Chances of Dying from Tummy Tuck

There are many risks that can come with having any type of surgery, but this is especially true if you are undergoing a tummy tuck. The mortality rate following tummy tucks is between 0.2% and 0.8%, with complications including infections, scarring and organ perforation if not treated immediately.

In this guide, we review the Chances of dying from tummy tuck, chances of dying during plastic surgery, panniculectomy death rate, and is a tummy tuck more dangerous than a c section.

Chances of dying from a tummy tuck

First, do no harm! We all learn that on the first day of medical school. The Hippocratic Oath that each of us takes when we obtain our medical degrees is the basis of who we are and what we, as patient protectors and caring compassionate physicians, stand for. As a board-certified plastic surgeon (R.J.R.), who has trained hundreds of residents and fellows, one must always ask, “How can we keep plastic surgery, especially the elective aspect of plastic surgery, safe?” We continue to hear that one procedure may be riskier than another (ie, abdominoplasty versus Brazilian butt lift [BBL]), but what do the data say? And how do these aforementioned procedures compare to facelifts, rhinoplasty, and other combined procedures?

Ensuring the safety of cosmetic surgery is necessary for its successful and continued practice. According to the most recent statistics from the American Society of Plastic Surgeons, board-certified plastic surgeons in the United States performed 1.8 million cosmetic surgical procedures in 2018. ¹ The 5 most commonly performed procedures included breast augmentation, liposuction, rhinoplasty, blepharoplasty, and abdominoplasty. While buttock augmentation with autologous fat grafting was not among the top procedures, its practice increased by 16% compared with the prior year.¹Table 1 compares the complication rates of these procedures.

Mommy Makeover Death Rate

Table 1. – Complication and Mortality Rates of Cosmetic Surgery

NR, not recorded.

In the literature, the mortality rates of various procedures have fluctuated and evolved over time. However, as the procedures become more established and the educational training advances, the studies become more accurate. Therefore, it is critical to evaluate the 3 key factors:

1. The quality of the study (ie, level 1-3, prospective versus retrospective, survey versus data collection etc.).
2. The uniformity of the training and the proficiency of the surgeon(s).
3. The specific technology used.

For example, a 2001 survey study with a response rate of 53% reported a mortality rate of 1:3,281 when lipoplasty was combined with abdominoplasty.⁸ Survey studies tend to have inherent biases such as a recall bias, participation bias, or subject bias. More accurate was a study by Keyes et al² in 2017 that analyzed data over a 10-year period from the American Association for Accreditation of Ambulatory Surgery Facilities to evaluate safe surgical practices in their accredited facilities. They reported a VTE-related mortality rate between 1:10,082 and 1:13,126.

Overall, outpatient surgery has been studied extensively and is safe. The rate of operative mortality associated with anesthesia and surgery in the outpatient setting (either in the operating room [OR] or in the postanesthesia care unit) has been estimated to be 0.25 to 0.50 per 100,000 outpatient procedures.⁹ In addition, cosmetic surgeries performed in a hospital, ambulatory surgery center, or office-based surgical suite are all safe. Table 2 compares cosmetic surgery complication rates by facility.Table 2. – Cosmetic Surgery Complication Rates by Facility

VTE, Venous Thromboembolism; ACS, Ambulatory Surgery Center; OBSS, Office-Based Surgical Suite; NR, not recorded.

Buttock augmentation with fat grafting (BBL) in the United States has been increasing at a dramatic rate in recent years. In 2018, there was a 15.8% increase when compared with 2017 and a 61.1% increase when compared with 2014.¹⁰ With the rise in popularity of this procedure, so too has there been a rise in concern over the safety of this procedure. In 2015, a group from Mexico and Colombia reported 14 intraoperative deaths during lipoinjection and 8 perioperative deaths.¹¹ In 2017, Mofid et al¹² reported a risk of mortality from gluteal fat grafting between 1:2,351 and 1:6,214 after surveying 4,843 plastic surgeons worldwide. This report, which used a retrospective, anonymous surgeon survey, had only a 14% response rate.¹³ 

In May 2019, a new survey was sent to members of the American Society for Aesthetic Plastic Surgery and the International Society of Aesthetic Plastic Surgery. The survey asked about fat embolisms and deaths associated with gluteal fat grafting in the past 24 months (the time since safety recommendations were established, including the strong recommendation that all BBLs are done using only subcutaneous fat augmentation only) (Luis Rios Jr, MD, personal communication). This survey showed a mortality rate of 1:14,921, which means it is now statistically safer than an abdominoplasty.²

Similarly, when liposuction was introduced in the United States in the 1980s, there was a comparable concern for patient safety with higher than acceptable mortality rates. These high mortality rates were often due to massive blood loss in high volume liposuction with a prolonged operative time, thromboembolism, pulmonary edema, and abdominal/viscus perforation.^4,14 These deaths prompted the formation of a task force by the American Society of Plastic Surgeons. The fluid status of patients was mismanaged, resulting in both under- and over-resuscitation. With the advent of the superwet technique over tumescent liposuction, and proper training of board-certified plastic surgeons, the mortality rate dropped drastically, and liposuction is now considered one of the safest cosmetic procedures performed.¹⁴

Any major complication or mortality in cosmetic surgery deserves further evaluation. All measures should be made to identify risk factors and safe techniques and technology. The current reported mortality rate for buttock augmentation is 1:20,117, which is significantly lower than what was reported by the initial Aesthetic Surgery Education and Research Foundation study.³ This lower mortality rate, as with previous new techniques, is likely due to better educational venues and safer injection techniques, as well as a more accurate method of assessing the true mortality rate. A continued effort to produce quality peer-reviewed clinical and basic science and anatomical research along with technical improvements will serve to advance safety in cosmetic surgery.

What have we learned from past and current lessons of cosmetic surgery safety with new techniques and technologies? We know that we must do the following:

1. Conduct proper basic science and anatomical research to assure that new techniques and/or technologies are safe and reproducible.
2. Develop specific training modules to properly train both residents and established board-certified plastic surgeons. Ideally, a combination of hands-on cadaver dissection laboratories, live interactive surgery, and didactics should be used. Training must be done by those with expertise in the new technique or technology.
3. Mandate this type of training either in an approved plastic surgery residency or in post-graduate educational courses, similar to what has been done for laser training and other new techniques and technologies.
4. Be safe, always! Be rational! Above all, put patient’s safety first, both in and out of the OR!
5. Do not operate on patients who smoke, as they have a higher complication risk in all aspects of surgery.
6. Avoid complex combination procedures that exceed 6 hours, as this will increase your risk of complications.
7. Be forthright and honest in telling your patients what you can and cannot do and inform them of the inherent risks of each specific plastic surgery procedure.
8. Always strive to deliver the best and safest care in and out of the OR and never leave the OR until the patient looks as good as they can within the best of your abilities.

What do we tell our patients and the public?

1. Cosmetic surgery, and elective surgery in general, is safe when performed in an accredited facility by properly trained board-certified plastic surgeons.
2. The mortality rate for outpatient surgery is 0.25–0.50 per 100,000 procedures.⁹
3. The mortality rate today for liposuction is 1.3:50,000.⁴
4. The mortality rate for abdominoplasty is 1:10–13,000.²
5. The mortality rate for BBL is 1:15–20,000.³

What do we tell our patients and the public about being safe and making the correct choices?

1. See a board-certified plastic surgeon who has been trained in the specific technique or technology desired.
2. Ensure anesthesia is administered by a Certified Registered Nurse Anesthetist (CRNA) or a board-certified anesthesiologist.
3. Check to see that the OR facility is an accredited operating facility.
4. Research your surgeon’s, anesthesiologist’s, and the support staff’s experience, credentials, and expertise.
5. Quit smoking or vaping NOW.

As a specialty, what we must do to maintain a high standard of patient safety?

1. Vow to consistently train our residents, fellows, and practicing plastic surgeons to be safe and competent throughout their careers.
2. Always put good judgment and patient safety first over financial gain.
3. Be a great physician first, and then be a plastic surgeon.
4. Only operate on healthy patients who do not smoke.
5. Become a board-certified plastic surgeon and stay up to date with new techniques and technologies.
6. Remember that patient safety is first and foremost.

Mommy makeover: It’s the cutesy term for a serious package of surgical procedures aimed at returning a woman’s body to its pre-pregnancy state (one could easily argue the term is pretty problematic, too). And, fair warning, uttering the phrase repeatedly while interviewing the smartest aesthetic minds in the country will absolutely make you feel like a puerile twit.

The moniker irks many doctors as well. “I find it simplistic and annoying when surgeons say, ‘I’m doing a mommy makeover today,’” says Steven Teitelbaum, a plastic surgeon in Santa Monica, CA. “What does that mean? A breast lift and a bit of lipo? Or a giant reduction, a full tummy tuck, and a total body contour? It’s wiser for patients and surgeons to be specific in their language.” Indeed, the classic makeover involves a combination of a tummy tuck (aka abdominoplasty) and breast surgery. But within that framework, there are variations galore: the mini tuck, full tuck, skin-only tuck (as in, cutting away lax, stretch-marked skin but not repairing and tightening the abdominal muscles, which commonly separate in pregnancy); and for breasts, there’s the lift, reduction, augmentation (implants), or some hybrid therein. What’s more, “the modern-day concept of the mommy makeover has broadened further to include liposuction, fat injections to the buttocks, and vaginal rejuvenation,” says Jeremy White, a plastic surgeon in Miami.

If you’re thinking that seems like A LOT, that’s because it is. “The Internet sometimes presents cosmetic surgeries as the same as going and getting a haircut, but these are significant procedures,” says Robert Singer, a plastic surgeon in La Jolla, CA. “While the vast majority of patients who have them done are thrilled with the results, people need to be aware of the risks and understand that while it seems desirable to have everything done at once — one anesthesia, one downtime, one recovery — there are some limits as to what can be safely done as far as risk factors.” As a general guideline, he adds, an elective surgery should never run longer than six hours, as “risk factors go up after that.” Yet, a tummy tuck alone can take three to four hours.

Still, the promise of a flatter tummy and perkier boobs — the chance to reclaim what may have been lost in the turbulent transition to motherhood — that’s compelling stuff for some people. “We’ve definitely seen an uptick in mommy makeover-type procedures,” says Richard Baxter, a Seattle-based plastic surgeon. “I think a lot of it has to do with the fact that most new moms are millennials, and they tend to be more accepting of the idea [of plastic surgery].” According to the aesthetic-industry information mill that is RealSelf, the primary demographic researching mommy makeovers is 25- to 34-year-olds. Additionally, according to statistics from the American Society for Aesthetic Plastic Surgery, this subset of patients underwent close to 47 percent of all breast augmentations, 55 percent of labiaplasties, and 20 percent of tummy tucks in 2017.

Medically speaking, their age is an advantage: “The younger you are [at the time of surgery], the better your skin quality will [likely] be — and the more elastic your skin, the better your results,” says New York City plastic surgeon Z. Paul Lorenc. But that doesn’t mean one should go straight from the delivery suite to the operating room: Plastic surgeons generally recommend waiting at least six months after giving birth, and another six months after weaning (if breastfeeding), “to allow the uterus to contract, the breast tissue to shrink, and the body to recover from the stresses of pregnancy and childbirth,” says White. (One’s emotional readiness is a separate but equally crucial consideration, and many moms do choose to wait until their little ones are more independent before going under the knife.) Makeover-seeking moms should also be “as close to their pre-baby weight as possible, or at least stabilizing at their body’s new set point” before surgery, says Teitelbaum.

Behind the Popularity Boost

While social media-savvy surgeons, open-book patients, and encyclopedic websites like RealSelf have helped popularize and demystify the various elements of the mommy makeover, recent surgical advances are yielding safer operations and less brutal recovery periods. One of the biggest improvements is “the use of long-acting numbing agents, like Exparel, which are injected into the surgical site and block much of the pain for up to three days following,” says Baxter. “Less post-op discomfort means less reliance on opioids and fewer side effects from those drugs.” The built-in pain relief also gets patients on their feet faster, jumpstarting recoveries, and curbing the risk of blood clots (more on that ahead).

In another move to fast-track healing after abdominoplasties, doctors are working to obviate the need for surgical drains, which have long come standard with the procedure. “When a tummy tuck is done, there’s a large space that needs to be collapsed, and the tissue has to grow together,” explains Teitelbaum. Drains are inserted to prevent fluid from pooling and impeding this process. But “everyone hates them — they interfere with bathing, and make people queasy and uncomfortable.” By adopting a technique called progressive tension sutures — special internal stitches that reduce potential fluid buildup — or incorporating tissue glues and compression garments, surgeons can offer drain-free tummy tucks.

Even smaller tweaks to protocol can reap big rewards. Bucking the usual dictum of not eating or drinking after midnight prior to surgery, White follows more recent data “showing that allowing patients to drink Gatorade the night before and the morning of surgery, along with giving them certain anti-inflammatory medicines, can speed recovery by improving hydration and decreasing postoperative pain,” he says.

Laurie Casas, a plastic surgeon in Chicago, is also exploring new ways to ease the surgical aftermath for moms. One of the most meaningful, she says, has been performing noninvasive fat-reduction in the months leading up to surgery. Before CoolSculpting, “I could only offer liposuction, which is an excellent technique but means tacking on one more invasive procedure, and ultimately lengthening patients’ operating time and healing time,” says Casas. Now, she has suitable candidates undergo a course of CoolSculpting ahead of surgery to freeze away fat in exercise-resistant areas. During this preoperative window, she also provides patients with personalized nutrition and exercise plans to restore as much abdominal muscle tone as possible and minimize the need for muscle-tightening during tummy tucks. With this approach, says Casas, “90 percent of my patients do not need muscle work, and the procedure involves only skin excision and possible umbilical repositioning,” making for a smoother recovery.

For such less-extensive cases, Casas gives women the option of having surgery under local anesthesia. “If you ask moms what makes them most nervous about surgery, they’ll say general anesthesia,” says Casas, noting that it sometimes leaves patients foggy and nauseous (the risk is between 10 and 15 percent), while also carrying the obvious, but rare, risk of death. With a cocktail of “oral medicines that induce relaxation and sleep” — plus numbing injections, and music therapy and eye masks to block environmental stimuli — she can perform a skin-only tummy tuck, or a breast lift, for example — sometimes both at once — without the added worry of general. Says Casas, “In seven years and over 500 cases, not a single patient has said they would opt for general.”

Tummy Tuck Before and After

chances of dying during plastic surgery

Do laws in Texas, Virginia, and Alabama requiring women’s health clinics to provide hospital-type surgical facilities show how much these states’ legislators care about women’s health, as Texas’ Governor Perry and others have claimed? Or is the goal to limit women’s access to safe abortions, as Wendy Davis and many others have suggested? Whatever the reason, these laws, cloned from state to state, will result in few, if any, safe options for women seeking family planning services, screening, and other services, in addition to abortions.

If these legislators really want to help women, I hope they will take advantage of an opportunity to protect many more women, including many of their friends and loved ones, from far more dangerous medical procedures. While approximately 1 in 1 million women who undergo abortions during the first eight weeks of pregnancy die from the procedure, 1 in 50,000 women are dying from other, more popular elective procedures in clinics and doctors’ offices: cosmetic surgery. These cosmetic surgery patients are at 20 times the risk of death, and they need protection, too.

Every year, clinics perform cosmetic surgery on approximately 1.4 million women and 200,000 men, and perform an additional 13 million “minimally invasive” cosmetic procedures, such as facial injections to make wrinkles disappear and chemical peels intended to make skin look better.

As you can see, the numbers are staggering, compared to approximately 1 million abortions, many of which involve pills rather than surgery. Physicians tell us that abortion and cosmetic surgery are usually simple and safe procedures, but of course undergoing surgery always presents some risk. Cosmetic surgeons estimate that the invasive procedures and anesthesia involved in their procedures result in a death rate of 1 in 50,000 outpatient procedures. This translates to approximately 100 cosmetic surgery-related deaths per year. In contrast, many abortions rely on pills instead of surgery, making them much safer, with approximately 12 women dying from complications of an abortion in a typical year, according to the Centers for Disease Control and Prevention.

Women who have abortions later in their pregnancies have a death rate higher than 1 in 1 million–approximately 1 per 29,000 during weeks 16 to 20 of pregnancy. While this is tragic, later-term abortions still have a better safety record than pregnancy and childbirth, which is fatal for 1 in 7,700 American women each year. And both are safer than liposuction, which is a fatal procedure for 1 in 5,000 women each year.

Given the higher death rate from cosmetic surgery and the much larger number of women undergoing cosmetic surgeries and procedures, why is it that the legislators in Texas, Virginia, Alabama, Mississippi, North Dakota, and so many other states are so concerned about the safety of abortion clinics? According to abort73.com, an antiabortion website, there are fewer than 2,000 abortion providers in the entire country. This number compares to over 5,000 board-certified plastic surgeons, and thousands more men and women who perform cosmetic surgery but are not trained as plastic surgeons. (Here’s something for legislators to consider: Any doctor or dentist in the U.S. can call him- or herself a plastic surgeon and perform surgery on any patient, without telling the patient that he or she was not trained as a surgeon.)

Last year, a plastic surgeon in Michigan wrote about the “Wild West” of plastic surgery, explaining that since plastic surgery is a lucrative business, “an increasing number of doctors are closing their traditional medical practices and opening cosmetic surgery centers. These physicians learn the basics of plastic surgery through weekend courses, shadowing other doctors and even online webinars.” He explained that their procedures are performed in doctors’ “in-office operating rooms or at ambulatory surgery centers, where the credentialing requirements may not be as strict.” He concluded that “this influx of poorly trained cosmetic surgeons” has resulted in terrible cosmetic outcomes such as women with breast implants in their armpits and one woman with “shark-bite-sized divots all over her thighs and stomach after undergoing laser liposuction.”

The plastic surgeon who was criticizing other plastic surgeons was talking about bad cosmetic outcomes. He didn’t mention the death rates.

Regulations can protect our health, but they need to make sense. Requiring hospital-style facilities for early abortions and not for cosmetic surgery just doesn’t. I think the comparison between abortion clinics and cosmetic surgery spas and clinics is enlightening. It would seem hypocritical for the Texas legislators not to do something about this, as Texas women undergo many more cosmetic surgeries and procedures than women in almost any other state.

Perhaps what’s going on in Texas and these other states has much more to do with women’s reproductive body parts than it does with women’s health. Even so, I believe that legislators can be persuaded to consider facts before they legislate.

Tummy Tuck Risks

panniculectomy death rate

Abdominoplasty alone is considered a “major” surgical procedure in terms of risk and impact on normal homeostasis. Relative to other aesthetic surgical procedures, it is associated with higher rates of morbidity and morality, although with lower rates when compared with such reconstructive procedures as craniofacial surgery. According to Grazer and Goldwyn, it carries a mortality rate of 1:617 (.16 percent). about the same as that of hang gliding (1:600). A recent survey reported a rate as 1:2324 (.04 percent).

The implication is that abdominoplasty has a significant and definable mortality risk associated with it; therefore, any additional procedure added to an abdominoplasty with further risk should caution the surgeon to minimize adverse outcomes before proceeding. Since not operating incurs no medical hardships, any further risks imposed by liposuction must be weighed by the physician and patient against potential gains.

Another Abdominoplasty Study Showing a 20% Blood Transfusion Rate!

Department of Plastic Surgery, Queen Mary’s Hospital, London

A 6-year retrospective series of 133 abdominoplasties was studied and type and incidence of complications are presented. From this series a group of 34 patients was re-examined between 4 and 10 1/2 years postoperatively and conclusions were made from this long-term follow-up. A high incidence of injury to the lateral cutaneous nerve of the thigh was recorded. A blood transfusion was required in 19% of the cases, the average hospitalization was 12.4 days and the complication rate ranged between 24% in those who did not attend review and 65% in those who were re-examined. Objectively judged, 55% of the patients had excellent or good results, but subjective patient satisfaction was nearly 90%.

A Safer Alternative

We recommend instead the Yoho Method “No Scalpel Tummy Tuck”, done with liposuction, which in most cases gives you a much better result with skin shrinkage and almost no scarring. If you are indeed a tummy tuck candidate, we will tell you. For more information, read “Liposuction vs. Tummy Tucks”.

is a tummy tuck more dangerous than a c section

In general, there is more dissection involved with a tummy tuck than a cesarean section. In a c-section, there is an intraabdominal component to the operation and the fibrous tissue layer is cut. In abdominoplasty, the fibrous tissue layer is plicated (folded in or tucked) leading to tightness.

However, people experience pain and discomfort differently. First we must realize that everyone handles pain differently. A history of chronic pain and long term pain medication usage will lead to a tolerance to the pain medication which may result in taking higher doses of medication for pain relief. Treating pain promptly is always best. You should not delay taking prescribed medication when the pain starts.

“Generally speaking, most of my patients who have had a history of cesarean sections are able to handle the abdominoplasty recovery beautifully. Most of our patients do not even finish the first prescription of pain medication that I give them,” states Dr. Jon Paul Trevisani.

Taking the time to talk to your surgeon and anesthesiologist about your concerns and needs as they relate to pain management following surgery is important. Discussing with your surgical team about your medication history is vital and relevant to efficient pain control. Your doctor needs to know about all your supplements, prescription drugs and over-the-counter medications you take in order to prevent unwanted drug interactions.

About Dr. Jon Paul Trevisani

Dr. Jon Paul Trevisani earned his medical degree with Alpha Omega Alpha (AOA) distinction at the University of Nebraska Medical School in Omaha, Nebraska. He then completed five years of general surgery residency training at the University of Kansas Medical Center and a 2 year residency in plastic surgery at the University of Rochester, Strong Memorial Hospital in Rochester, New York. Dr. Jon Paul Trevisani is certified by the American Board of Plastic Surgery, a Fellow of the American College of Surgeons, and a member of the American Society for Aesthetic Plastic Surgery, the American Society of Plastic Surgeons, Florida Society of Plastic Surgery and the Florida Medical Association. He has also received numerous awards for his work in plastic surgery including the Patients’ Choice Award, America’s Top Physicians in Plastic Surgery, Doctor’s of Distinction selection for Orlando Magazine, and voted the best in his field in the Orlando Sentinel two years in a row.

For more information on Dr. Jon Paul Trevisani, please call our office today at (407) 901- 4934 to schedule your complimentary consultation or complete our contact form online. The Aesthetic Surgery Centre is located at 413 Lake Howell Road Maitland, FL 32751, and can be found online at jptrev.com or our Facebook Page. You may also visit our exclusive website dedicated to only breast surgery at usabreast.com. Submitted by: Roshani J. Patel.