
A woman may develop a bladder infection if she has difficulty emptying her bladder or if she requires a catheter. I generally do not ask nurses to place urinary catheters on my patients to minimize the risk of infection.
However, if your surgeon expects the operation to last more than three hours, you may need to have a catheter inserted to avoid over-distension of the bladder and to allow the anesthesiologist to monitor fluid balance.
Bladder infections are treated with antibiotics. Tell your surgeon in advance if you are prone to problems emptying your bladder or have had infections.
Late complications of reduction mammoplasty
Changes in skin pigmentation
Scars from breast reduction surgery will always be a different color from the surrounding skin, regardless of the woman's natural skin type.
Pigment loss is a particular problem for dark-skinned women. Partial loss of pigment may be observed in the nipples and areolas, especially in the presence of marginal necrosis. Loss of pigment in the nipple and areola occurs in 100% of free SAH transplants and may be permanent.
Nipple tattooing to restore color is an option for women who are concerned about pigmentation changes.
Problematic scars
Sometimes a woman will develop welts on her breasts that are red, raised, and painful. These are hypertrophic scars and are most common in young, usually fair-skinned patients. However, they can occur in patients with any skin type.
Hypertrophic scars usually improve over time, but there are a number of treatments that can improve particularly troublesome scars.
Surgical exploration is usually futile, although if the hypertrophic scar is the result of infection or delayed healing, surgical excision and closure may be required.
Other treatment options include local steroid injections, silicone patches, gels, creams, laser treatments, and radiation therapy.
Keloid scars are more common in younger patients. Keloids are thick, cauliflower-shaped scars that grow beyond the original incision.
Keloids may be confused with the more common raised, red, hypertrophic scars that remain at the incision line.
Like hypertrophic scars, keloids can be painful or itchy. Keloids can be described as a scar in which the healing process is “on” and never “off.” True keloids should never be treated with surgery alone as they may recur in a more severe form.
Injectable steroids and/or radiation therapy may be helpful alone or in combination with surgical excision. Keloids are difficult to treat and impossible to control. Fortunately, they rarely develop after breast reduction surgery.
A patient with a personal or family history of keloids should discuss this issue in detail with her surgeon, who can help her assess her risk of developing keloid scars after breast reduction.
After surgery, the weight of the breast puts pressure on the scars under the breast. Prolonged healing in this area is common. Often this delayed healing has little effect on the appearance of the scar in the long term, but sometimes the scar under the breast expands excessively and can cause noticeable discoloration in the area.
The surgeon can adjust this scar to improve its appearance, but most patients are not too concerned about scarring in this relatively hidden area.
Sometimes the scars are visible outside the breast. This problem can be resolved with additional minor surgical correction to reorient the visible portion of the scar.
Cysts
When forming the feeding stalk of the SAH, a thin layer of the epidermis is separated from this stalk. This process is called deepithelialization (deepidermization).
This de-epithelialization leaves tiny islands of epidermis inside the breast, and sometimes these islands form cysts, similar to the skin cysts that people develop due to acne or similar problems. These cysts can become inflamed and fester. Treatment requires opening such a cyst, draining it and prescribing antibiotics.
Breast asymmetry
Slight asymmetry in the size, shape or position of the nipples between the mammary glands is common, even in normal conditions.
If a woman develops a complication such as fat necrosis in one breast, she may end up with a significant discrepancy in breast size or shape.
Additional surgery will likely be required to correct this problem, but this is usually delayed until the tissue has completely healed and softened.
Problems with breast shape
No surgeon can guarantee a perfect result or a specific cup size, and you may well notice some features of your new breasts that you would like to change. This does not mean that you have a complication.
However, there are some undesirable results that can usually be corrected with additional surgery.
- Size
Your breasts may be much larger or smaller (may vary by two or more bra cup sizes) than you expected.
Perhaps for technical or medical reasons the surgeon was unable to achieve your goal, or perhaps you developed a complication such as fat necrosis, causing one or both breasts to become too small. You and your surgeon may not have a clear understanding of your target size. Breasts that are still too large after the swelling has subsided can be further reduced. Breasts that are too small usually require breast implants to increase volume.
- Form
Irregularities in shape may result from complications such as fat necrosis. Undesirable contours may also develop due to the force of gravity on the breast, especially the nipple pedicle, especially in patients with poor skin elasticity.
Excess breast tissue, fat or skin is quite common at the ends of a horizontal incision (called "dog ears") or along a vertical incision in vertical mammoplasty. Many of these problems can be corrected with surgery if they do not go away within six months to a year.
Problems with the size, shape, contour or position of the nipple/areola
If the diameters of the areolas are not the same after surgery, they can usually be evened out by reducing the larger side. If the SAH is severely off-center of the areola (keep in mind that some asymmetry is common even in breasts that have never had surgery), minor surgery may improve or correct the problem.
Some women have huge areolas before surgery, and it is not always possible to remove all the excess pigmented skin. These patients will have some residual pigmentation along the vertical scar between the nipple and the crease under the breast. For patients who are concerned about this persistent pigmentation, it is possible to remove the remaining darker skin after the breast scars have matured.
The SAH is in a good position when it is positioned correctly in relation to the main part of the breast, the crease under the breast and the opposite SAH. If the SAH is too high in relation to the breast and crease, it can be lowered surgically, but usually at the cost of creating a new scar on the breast skin above the nipple.
If the SAH is in the correct position in relation to the fold, but the breast tissue has sagged underneath, this problem can be corrected with minor adjustments.
An asymmetrical location of the SAH may require additional surgery, although keep in mind that this problem may not actually be a complication at all, but rather the result of an asymmetry between the two sides of the chest and shoulders.
Chest asymmetry may have been present preoperatively but was not noticed by the patient when her breasts were larger and the SACs were located lower on the chest.
Periodic breast enlargement
This is an undesirable phenomenon that is not a complication as such. Occasional enlargement must be distinguished from persistent oversize, in which the breasts are still too large after surgery.
Periodic enlargement is usually the result of constant hormonal stimulation, either during puberty, pregnancy, or the use of hormones.
Need for reoperation
There are two periods of time after breast reduction when you may need additional surgery.
First, you may need it early in the healing process if a serious complication develops. For example,
- one or both nipples may need to be converted to a free SAC graft,
- you may have heavy bleeding, or
- you may develop an infection or fat necrosis that needs to be corrected with surgery.
Fortunately, such serious complications are rare, and most complications that do occur are less serious and can be treated without surgery.
Second, you may have significant breast contour irregularities or a serious breast size discrepancy that will require another surgery to correct. Surgeries to correct these types of problems are usually delayed for six months to a year after the initial breast reduction until the scar has fully matured and the final contour of the breast can be assessed.
Secondary procedures may be performed under local anesthesia, or in some cases another general anesthesia may be required.
You should also find out what your activity restrictions will be after your revision surgery. In most cases they are minimal.
The choice is yours whether to have this corrective surgery or not. This unevenness may bother your surgeon more than it bothers you.
Likewise, you may be concerned about an abnormality that your surgeon believes is not significant and does not require correction. In such a situation, you are free to seek a second opinion from another plastic surgeon.
From a purely medical perspective, there is no "deadline" by which you need to have corrective surgery, although a period of six months to a year after the initial surgery and healing is usually required.
Dissatisfied patient
Dozens of studies have shown that the vast majority of breast reduction patients are satisfied that they had the surgery and that they chose to have it.
What about the minority?
In general, several statements can be made:
- Often, unsatisfied patients are those for whom the cosmetic aspects of surgery are more important than symptom relief.
- For every dissatisfied patient, there are many others who are satisfied with the same result.
- Dissatisfaction is often not the result of a serious complication.
- Patients who experience a major complication do not necessarily become dissatisfied with the final results of surgery, even if the results are suboptimal.
- Dissatisfaction is often the end result of poor communication between patient and surgeon.
- Dissatisfaction is more likely to develop in a patient who is not educated prior to surgery regarding what results she can expect.
- A patient with unrealistic expectations is more likely to be dissatisfied with the outcome of the surgery. For example, a woman with a very specific mental image of exactly what her breasts should look like is likely to be disappointed after surgery, especially if she was not fully aware of her desires or was unable to communicate them to her surgeon.
To maximize your chances of a satisfactory result, remember:
- Don't expect surgery to radically change your life, even though it will likely improve.
- Your results will not be perfect.
- You will have visible scars.
- No surgeon can guarantee future cup size. If you have a preference, tell your surgeon in advance.
- Complications are not uncommon with breast reduction surgery, but most are minor and do not significantly change the long-term outcome.
Undesirable results can often be improved with additional surgery.
If you are unhappy with your results, talk to your surgeon about it. Don't expect him or her to read your mind. Most surgeons want you to be a happy patient.
In some cases, your surgeon may not be able to offer you the solution you are looking for. In this case, I recommend that you seek a second opinion from another plastic surgeon. Your surgeon may suggest this option to you. Neither you nor your surgeon should take offense at this suggestion, as having a second opinion is often extremely helpful and reassuring.
Stages of scar formation
There are several stages of scarring of the damaged area:
- the first lasts about 5-7 days,
- the second lasts up to 1 month,
- the third lasts for 6 months,
- the fourth lasting about 12 months.
The first phase is also called the inflammatory phase. At this time, granulation cells form at the site of the incisions. It is at this moment that the mark from the operation has the most pronounced red or burgundy tint, and also protrudes noticeably above the level of the rest of the skin.
The location of the scars depends on the type of correction.
The second stage, proliferation, is characterized by the formation of a new capillary network at the site of damage, the removal of swelling and redness. During the third phase, over six months, the scar becomes lighter and less prominent.
Finally, at the final fourth stage, the scar after abdominoplasty gradually acquires its normal, natural appearance, becoming light, flat and inconspicuous against the background of normal skin.
Symptoms of seam dehiscence
Remember that the presence of aching pain, slight swelling and discomfort in the oral cavity is considered normal within three days from the date of surgery. Let's look at a few signs that may indicate seam separation:
- Presence of blood on the wound. It may come out abundantly or leak slightly.
- Body temperature may be several degrees higher than normal.
- The pain does not go away, but only intensifies.
- Swelling, feeling of pulsation and redness of soft tissues.
- Sometimes there is the formation of pus and an unpleasant taste in the mouth.
Types of scars
The size, location and visibility of postoperative marks depend on the type of abdominoplasty.
- The classic operation leaves a long incision, located in a horizontal direction and passing through the entire abdominal area. In some cases, small incisions in the shape of a horseshoe or triangle are possible, particularly if repositioning of the navel is required.
- Vertical abdominoplasty is most often indicated in the presence of diastasis of the abdominal muscles. This technique combines a classic plastic surgery incision and a vertical one, running from the navel to the sternum.
- To remove fatty tissue located on the sides and form a pronounced waist, you will need a classic incision and two side incisions located in parallel.
- If it is necessary to perform a lift in the hip area, then a horizontal incision is combined with two lateral ones extending to the lower back.
- Mini abdominoplasty involves the removal of a small amount of tissue, so in this case the mark after the operation is short in length (no more than 20 cm), located along the bikini line and is usually hidden under underwear or a natural fold of the body.
- Circular abdominoplasty is considered the most complex technique; with this technique, incisions are made in the abdomen, around the body, on the sides and on the back.
Disturbances in the formation of scar tissue
After abdominoplasty surgery, the suture can develop into one of four types of scars:
- normotrophic,
- atrophic,
- hypertrophic,
- keloid.
Normotrophic, as the name implies, is considered a normal result. Such a scar is hardly noticeable against the background of the epithelial cover and is sensitive.
Atrophic are the result of a slowdown in collagen synthesis. They are light in color, lack sensitivity, located below the level of the skin, as if “pulled in” inside. Hypertrophic ones, on the contrary, seem to protrude above the epithelium, have a noticeable tint and uneven edges. The reason for their appearance is excess collagen against the background of sprains, inflammation and other problems during the rehabilitation period.
Types of scars: a - atrophic, b - normotrophic, c - hypertrophic.
A keloid scar is the most unpleasant defect of all. The formation of keloid scars is possible due to unfavorable conditions during healing. The tendency to form keloid scars is also a congenital feature of some patients. But keloid-type scar tissue is an extremely rare complication of surgery.
Materials
Dentists today use several different materials for suturing. Some of them resolve on their own after a few weeks, while others need to be removed in the clinic. Catgut is a true classic and has been used for over a century. Refers to those that are able to resolve on their own. Since the composition contains proteins, it can lead to inflammation, so during implantation they try to use alternative options.
These include Dexon and Vicryl. These are synthetic threads in which the active components are polylactin and polyglycomic acid. Disintegration occurs in about a month to a month and a half. Cases of complications developing are extremely rare and, as a rule, due to personal intolerance in individual patients.
Sutures are removed without anesthetic, as this happens in a matter of seconds. The person doesn’t even have time to feel the pain. First, the assistant cuts the thread into several pieces, and then one by one pulls each of them out of the gums. At the end of the procedure, the injured area is treated with an antiseptic.
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Caring for sutures in the postoperative period
Rehabilitation plays a very important role in the formation of scar tissue. To make the traces of the intervention as less noticeable as possible, it is necessary to follow all the doctor’s instructions. In particular, do not touch the bandage applied after surgery, wear compression garments and sleep in a bent position. You will also need to give up sports, solariums, beaches, baths, saunas and hot tubs. Heat treatments or ultraviolet light are a sure way to noticeable scars. The use of any medications is only on the recommendation of the surgeon.
As a rule, proper care and adherence to the rules make it possible to make the place where the suture was placed after abdominoplasty indistinguishable from the surrounding skin. The result can be assessed no earlier than a year after plastic surgery. If the patient is not satisfied with the appearance of the scars, you can resort to cosmetology services. Laser resurfacing, chemical peeling, or surgical removal of excess scar tissue can help achieve the desired aesthetics.
Preventive measures
To prevent sutures from coming apart and to avoid serious complications after surgery, you should follow some recommendations. In the first few hours after installation of the implant, you should not eat, so as not to accidentally injure the area where the structure is implanted. The diet should not contain hard vegetables and fruits, crackers, and nuts. It is better to eat cereals, soups, pureed vegetables, broths, etc. Chewing is allowed only on the opposite side of the jaw.
To cope with severe swelling and prevent its occurrence, cold compresses can be applied to the cheek. This will also help relieve pain and reduce bleeding. Several times a day you need to treat the wound with an antibacterial solution using a small cotton swab. It is allowed to rinse the mouth with a decoction of chamomile or calendula; Chlorhexidine is also suitable for this purpose.
In order not to provoke too much blood flow to the gums, it is not recommended to visit the sauna, fly on air, or be in direct sunlight. You should also not drink too strong black or green tea, coffee or other caffeine-containing drinks. Alcohol and cigarettes, physical activity and overwork are also temporarily prohibited.
What to do if the seam comes apart?
Tummy tuck involves strong tension in the suture area during the rehabilitation period due to the large volume of tissue removed. Surgeons take measures to hold the tissue, but it is impossible to completely protect against discrepancy. The problem may arise due to errors in the choice of suture material, due to the patient’s activity or physiological problems (suppuration, necrosis).
If a stitch breaks after abdominoplasty, you should immediately contact your surgeon, and until your visit, you must follow a number of measures:
- continue to process the edges of the incision according to the instructions received from the surgeon,
- additionally apply a patch to reduce tension,
- do not allow water and especially dirt to get into the seam area,
- It is mandatory to wear compression garments,
- avoid straining the abdominal and abdominal muscles.
These measures will help delay further dehiscence until you see a doctor. Depending on the situation and condition, the surgeon will provide assistance and adjust home care.
Why do the seams come apart?
Any surgical intervention can be accompanied by complications, implantation is no exception. In addition to pain, swelling and discomfort, the patient may experience dehiscence of previously placed sutures. This can lead to a dangerous process of inflammation due to infection or food particles entering the wound. Of course, the threads cannot separate on their own. This occurs due to the patient’s violation of medical recommendations; less often, the cause is low qualifications of medical personnel.
Even improperly cleaning the mouth with a hard brush and using an irrigator can lead to undesirable consequences. Also, the condition of the seams is negatively affected by too hot and cold, very hard food. Unfortunately, medical errors also occur, for example, insufficiently tightened nodules or the needle catching only the upper, epithelial layer.
Much less often, discrepancies occur due to the use of low-quality materials or due to contacting a specialist who does not have the proper experience in carrying out such operations. Some patients experience allergic reactions to materials, and then they have to change them to others. Also, those who have had extensive surgery, resulting in many wounds having to be sutured, may encounter discrepancies.
