A tummy tuck is a common procedure that is used after childbirthing in women and significant weight loss in both sexes. Aside from the bariatric surgery patient, the vast majority of tummy tucks are done in women. Tummy tucks have a certain number of variables in their execution from a mini- vs a full skin excision and theuse of liposuction from the abdomen out into various areas of the waistline and back.

Despite the many very successful results and happy patients that result from a tummy tuck procedure, infrequent complications can and do occur. Most of these result from either a misunderstandingof what the procedure can really do or an outcome that may require a revision to achieve the best aesthetic result.

Failed expectations occur in tummy tucks just like any other cosmetic plastic surgery procedure. One must realize that the more skin that is removed the better the result. But the greater the amount of skin removal, the longer the horizontal incision must be. It is not possible to remove a large amount of skin with a very small scar. A tummy tuck is all about understanding that one is getting a better body shape at the expense of a scar. Minimal scar tummy tucks (e.g., mini-tummy tucks) only work well in someone with a minimal stomach problem. In addition, a tummy tuck will not produce a six-pack look in any patient and may not create a completely flat stomach in all patients. How flat one’s stomach can get all depends on what you have to work with from the beginning.

Scar appearance and position are potential reasons for postoperative dissatisfaction. While many patients are concerned about undesired scar widening and thickening, it is actually very uncommon and is more of a risk in patients with intermediate skin pigmentation. (e.g., Asians, Hispanics) Almost invariably these ethnicities develop hyperpigmentation of the scar which is slow to fade if it ever does. African- Americans, despite more skin pigmentation, do not have this same concern and I have never seen a single case of keloid scar formation. Regardless of ethnicity, the most common scar problem is that of a dogear, a bunching of skin and fat on the side ends of the tummy tuck incisions. These can usually be resolved by a small excision of the dogear done under local anesthesia.

The too highly positioned scar is a more difficult revisional challenge. Patients need to understand that full tummy tuck scars will almost always end up higher than a mini-tummy tuck scar. That is what happens when more skin is removed and there is a greater ‘pull-up’ of the pubic skin and hairline. While it could have occurred from the way the tummy tuck was marked out before surgery, it is more likely the result of how much skin was removed. The price of the flattest stomach and no residual loose skin may be a higher scar. If too high, it is very difficult to move it lower more than an inch or so. This may or may not make a revisional procedure worth it.

Residual fullness in the upper abdomen after a tummy tuck is not rare. Unlike the result between the belly button and the pubis, the upper abdomen may not be quite as flat due to a residual fat thickness of the upper skin flap. This can easily be thinned out and made flatter with a secondary liposuction procedure. In many of my tummy tuck patients who have a very thick upper skin flap, I tell them beforehand that they will need liposuction of the upper abdomen 6 to 12 months after their tummy tuck if they want the flattest and most contoured result. While some plastic surgeons perform liposuction of it at the time of the tummy tuck, there is an increased risk of wound healing problems with the incision afterwards. I prefer to avoid that risk completely by delaying liposuction of that area until later if desired.

Dr. Barry Eppley

Indianapolis, Indiana