Fat necrosis is characterized by hard lumps under the skin that feel like small rocks or stones. The lumps may appear anywhere on your body, but they are most commonly found in the abdominal region following tummy tuck surgery. If you notice lumps under your skin after having liposuction, contact your doctor immediately so they can rule out fat necrosis as a possible cause before making any treatment recommendations for how to deal with this condition
Fat necrosis abdomen after tummy tuck: Fat necrosis occurs when fat cells die after trauma to the body. It can be caused by a variety of factors, including surgery, liposuction, or even vigorous exercise. In the case of abdominal liposuction, fat necrosis can occur when a large amount of fat is removed from the area and not properly treated before being re-injected into other areas of the body.
Read on to learn more about Fat Necrosis Abdomen After Tummy Tuck, What Causes Fat Necrosis After Tummy Tuck
Fat Necrosis Abdomen After Tummy Tuck
A whopping more than 17.7 million surgical and minimally invasive cosmetic procedures were performed in the United States in 2018. Tummy Tuck or Abdominoplasty ranks the 5th on the list for now, but an increasing trend seen in body-shaping procedures, according to a report by the American Society of Plastic Surgeons (ASPS). Australians follow the same trend and don’t seem to be fazed by the fact that Private Health funds have stopped paying for the cosmetic Tummy Tucks.
Tummy Tuck is the only permanent way to get your pre pregnancy flat tummy in the best possible way. As regulators and advances in surgical techniques have made it much more safer for patients, there are some inherent postoperative complications that come in a package even with the best surgeon. At Esmée Clinics, Dr Mahadik endeavours to educate his patients by providing evidence and research based data to guide them through this unforeseen aspect of their cosmetic journey.
Lets briefly outline some facts on complication rates after a Tummy Tuck procedure (1). We believe that patients should be aware of them before signing up. The numbers reflect only those needing hospitalisation and those complications managed from clinics were excluded.
- Abdominoplasty accounts to higher major complication rate of 8-10% (4) compared to other cosmetic surgery procedures
- When combined with multiple procedures like other body contouring procedures the rate spiked higher(1)
- Seroma, Fat Necrosis and Infection were the top 3 complications
- They pose a significant financial burden on the surgeon and the patient as most expenses are out of pocket, uncovered by private funds.
WHAT IS FAT NECROSIS?
Fat necrosis is the death of fat cells due to shortage of or a disruption of blood flow to the abdominal fat and skin. Fat necrosis causes wound breakdown and delayed healing.
The signs are similar to wound infection. Infection,however is caused by bugs while fat necrosis is tissue death which can then be a good medium to get colonized by bugs.
HOW DO I KNOW, I HAVE FAT NECROSIS?
After an uneventful surgery patients are usually followed up day 7 to 10 to check sutures and dressing changes. The signs of fat necrosis usually take 5-7 days or sometimes 2 weeks to appear.
They appear to be similar to infection, but infection is due to bugs while fat necrosis is a death of fat cells under the skin due shortage of or a disruption of blood flow to the abdominal fat and skin.
- Skin next to incision site is discoloured, bluish- black or scabby
- The area becomes lumpy, firm, swollen and warm.
- Small red patchy areas may develop on the upper skin flap below the umbilicus
- The skin may break into tiny 3-4 mm areas at one or more locations along the scar
- Discharge of think reddish yellow fluid from the scar.
Although it might appear to be superficial infection that can settle with antibiotics, more often than not, it is more sinister than this.
It is FAT NECROSIS of the abdominal skin flap that will cause a wound breakdown.
WHAT CAUSES FAT NECROSIS?
The primary cause is shortage of blood supply to keep the fat alive.
Sir Harold Gillies wrote that “Plastic Surgery is a constant battle between blood supply and beauty’* (Gillies and Millard, 1957)-a struggle which has not yet been resolved.
These fat cells typically located in the middle portion of the abdominoplasty scar are at the farthest point of the blood supply, may die causing the wound to break and dehise. The size of breakdown is proportional to the amount of fat death secondary to ischemia (lack of blood supply).
Skin is more tolerant than fat to ischaemia. Hence it survives and the underlying fat dies.
There are a few other contributing factors –
- Tension closure – Over zealous cut out of the skin apron often leads to tight closure of the skin which contributes to fat necrosis. The heavy sutures cut like a cheese wire through the fat layers
- Diabetes and Smoking – reduce the baseline blood flow to tissues. Smoking ideally should be ceased 4 weeks before the procedure.
- Infection – Surgical site infections can cause wound breakdown and fat necrosis
- Obesity in general and patients with massive weight reduction are high risk for fat necrosis.
- In a small percentage of patients it can happen without an identifiable cause
WHAT TO EXPECT & HOW DOES FAT NECROSIS HEAL?
Mild cases – The inflammation, induration and lumpiness settles over time and the skin may not breakdown
Moderate to Severe cases – Small areas of skin breakdown will continue to ooze thin fluid. Gradually, the broken down areas will grow into a bigger wound with more discharge. This may progress depending on how much of the fat is subject to slow death.
1. Yellow Dots – Perforators (Blood supply to the skin flaps) 2. Blue Arrows – Indicate the pull of the upper skin flap to achieve a fine line bikini scar. 3. Broken White Line – Mid line dissections allowed 4. Fat Necrosis – increases if Critical Zone is breached
Treatments may include :
- Surgical debridement procedures – This is usually the first step to excise dead tissues, up to bleeding healthy tissue. This will create an environment for faster healing from healthy viable tissue. The wound is left open for dressings and to be healed by secondary intention.
- Short period of hospitalization – should be expected after debridement for a couple dressing changes till the wound is stable and suitable to be managed in the clinic setting.
- Regular dressings over a period of 4 -10 wks on average. Frequency of dressings depend on the wound size and the amount of wound discharge.
- Skin graft or Secondary closure – Once the wound is clean and healthy, the surgeon may decide to cover it with a split skin graft or close it with sutures. Skin graft – can be quite unsightly with a darker color tone and a visible indentation. It is however a good means to cover and close a large wound that otherwise may take ages to heal. The unsightly graft can be later excised and converted into a good scar.
TAKE HOME MESSAGE
Medicine is a science and there are no fixed answers for all questions as science still continue to unlock new things every day.
Esmée Clinics would like to summarize this a small take home message for those considering an abdominoplasty procedure. As long as patients are educated, they are better prepared mentally and financially to face any odds.
- Tummy Tuck has a higher complication rate of 8-10%
- Certain surgical principles should be followed to minimize fat necrosis, but some patient factors play an important contribution
- Most cases of fat necrosis can drag the healing process over 4-10 weeks
- Delayed healing can be resource intensive and cause a significant mental and financial stress to the surgeon and the patient
What Causes Fat Necrosis After Tummy Tuck
Fat necrosis is a rare complication of tummy tuck surgery. It occurs when the fat in your body dies.
Fat necrosis is a common complication of liposuction. However, it is less common after tummy tuck surgery because most of the fat in your abdomen was removed during your procedure.
If you experience fat necrosis after tummy tuck surgery, it can be very painful and will require treatment by your surgeon.
What is fat necrosis?
Fat necrosis is a condition in which dead fat cells are replaced by scar tissue and become hard lumps under the skin. Fat necrosis can occur anywhere in the body where excess fat has been removed, including:
Abdomen (tummy tuck)
Thighs (liposuction)
Fat necrosis is a condition in which the fat around your body is damaged. Fat necrosis is most common after plastic surgery and can happen anywhere on the body.
Fat necrosis can occur when there is bleeding in the fat tissue, as well as when dead cells begin to form in the area. The dead cells lead to inflammation and swelling of the surrounding tissue, causing pain and discomfort.
In some cases, it will heal on its own; however, if it does not then antibiotics may be prescribed to treat any infection that may have occurred as a result of this condition.
In most cases, fat necrosis occurs within the first two weeks after surgery; however, it can also occur several months later.
Causes of Fat Necrosis after Tummy Tuck Surgery:
The following are some causes of fat necrosis after tummy tuck surgery:
1) Trauma or injury during or after surgery; 2) Surgical errors made during surgery; 3) Surgical instruments used during surgery that were not sterilized properly; 4) Blood clots forming inside the fat tissue; 5) Infection contracted at the surgical site
Signs Of Necrosis After Tummy Tuck
Necrosis is a condition in which the skin or other body tissues die. Necrosis can occur due to lack of blood supply (ischemia) or from trauma that damages the tissues.
Necrosis after tummy tuck is a rare complication, but it does happen. The necrosis can occur in any area where there was liposuction, but it most often occurs around the navel or umbilicus.
The signs and symptoms of necrosis after tummy tuck include:
Swelling (edema) and bruising around the navel or umbilicus
Redness and warmth around the navel or umbilicus
Tenderness when pressing on the area around the navel or umbilicus
Pain when pressing on the area around the navel or umbilicus
Necrosis is the death of tissue. It can occur when a blood vessel is accidentally cut or damaged during surgery, causing bleeding that cannot be stopped.
The body responds by sealing off the injured area with scar tissue. This is called a hematoma and it can cause swelling, pain and numbness in the area around the wound.
When necrosis occurs after tummy tuck surgery, it usually appears as a lump or mass under your skin. If you’re experiencing any of these symptoms after your tummy tuck, call your doctor immediately:
Swelling in one area of your incision site
Pain around the incision site
Redness or pus discharge from the incision site
The most common sign of necrosis after tummy tuck is a dark purple or black area on the incision. This discoloration may also be accompanied by swelling and pain.
Necrosis in the tummy tuck scar can be dangerous. If left untreated, it can lead to infection and even death.
If you experience any of these symptoms after your tummy tuck, contact your doctor immediately.