Cosmetic Surgery Tips

Belly button necrosis after tummy tuck

In this guide, we review the aspects of Belly button necrosis after tummy tuck, tummy tuck necrosis healing stages, Is necrosis normal after tummy tuck, and How do I know if my belly button is infected after tummy tuck?

Necrosis is the medical term for tissue death. Umbilical necrosis is when the umbilical tissue dies, which usually occurs as part of a medical procedure such as an abdominoplasty.

All steps within Plastic Surgery procedures require an understanding of blood supply, so that tissues heal rather than die. As the umbilicus is a scar, Specialist Plastic Surgeons understand that the blood supply to the umbilicus comes from both the surrounding abdominal skin as well as from the abdominal muscle layer. These two blood supplies are termed superficial (skin) and deep (muscle).

Belly button necrosis after tummy tuck

During most abdominoplasties, Specialist Plastic Surgeons will dissect out the umbilicus down to the abdominal wall. This disconnects the blood supply from the abdominal skin (superficial) and isolates the umbilicus on the blood supply from the muscle layer (deep). In rare circumstances, the opposite technique is used. Leaving the umbilicus attached to the abdominal skin and disconnecting it from the linea alba is termed an “umbilical float”. Umbilical floats are only useful in patients with minimal skin laxity AND an umbilicus that naturally sits abnormally high.

What happens if the deep blood supply to the umbilicus is inadequate?

The deep blood supply to an umbilicus can be reduced several situations. The most common is the prior use of the umbilicus as an access port for laparascopy (or multiple laparoscopies), or other general surgical procedures. Some surgeons will incise in and around the umbilicus, and the umbilical stalk can be completely divided during a laparoscopy approach.

A second reason that the deep blood supply to an umbilicus can be reduced is if the Specialist Plastic Surgeon finds an umbilical or paraumbilical hernia that requires repair during your abdominoplasty. These hernias can be in combination with the scarring from past laparoscopies, which is a double whammy for the umbilical blood supply. Umbilical and paraumbilical hernias are also very common in ladies who have rectus diastasis from pregnancy.

Some Specialist Plastic Surgeons will not repair an umbilical or paraumbilical hernia at the same time as performing an abdominoplasty due to the increased risk of umbilical necrosis. It is Dr Gavin Sandercoe’s view that all midline hernias should be repaired during an abdominoplasty, as the access (view) of the hernias is much greater than that during a normal hernia repair. This allows a stronger and safer repair of those hernias. In the long run, a well repaired hernia and a planned umbilical reconstruction has less scarring on the abdomen than a normal umbilicus requiring a hernia repair after the abdominoplasty.

What happens if this altered blood supply is not predicted?

Alteration to the umbilical blood supply can be predicted preoperatively sometimes, but sometimes Specialist Plastic Surgeons only find out during your abdominoplasty. Your Specialist Plastic Surgeon is then in an awkward position – try to save the umbilicus or discard it & commit to an umbilical reconstruction.

It sounds tempting to attempt to save the umbilicus, but if it does not survive the chances of a good reconstruction fall greatly. Umbilical reconstructions look most normal if they are performed in fresh skin without tethering from prior scarring. Umbilical reconstructions should be staged about 3 months after an abdominoplasty so that the blood supply to the abdominal skin has recovered & normalised.

What can be done to salvage an umbilicus?

Once a Specialist Plastic Surgeon has raised the abdominal fat & skin off the muscle, they will have a reasonable assessment of the amount of risk to the umbilical blood supply during your abdominoplasty. If the umbilical stalk looks thin, scarred or otherwise dicey they will know that tough decisions might lay ahead. Repairing a rectus divarication will further reduce the blood supply but leaving space around the umbilical stalk helps reduce that impact. If an umbilical or paraumbilical hernia require repairing at the time, then a strong repair will reduce the amount of blood flowing into the umbilicus.

If the umbilicus looks to be in trouble during the operation, your surgeon can loosen the repair of any nearby hernias and rectus divarication. At that point, they need to make an assessment as to if the umbilicus looks like it will recover. It is Dr Gavin Sandercoe’s opinion that if the umbilicus does not pink up quickly, the best decision is to remove the umbilicus and plan for a reconstruction in 3 months. There are some Specialist Plastic Surgeons who prefer to reconstruct the umbilicus rather than using the native one (even when the blood supply is healthy & normal), so this is not a disaster!

Should the umbilicus look like it is going to recover, your Specialist Plastic Surgeon will inset the umbilicus like they would normally and finish your abdominoplasty. From this point onwards, it is a waiting game. If the umbilicus dies, then your surgeon will dress the wound until it heals. This may require a small procedure to remove any non-viable tissue to speed the healing. Your umbilicus may go through a phase where the outer layer of skin dies off and it heals from the deeper layers of skin.

If you are in Sydney and considering an abdominoplasty, we invite you to use the form below to contact the team at Dr Gavin Sandercoe Specialist Plastic Surgeon. All surgical procedures have some risk, and you should consider a second opinion from another Specialist Plastic Surgeon in Sydney.tummy tuck necrosis healing stages

tummy tuck necrosis healing stages

I answer a lot of questions on Realself.com and a question I have seen many times concerns tummy tuck necrosis which is the dying of live skin cells, following a tummy tuck. It is very important to know that this complication occurs occasionally to every plastic surgeon, no matter how careful he is. As I was once taught and it is very true: the only surgeons who do not get complications with this don’t operate or they lie (courtesy of Dr. John Guy, one of the better surgeons that I trained with many years ago).

What causes skin necrosis after a TT ?

This is always due to an insufficient blood supply. It is much more common in smokers or nicotine users. I insist all of my patients refrain from all nicotine products (including cigarettes, patches, gum etc) for 3 weeks before and after surgery. Diabetics are also more likely to have decreased circulation after a TT to the distal flaps of tissue. An extremely tight garment that interferes with the blood supply can contribute to this.

However, most of the time when it occurs, it just happens, and there is no obvious reason. I had a female patients many years ago who placed a very hot pad on her abdomen for menstrual cramps and gave herself a 3rd degree burn, which caused skin loss – but this is a very unusual case.

Where does the skin loss occur?

Almost always, the skin loss occurs at the farthest point of the flap, where the blood supply is the weakest. This is at the lower abdominal incision, usually close to the middle of the incision or at the T-junction if there is a small vertical part of the scar.

Skin Necrosis Treatment

This will depend on the size of the area and how it looks. This will require frequent visits to the plastic surgeon or a wound healing center. If the area is fairly small, local wound care is usually all that is needed, plus lots of patience. The area will usually go black, lift off and then heal fine. Sometimes the scar will need to be revised in the office at a much later date. The final result is usually excellent but you need to have a lot of patience since you cannot rush the process.

Is necrosis normal after tummy tuck

Opting for a tummy tuck, medically known as an abdominoplasty, involves a significant decision for individuals desiring a more sculpted and toned abdomen. While the procedure can deliver transformative results, it is important to be knowledgeable about potential risks and complications that may arise. One such complication is necrosis, which refers to tissue death caused by inadequate blood supply. This blog post aims to delve into the question of whether necrosis is a common occurrence after a tummy tuck, its underlying causes, and effective management strategies.

Understanding Necrosis and its Causes:

Necrosis stands as a potential complication that may emerge following various surgical procedures, including tummy tucks. It encompasses the demise of tissue, which can occur either at the surface level or extend to deeper layers. The most prevalent cause of necrosis after a tummy tuck lies in compromised blood flow to the abdominal tissue. Multiple factors can contribute to this condition:

  1. Impaired Circulation: Insufficient blood supply to the abdominal region can lead to tissue necrosis. Factors such as smoking, pre-existing medical conditions (e.g., diabetes), and prior abdominal surgeries can increase the risk of poor circulation.
  2. Incision Tension: Excessive tension along the incision line during a tummy tuck can impede blood flow, resulting in necrosis in the surrounding tissue.
  3. Infection: Postoperative infections can further compromise blood supply to the incision area, heightening the likelihood of tissue necrosis.

Is Necrosis Common After a Tummy Tuck?

While necrosis is not a frequent occurrence following a tummy tuck, it can manifest in certain cases. However, it is important to note that necrosis is considered a complication and not a typical aspect of the healing process. The overall risk of necrosis can vary depending on factors such as the patient’s individual health, the surgeon’s expertise, and postoperative care.

Recognizing the Symptoms of Necrosis:

Recognizing the signs and symptoms of tissue necrosis after a tummy tuck is crucial. Some common indicators include:

  1. Darkened or Blackened Tissue: Necrotic tissue often exhibits a dark, discolored, or black appearance.
  2. Delayed Healing: Slow or non-healing wounds despite appropriate wound care can suggest tissue necrosis.
  3. Foul Odor: Necrotic tissue may emit an unpleasant odor due to bacterial colonization.
  4. Increased Pain: Experiencing severe or worsening pain in the incision area may indicate tissue death.

Managing and Treating Necrosis:

In the event of suspected or diagnosed tissue necrosis following a tummy tuck, seeking immediate medical attention is vital. Early intervention and proper management significantly enhance outcomes. The treatment approach may include the following:

  1. Debridement: The removal of dead tissue to prevent infection and promote the growth of healthy tissue.
  2. Antibiotics: Administering antibiotics to prevent or treat any associated infections.
  3. Wound Care: Diligent wound management, encompassing cleaning, dressing changes, and careful monitoring, to facilitate healing.
  4. Supportive Measures: Depending on the extent of necrosis, additional treatments such as hyperbaric oxygen therapy or specialized wound care products may be recommended.

How do I know if my belly button is infected after tummy tuck

Your doctor should give instructions on how to care for your belly button after a tummy tuck. This may include cleaning the area with warm water or a saltwater solution.

It’s normal for the area to look swollen and even a bit crusty after surgery, and it may take as long as 6 months for the belly button to heal.

When to see a doctor

Call your doctor right away if you notice signs of infection in the belly button after a tummy tuck. These signs include:

  • The belly button looks too constricted or too open.
  • Pus or discharge is coming from the naval.
  • Your belly button protrudes for more than a few weeks.
  • You feel something hard behind the naval.
  • The belly button looks distorted or “off.”
  • The scar feels painful or becomes more prominent.
  • You notice blood at the incision site.

The bottom line

A tummy tuck can be a good way to flatten the stomach and tighten muscles in the abdomen that may have gotten loose from pregnancy, weight gain, or just general aging, but many people wonder what’ll happen to the belly button as a result of the procedure.

Normally, an incision will be made around the naval and it’ll be lifted and put back in the appropriate place to fit the new shape of the stomach. Other times it may be necessary to make a new opening.

It’s always a good idea to see before and after pictures from your surgeon and pay close attention to the belly button area when viewing them.

Leave a Comment