Infection

While infection is unusual after liposuction, it happens from time to time after abdominoplasty. It presents with increasing redness ("cellulitis"), fever, and possibly a purulent drainage from the incision. A yellow drainage is normal and to be expected. But a greenish or white drainage or any foul-smelling drainage is not. This indicates infection. Antibiotics are prescribed and any purulent drainage is cultured. Infections typically respond to antibiotics, although drug-resistant strains of Staphylococcus (MRSA) are becoming more prevalent.

Seroma

A fluid collection under the skin is called a seroma. If the swelling seems to be getting worse, this may indicate that such a fluid collection has developed. Patients may reasonably wonder why the drain did not prevent such a problem. Should the drain simply be left in longer? The problem is that the longer the drain is left in, the greater the risk of infection. That is why we prefer to remove the drain three or four days after surgery. If a seroma develops, it is treated by injecting a needle into the swollen area and draining off the fluid. This maneuver immediately corrects the excess swelling and patients are more comfortable. Fortunately, it is not particularly painful because the skin where the needle is introduced is still numb. This aspiration typically needs to be repeated several times. Eventually, the lymphatics start working again to absorb the fluid and it is no longer necessary.

Surgeons find this problem a nuisance (as do their patients) and try to avoid it by preserving the "areolar" tissue layer over the abdominal wall during the abdominoplasty. The skin undermining is limited to just what is necessary to gain adequate release of the flap. (This also helps preserve blood supply and sensation). I personally find it helpful to avoid the use of cautery during the dissection. Pretreatment with the Marcaine^®/epinephrine solution reduces blood loss sufficiently to allow dissection using a scalpel. This technique limits tissue injury and inflammation that might otherwise cause more fluid release. The risk of seroma is minimized.

Hematomas can occur after an abdominoplasty, and can possibly necessitate a return to the operating room for evacuation, although this is very unusual, and a complication that I personally have been fortunate not to have had (yet). Prompt recognition and treatment is the key.

Deep Venous Thrombosis

A blood clot in the deep vein of the thigh ("deep venous thrombosis") is a serious and potentially life-threatening complication of surgery. The risk of a DVT is that a clot may break off, travel to the lungs and cause a pulmonary embolus, which can be fatal.

The risk is increased by immobilization of the lower extremities. It can even occur in patients after long plane flights. The risk may be reduced with the avoidance of paralysis (which reduces the sympathetic tone to the veins), the use of sequential compression devices in surgery, reduced operating times, and early ambulation. My patients are turned from side to side during surgery (during the liposuction treatment), and the prone position, which exerts pressure at the hips, is avoided entirely.

Even doing "everything right," a DVT can still occur. It can even happen without surgery. Some surgeons advocate the use of blood thinners (heparin or Lovenox^®) immediately before surgery, but their use has to be balanced against the risks of easier bleeding after surgery.

Skin Loss

Skin loss typically occurs where the skin circulation is most at risk. This is typically the central portion of the upper skin flap, that has been undermined the most in performing the abdominoplasty. Smoking causes constriction of the small blood vessels which can make the difference between tissue survival and loss. Cessation of smoking greatly reduces the risk of this complication.

Excessive Scarring

The central portion of the abdomionplasty may spread, depending on the patient’s healing characteristics and wound tension. Any factor that interferes with wound healing, such as an infection or skin loss (see above) can contribute to a wider, more conspicuous scar. After 6 months to a year, the tension has been relieved. At this point, the scar may be revised.