Medical Edge Newspaper Column

When Postsurgical Problems Are Hard To Stomach

May 15, 2006
DEAR MAYO CLINIC:
I've had complications following a tummy tuck six months ago. The area around my navel swelled up with fluid, and two large red areas with rock hardness directly beneath them showed up. I was put on antibiotics for four weeks. The symptoms improved, but haven't gone away completely. How long should it take to heal from this operation and these complications? What other treatment should I get?

ANSWER:
It may be small comfort for you to know that these complications do not happen very often after an abdominoplasty ("tummy tuck") procedure. That doesn't change the facts of your own case, however.

In this operation -- performed to flatten the abdomen -- loose skin and excess fat in the area are removed and the abdominal muscles are tightened. It is typically elected by women whose pregnancies have left them with skin stretched beyond the point of restorability or by individuals who, after losing a great deal of weight, have a surplus of skin in the abdominal area. Similarly, they may have abdominal fat deposits that resist change despite further weight loss.

The cosmetic effects of a tummy tuck can make a positive difference in a person's life, and most patients -- after a period of healing -- report great satisfaction. But this is a major operation that incurs risks and can produce complications such as infection. Moreover, the patient will have a permanent scar, though its prominence will vary.

Fluid collection occurs after a tummy tuck as an inevitable result of the open spaces created by the incisions. Consisting of lymphatic fluid, blood and serous fluid (the liquid that bathes cells), this material is usually removed by the temporary placement of drains -- a standard part of the abdominoplasty procedure. Fluid removal can be aided by needle aspiration. While these methods are usually sufficient, localized fluid buildup can occur, resulting in a seroma -- one of the complications that you report.

It's quite possible that the fluid collection in your case will resolve on its own over the coming months. Otherwise, additional aspiration or placement of a temporary drain should take care of the problem.

Regarding the "two large red areas with rock hardness" you report, there are two possibilities: a hematoma, resulting from bleeding under the skin; or fat necrosis, which is caused by the death of some tissue within the subcutaneous fat layer that remains along the abdominal wall. In either case, they will likely dissipate over time, though that could take months. If the red areas are due to fat necrosis, resolution could be hastened by ultrasound or massage therapy, which aims to break down the firm residual tissue.

In general, a patient's postsurgical activity -- or absence of it -- can make a difference. For example, wearing an abdominal binder can provide support, and avoiding strenuous or excessive exercise is essential for three to four weeks. It is important, however, for the patient to perform regular, mild exercise during this period. We recommend a short walk every two to three waking hours to prevent the formation of lower-limb blood clots. Also, to avoid compromising the healing process, the patient should not use tobacco.

Given that you still have remaining complications, the situation is understandably frustrating. Please bear in mind that six months is not a long time for post-abdominoplasty healing, even under routine circumstances. As long you have no signs of infection, a conservative (wait-and-see) approach -- for perhaps another six months -- is likely still indicated. Your symptoms may simply go away on their own.

-- Sarvam P. TerKonda, M.D., Plastic Surgery, Mayo Clinic, Jacksonville, Fla.