Abdominoplasty Risks and When Something Goes Wrong

A abdominoplasty is major surgery, and like all surgery it carries risks. The most common problem is a seroma, a collection of fluid under the skin. Others include bleeding, slow wound healing, infection, numbness and blood clots, which are rare but serious.

This guide explains each risk in plain terms, gives published rates where reliable figures exist, and sets out what Dr Reema Hadi, specialist plastic surgeon, does to lower it. Knowing the risks is part of deciding whether surgery is right for you.

About the numbers on this page

Whilst the figures below are from our experience of hunderds of abdominoplasties at the Swan Clinic, and your individual risk depends on your health, your weight, whether you smoke and which operation you have. Dr Hadi talks through your personal risks at your consultation.

Seroma (fluid under the skin)

A seroma is clear fluid that collects in the space where the skin was lifted. In our experience it occurs at 1/20 patients.

What is done about it: we use a quilting technique. In most cases the drains are removed before you go home. If the drains stay in, we keep them until than 30 ml a day for two consecutive days. Wearing a binder reduces swelling. If a seroma forms later, it may need to be drained with a needle, sometimes more than once.

Haematoma (bleeding under the skin)

A haematoma is a collection of blood under the skin. This had occurred only twice in the last 10 years out of hundreds of patients.

What is done about it: you stop blood thinners and products such as fish oil, krill oil and ginseng before surgery, unless Dr Hadi advises otherwise. A haematoma may need to be drained. Very rarely, significant blood loss during surgery means a blood transfusion is needed.

Wound healing problems and skin loss

Sometimes part of the wound heals slowly or opens, or an area of skin or fat does not survive (necrosis). Wound infection, wound breakdown or fat necrosis together affected 5.6%. A larger area that does not heal may need a skin graft. Thankfully this had not occurred i the last 10 years.

What is done about it: no smoking for 6 weeks before and after surgery, the wound is closed in layers, you avoid strain on it for at least 6 weeks, and Dr Hadi checks it at every follow-up. The vertical scar in a fleur-de-lis tummy tuck is more prone to slow healing.

Infection

A wound infection usually shows as increasing redness, pain, warmth, discharge or a fever. It may need antibiotics. This had only occurred once in the last 10 years needing admission to hospital out of hundreds of patients.

What is done about it: you shower with an antibacterial soap before surgery, which reduces bacteria on the skin, and you take antibiotic tablets while your drains are in.

Blood clots (DVT and pulmonary embolism)

A deep vein thrombosis (DVT) is a blood clot in a leg vein. Rarely, part of a clot travels to the lungs (pulmonary embolism), which can be life threatening. DVT and pulmonary embolism as rare but serious risks of major surgery. This had only occurred once in the last 10 years out of hundreds of patients.

What is done about it: you wear leg stockings for two weeks, move gently from the first days, and stop smoking.

Warning signs: pain or swelling in one calf, or chest pain or sudden breathlessness. Call 000 for chest pain or breathlessness [CHECK 3].

Anaesthetic risks

An abdominoplasty is done under general anaesthetic with a specialist anaesthetist. Nausea can happen and usually settles quickly. An allergic reaction to the anaesthetic is very rare. Discuss your own anaesthetic risks with your anaesthetist.

Numbness and changes in sensation

Numbness of the lower tummy is common. healthdirect says it usually improves after several months but could be permanent; the NHS says it can last for a few months to years.

What is done about it: Dr Hadi checks how sensation is changing at your follow-ups.

Tightness

Tightened skin can make it hard to stand up straight or bend forward at first. This usually improves over time. Walking a little bent for the first day or two is normal.

Scarring

Every tummy tuck leaves a scar. Some people form thick, raised scars (hypertrophic or keloid scars).

What is done about it: tape, then scar gel, and sun protection for at least 6 months. Creams, steroid injections and laser are treatment options tummy tuck scars and belly button.

Umbilicus (belly button) problems

In a full abdominoplasty, a cut is made around the belly button and a new hole is made for it once the excess skin is cut out. So it has its own small wound. That wound can have the same problems as any other: slow healing, a thick scar, or a shape you are not happy with.

What is done about it: the same wound and scar care, and a check at each follow-up.

Asymmetry, dog ears and an outcome you are unhappy with

Swan's pages list asymmetry or an unsatisfactory appearance as a risk. You can also heal with bulges under the skin and "dog ears", small folds of skin at the ends of the scar, although this is rare.

Your body continues to change after surgery. The Australian Society of Plastic Surgeons notes that a later pregnancy may undo some of the result, and weight changes can affect it too.

Revision surgery

The Australian Society of Plastic Surgeons says that in most cases an abdominoplasty does not need to be repeated, but revision surgery may be needed to correct minor irregularities. Dr Hadi explains her revision policy, including who pays which costs, before your surgery.

Who has a higher risk?

• Smokers: smoking significantly increases complication rates. Ask Dr Hadi about vaping and nicotine products too.
• People prone to bleeding or poor healing, or who cannot safely have an anaesthetic. The Australian Society of Plastic Surgeons says an abdominoplasty (tummy tuck) may not be suitable for them.
• People whose weight is still changing: you should only have surgery once you reach your target stable weight first.
• Fleur-de-lis patients: the vertical scar is more prone to slow healing.

If something goes wrong

Problems are easier to treat when they are found early. You are given Dr Hadi's number and an after-hours number before you leave hospital, and follow-up visits are at no extra charge. Call 02 9526 6885 straight away if you have

• a temperature above 38°C
• heavy bleeding, or a swelling that grows quickly
• pain, redness or swelling that is getting worse
• unpleasant-smelling discharge from a wound
• pain or swelling in one calf

Call 000 for chest pain, sudden breathlessness or any emergency. If you are unhappy with your result once you have healed, raise it with Dr Hadi at your follow-up. You can also seek a second opinion from another appropriately qualified practitioner.

Next steps

Read about the tummy tuck itself, what happens on surgery day and the recovery timeline. All surgery carries risks, and results vary. To book a consultation with Dr Hadi, call 02 9526 6885 or use our contact page.

Frequently asked questions

What is the most common complication of a tummy tuck?

Seroma, a collection of fluid under the skin. Published reviews put it at between about 4% and 11% of patients. In our experience it is around 5%.

What does a seroma feel like?

Usually a soft swelling, often above the scar. Call us if you notice one; it may need draining with a needle.

Can you die from an abdominoplasty (tummy tuck)?

A tummy tuck is major surgery, and serious complications can happen. The Australian Society of Plastic Surgeons says it is rare for a clot to travel to the lungs and become life threatening. Leg stockings, early movement and not smoking help lower that risk.

What are the signs of an abdominoplasty gone wrong?

Fever above 38°C, heavy bleeding, worsening pain, redness or swelling, smelly discharge, or calf pain. Call 02 9526 6885, or 000 for chest pain or breathlessness.

Will I lose feeling in my abdomen?

Numbness of the lower abdomen is common. It usually improves over months, but it can be permanent.

Does smoking really matter?

Yes. Smoking significantly increases complication rates, especially wound healing problems. Dr Hadi asks you not to smoke for 6 weeks before and after surgery.

Will I need a second operation?

Most people do not, but revision may be needed for minor irregularities or a complication.