We all know cosmetic surgery is on the rise. Do we know what scale it is growing?
A whopping more than 17.7 million surgical and minimally invasive cosmetic procedures were performed in the United States in 2018. Tummy Tuck or Abdominoplasty ranks the 5th on the list for now, but an increasing trend seen in body-shaping procedures, according to a report by the American Society of Plastic Surgeons (ASPS). Australians follow the same trend and don’t seem to be fazed by the fact that Private Health funds have stopped paying for the cosmetic Tummy Tucks.
Tummy Tuck is the only permanent way to get your pre pregnancy flat tummy in the best possible way. As regulators and advances in surgical techniques have made it much more safer for patients, there are some inherent postoperative complications that come in a package even with the best surgeon. At Esmée Clinics, Dr Mahadik endeavours to educate his patients by providing evidence and research based data to guide them through this unforeseen aspect of their cosmetic journey.
Lets briefly outline some facts on complication rates after a Tummy Tuck procedure (1). We believe that patients should be aware of them before signing up. The numbers reflect only those needing hospitalisation and those complications managed from clinics were excluded.
WHAT IS FAT NECROSIS?
Fat necrosis is the death of fat cells due to shortage of or a disruption of blood flow to the abdominal fat and skin. Fat necrosis causes wound breakdown and delayed healing.
The signs are similar to wound infection. Infection,however is caused by bugs while fat necrosis is tissue death which can then be a good medium to get colonized by bugs.
HOW DO I KNOW, I HAVE FAT NECROSIS?
After an uneventful surgery patients are usually followed up day 7 to 10 to check sutures and dressing changes. The signs of fat necrosis usually take 5-7 days or sometimes 2 weeks to appear.
They appear to be similar to infection, but infection is due to bugs while fat necrosis is a death of fat cells under the skin due shortage of or a disruption of blood flow to the abdominal fat and skin.
Although it might appear to be superficial infection that can settle with antibiotics, more often than not, it is more sinister than this.
It is FAT NECROSIS of the abdominal skin flap that will cause a wound breakdown.
WHAT CAUSES FAT NECROSIS?
The primary cause is shortage of blood supply to keep the fat alive.
Sir Harold Gillies wrote that “Plastic Surgery is a constant battle between blood supply and beauty’* (Gillies and Millard, 1957)-a struggle which has not yet been resolved.
These fat cells typically located in the middle portion of the abdominoplasty scar are at the farthest point of the blood supply, may die causing the wound to break and dehise. The size of breakdown is proportional to the amount of fat death secondary to ischemia (lack of blood supply).
Skin is more tolerant than fat to ischaemia. Hence it survives and the underlying fat dies.
There are a few other contributing factors –
WHAT TO EXPECT & HOW DOES FAT NECROSIS HEAL?
Mild cases – The inflammation, induration and lumpiness settles over time and the skin may not breakdown
Moderate to Severe cases – Small areas of skin breakdown will continue to ooze thin fluid. Gradually, the broken down areas will grow into a bigger wound with more discharge. This may progress depending on how much of the fat is subject to slow death.
1. Yellow Dots – Perforators (Blood supply to the skin flaps) 2. Blue Arrows – Indicate the pull of the upper skin flap to achieve a fine line bikini scar. 3. Broken White Line – Mid line dissections allowed 4. Fat Necrosis – increases if Critical Zone is breached
Treatments may include :
Dressings that are offered :-
a) VAC (vacuum assisted closure) dressings gold standard that heal the wound faster, help the wounds to contract in size and are patient friendly. They work on the principle of negative pressure therapy and are quite expensive, unless funded by public health. VAC is to be changed twice a week.
b) Gauze dressings – The wounds may be packed with guaze soaked with an antiseptic with some tapes to hold it in place. They need more frequent changing than VAC and could be managed by wound nurses or GP’s.
TAKE HOME MESSAGE
Medicine is a science and there are no fixed answers for all questions as science still continue to unlock new things every day.
Esmée Clinics would like to summarize this a small take home message for those considering an abdominoplasty procedure. As long as patients are educated, they are better prepared mentally and financially to face any odds.
Plastic Surgery Department, American Academy of Cosmetic Surgery Hospital, Dubai Healthcare City, Dubai, U.A.E