Dermal or skin necrosis develops when there is a lack of blood supply to part of your skin. The lack of blood supply damages not only your skin but also the surrounding tissues. This compromise to the skin results in it turning black. Although rare, it can be a complication of breast lift, breast reduction, tummy tuck and/or facelift procedures.
Blood carries oxygen and nutrients necessary to maintain healthy tissue. When there is a disruption to your blood supply, not enough oxygen will reach your tissues.
Formally known as abdominoplasty, the tummy tuck is a surgical body contouring procedure designed to improve the appearance of the abdomen by removing excess skin and, in some cases, tightening the underlying abdominal muscles. Oftentimes, the surgeon will combine liposuction with a tummy tuck to remove stubborn areas of fat and further enhance the results of the procedure.
What Does Skin Necrosis Look Like?
In dermal necrosis, the affected area lacks adequate blood supply and nutrients. Eventually, the lack of oxygen will lead to the death of your tissues that may appear as:
- Dark blue, tan, or black tinge in the affected skin.
- Dry, leathery, and thick appearance that you usually see in scabs.
- Open wound on the affected skin.
When Do I See My Surgeon?
If you feel any of the abovementioned symptoms after breast surgery or tummy tuck, always inform your surgeon. An increase in pain, non-healing wounds, and/or fever should always prompt medical assessment.
Early treatment is essential to ensure proper treatment and the best possible cosmetic outcomes.
After Which Procedure Is Skin Necrosis Seen?
Skin necrosis is a rare complication of surgical procedures that may disrupt the vascular supply of your tissue. This is most commonly seen in;
- Breast Reduction or Mammoplasty: Reshaping the breast by removing excess fat, tissue, and skin.
- Lumpectomy: Surgical removal of cancerous tumours from the breast.
- Breast biopsy: Getting a sample of breast tissues for diagnosis.
- Mastectomy: Removal of the entire breast.
- Breast lifting or Mastopexy: Removal of excess breast skin and tightening the breast skin.
- Breast reconstruction surgery: Rebuilding the shape and appearance of the breast.
- Abdominoplasty or Tummy tuck surgery: Removal of excess skin to tighten the abdominal wall and muscles
- Nipple-sparing mastectomy: Removal of the breast tissue while preserving the nipple-areolar complex
- Face and/or neck lift:
Risk Factors of Skin Necrosis
Certain factors can increase your chances of developing skin necrosis after surgery. You can manage these risks with the help of your surgeon’s expert care and advice.
Smoking can increase the likelihood of many complications occurring including skin necrosis. Smokers have lower immunity, poorer wound healing, clogged blood vessels, and low blood oxygen levels. That’s a golden recipe for plastic surgery failure and skin necrosis.
The blood circulation in diabetic patients is usually less than ideal. Diabetes leads to the narrowing of blood vessels, which increases the risk of tissue ischaemia. Moreover, wounds in diabetics take longer to heal than average. This prolonged wound healing can increase the chances of both infection and skin necrosis.
Bacterial or Fungal Infections
Regardless of how thorough the sterility techniques in the Operating Room (OR) are, it is impossible to completely prevent all microbes from striving in some areas of the body, like the nipples. The nipples contain a rich bacterial flora. These might sometimes spill and cause post-op breast infection, and in rare cases skin necrosis.
Bacterial and fungal infections can compromise the blood supply to your skin and lead to skin necrosis after surgery. Whilst your surgeon will do everything they can to reduce the chance of infection, you can help reduce your bacterial load with thorough pre-operative body washes of your surgical area before coming to the hospital.
Obesity can significantly increase your chances of developing skin necrosis. In obese patients, there is extra pressure on your arteries and a need for your body to work harder to pump blood. Aside from that, extra fat cells and tissues require extra blood and oxygen supply. Obesity puts your cells at a higher risk of not getting adequate nutrition and developing necrosis.
Steroids can lead to poor wound healing and can increase your risk of skin necrosis. If you are taking steroids, you must ensure you inform your Plastic Surgeon in your consultation so that they can formulate a specific plan for you.
Excessive alcohol consumption can lead to lower immunity and can reduce your body’s ability to heal itself after surgery.
Amount of Tissue removed during surgery
The more tissue you are having cut away, the higher the risk you’ll develop skin necrosis.
What Are The Complications Of Skin Necrosis?
If detected early, your surgeon can treat necrosis with a reduced chance of potential complications. If you do not undergo treatment in a timely manner, the reduced blood supply can be detrimental to the health of your tissue and your overall cosmetic result.
Dermal necrosis may lead to bacterial superinfection and the development of gangrene. Gangrene is the build-up of dead cells and tissues when the blood supply to a large area is cut off. The affected skin can turn a greenish-black colour and contain foul-smelling fluids.
The infection might extend further and pose a risk to your health. This is why we instruct our patients to seek help as soon as they suspect skin necrosis after any cosmetic surgery.
When does necrosis occur after tummy tuck
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.
What Are The Treatment Options For Skin Necrosis?
If you are experiencing skin necrosis as a complication of a recent operation, it may resolve on its own if the area is small. The treatment options your surgeon may recommend will depend on the area, cause, and appearance of your skin necrosis. Treatment options for skin necrosis include the following;
- Debridement is the standard procedure for treating post-surgical skin necrosis.
- It involves the removal of the dead or necrotic tissue through surgical or non-surgical means.
- Removal of the dead tissues is necessary to induce your healing process and tissue regeneration.
- Once these tissues are removed, you may be placed under advanced wound care treatment, including antibiotic medication, for faster healing.
- Depending on the severity of your case, debridement can range from removing small patches of necrotic skin to total amputation.
- This applies to necrosis after breast reduction, breast lift, tummy tuck, or any other kind of post-surgical skin necrosis.
Daily Dressing Change and Improved Sterility
- Changing the dressing daily promotes hygiene and faster healing of your skin necrosis.
- Your surgeon will give you instructions on how to clean the wound with povidone-iodine and dab it dry with gauze.
- Daily dressing change combined with surgical debridement and antibiotics promote quicker healing of skin necrosis.
- Necrosis can leave your skin damaged and vulnerable to further injury and infection.
- Your surgeon is likely to prescribe antibiotics to prevent the risk of infection.
Negative Pressure Wound Therapy (NPWT)
- Negative pressure wound therapy (NPWT) is a method of drawing out fluid and infection from a wound to help it heal.
- A special dressing (bandage) is sealed over the wound and a gentle vacuum pump is attached.
- The device can drag fluid, debris, and dead tissue from the wound and reduce swelling.
- It keeps the wound clean and helps to prevent bacterial infection.
- NPWT also helps to bring the edges of your wounds together. It can stimulate the growth of new tissue that helps seal the wound.
Hyperbaric Oxygen Therapy (HBOT)
- Hyperbaric oxygen therapy (HBOT) is used to treat infections in oxygen-deprived tissues.
- Your doctor asks you to inhale oxygen from a chamber that has above average pressure levels.
- It increases the oxygen-carrying capacity of your blood and subsequently the healing tissue.
- It might halt the necrosis in some cases and lead to better outcomes.
- HBOT is not for everyone.
- There are other risks with the use of hyperbaric oxygen therapy including;
- Temporary short-sightedness
- Damage to the middle ear
- Barotrauma injury from a change in air pressure
- Seizures from too much oxygen
- And more.
Larval (Maggot) Therapy
- In some cases of skin necrosis, a specific species of maggots raised in sterile environments can be used to debride wounds. We call this process biological debridement.
- These maggots secrete enzymes that break down dead tissue and digest it.
- They remove infected tissue and do not affect any of your healthy tissue.
Nipple Tattooing to re-colour lost skin
- After breast reduction surgery or breast lift, breast necrosis may develop. Although it is rare, it may affect your nipple-areola complex and will lead to the loss of the nipple.
- After treating the necrosis, nipple tattooing may be an option.
- Patients can undergo nipple tattooing after debridement, daily dressing, and the use of antibiotics. It can restore an acceptable appearance of the nipples.
- Tattooing can be carried out with or without a skin graft to recreate both the shape and colour of your nipple and areola.
- Over time, the tattoo can fade but you can have a touch up to restore the look you desire.
Before undergoing any tattooing to the area, please check with your Plastic Surgeon to ensure the wound has completely healed.
Avoiding Skin Necrosis
Regular visits with your plastic surgeon and nursing team after your cosmetic procedure are necessary to detect any wound changes in a timely fashion.
The treatment of skin necrosis depends entirely on its early diagnosis. Identifying the development of skin necrosis, the type of necrosis, and the underlying cause of your necrosis is essential for determining appropriate treatment.
Dermal necrosis can leave the affected skin vulnerable to further damage and injury. When treated correctly, it allows for quick healing and speedy recovery.
So, if you suspect that you might have skin necrosis, please contact us to schedule a visit with your surgeon to receive proper assessment and treatment.