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Tummy Tuck, Smoking and Skin Loss

"OK, Doc. I smoke. That won't be a problem now, will it?"

Well not if you don't mind a possible wound healing problem.

Skin Necrosis in Smoker - Tummy Tuck
A Smoker's Wound After A Tummy Tuck.

Smoking, Wound Problems and Tummy Tuck Surgery

Tummy Tuck surgery is a big deal. I never treat these as small scale surgery. For the right patient, it is a great transformation. A great deal of this is brought to us by your body's capacity in wound healing.

Your surgeon takes the lower abdominal skin and literally pulls it to its limit. He relies upon this skin to be resilient enough and healthy enough to heal in the face of this manipulation. Smokers don't have the most tolerant skin as smoking decreases the blood flow to it over a long period of time. Obviously, the more you smoke and the longer you smoke, the more the problem can be. The nature of the operation decreases blood flow as well (as does breast reduction and full breast lift surgery). If, when all is said and done, your skin's blood supply is not robust enough, portions of it can fail and breakdown. This is called "Skin Necrosis."

Skin Necrosis is a problem that will usually show itself in the first few weeks after tummy tuck surgery. The most commonly affected area is that just over the pubic hair. The skin will initially be discolored and then it will blister and/or drain. It may turn dark or black and within a few weeks it will frequently appear to melt. The fat beneath it (if the full thickness of the skin is involved) will show. Some of this may also breakdown. These wounds tend to be deep and can be several inches in diameter.

Can this happen in a non-smoker? Sure. It usually happens in smokers though.

In my practice, I have had three post-operative tummy tucks with skin necrosis. Two of these were in smokers or previous smokers. The wounds have taken 1-3 months to heal in. If the patient would like revision, I usually do these at a year or when the scar softens.

"But I smoke and I want a Tummy Tuck"

Quitting smoking for a month before and a month after can limit your risk. Your tissues will never heal like a non-smoker's tissues, but stopping smoking in this manner seems to make wound breakdown less likely. Also tell your surgeon so he or she can limit your degree of surgery to also limit your risk. Any smoker or any prior smoker should think long and hard before a tummy tuck to make sure this risk is acceptable. Otherwise, don't have the surgery.

Patients with a heavy smoking history do not get abdominoplasty in my practice.

"Can I Still Look Good after Surgery If I Have Smoked?"

This woman (the same one with the wound at the top of the page at 2 months) had smoked for many years and was down to 1 pack a day at consultation. She told me she had quit for a month before and after if you don't count "sneaking a few." Please don't sneak. Quit First.

Her wound took 3 months to close. I saw her in the office a dozen or more times over this period of time to help her with wound care.

She was not bothered by the scar once the wound softened after almost a year. She still felt her abdomen looked better after the surgery.

Smoker Before Tummy Tuck
Smoker Prior To Tummy Tuck
Smoker After Tummy Tuck with Skin Necrosis
7 Months (No Revision)

Special Issues For Smokers After Abdominoplasty

(1) Skin Necrosis - The skin's blood supply is more tenuous. This problem is lessened but not eliminated when smoking is stopped before surgery. It is worse if the smoking is continued. If the skin's blood supply is not adequate, portions of the skin may "die." This frequently means a deep wound and months for wound healing. Delayed healing and distortion from scarring can detract from the ultimate cosmetic appearance.

(2) Delayed Wound Healing - Again because the blood supply is lessened, the wound will frequently take longer to heal. Scars may be more apparent.

(3) Coughing - Smokers tend to cough more after surgery. They also have trouble getting the secretions in their chests up and out with coughing. This can strain the repair of the abdominal wall. For this reason most surgeons do not make the abdominal wall repair as tight in smokers. Translation: You may not be as "flat" as you would like to be. Smokers will require more pulmonary care involving the use of inhalers, breathing treatments and incentive spirometry.

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© John Di Saia MD... an Orange County California Plastic Surgeon       John Di Saia, M.D.