Pitfalls and Complications
PITFALLS AND COMPLICATIONS OF A TUMMY TUCK
The analysis of any surgical intervention is never complete without a visit to the dreaded domain of complications. While rare in Esthetic surgery because of the usually superficial nature of the interventions and the healthy tendency of its patients, complications are nonetheless ever present, calling for vigilance on the part of surgeon and patient alike.
Anyone contemplating the prospect of going to sleep for an operation is liable to hear the awful phrase: "You can die under anesthesia" told matter-of-factly. In the cosmetic domain, this is a tried method for separating those who are serious about intervention from others who have not done the internal soul-searching work needed to overcome their apprehensions. The reality is that general anesthesia is extremelly safe, accounting for only one on-table death in a quarter million patients operated on for all types of surgeries (brain; heart; lungs; intestines...etc) and for all reasons (cancer; trauma; chronic diseases...etc). It goes without saying that our healthy esthetic patients have a better-than-average chance of making it through general anesthesia unharmed. My score in this arena remains perfect but enough said as I do not wish to tempt fate.
There can be no accurate evaluation of outcomes without numbers. Surgeons who perform one case here and there do not have this luxury. Over the interval of six years (2002 - 2007), I have had the privilege of performing over 300 Mercator Abdominoplasties. I am thus in the unique position of being able to look back on my experience and subject my results to the dispassionate analysis of statistics (for complete transparency I would have to disclose that statistical analysis was performed at Cornell University in Ithaca, NY, by my son, a student in the department of physical engineering, using a program called Winstat for Excel (R. Fitch Software). I never threatened him with a reduction in support and he performed independently). What did the numbers tell me?
In 211 cases reviewed (2002 - 2006), the infection rate was 4%, clot formation 1% and incision breakdown (minor or major) 11.5%. I learned that there were predictors of complications, namely a Height/Weight ratio (Body Mass Index or BMI) above 30; Residual deep stretch marks (Type III to V, my classification) that could not be included in the excision; Smoking; and the middle-aged Male patient. The reasons behind this last one are too technical to be described here but, to my knowledge, I was the first one to offer a rational explanation of what happens in these cases. Later studies validated my find.
Does this mean that I turn away heavy set patients, those with deep stretch marks, smokers and men? Of course not. I am however in a better position to evaluate individuals and to advise them of their chances of having a problem based on certain features. This empowers YOU to make an informed decision.
What I would like to address here is the possible breakdown in the Patient/Physician relationship that could potentially result from a complication. Esthetic surgery is unique in the fact that it is unecessary surgery (physically), performed (usually) on a healthy individual for beautification reasons (mostly). Furthermore, it is a transaction where money exchange hands before service is rendered. Expectations are high. If the bond between the surgeon and the patient is not rock-solid, doubt about the surgeon's competency will set in at the first sign of a problem. Second-guessing, second opinions and visits to the emergency rooms will further widen the divide especially when other Health-care professionals, unaccustomed to and untrained in tummy-tucks, render the usual garden-variety opinion of "infection" when non-exists. If in addition the patient is begging for validation of suffering from her/his entourage, the surgeon becomes an easy target for the wrath of the entire circle of family and friends.
The unwritten contract between the patient and the doctor is TRUST. I am not only here for you when things go right, that is to say in most instances, but also when things are not optimal. If you have trusted me to be holding a knife while you were asleep, trust me to guide your boat out of the troubled waters when you are awake. Just allow me to do my job caring for you. Ask all the questions you want and I will answer them honestly, but when I do, please do not doubt my intentions. If I see the need for a second opinion, I will be the first one to tell you so as I will never allow my ego to interfere with your well-being.
Here are pictures of a very courageous lady who has allowed me such trust.
Warning: the following photographs are graphic in nature. If you wish to procede click on the link below.
Click here to view photograghs of "fat necrosis"
"Result at three months following scar revision"
It is easy to see the potentially disastrous sequence of events that inexperience on the part of the surgeon (or other health care professionals) can cause. The frequently used "shotgun" approach of calling every wound an infection and treating the patient with antibiotics and many visits to the operating room for debridement (excision of dead tissues) is, in my opinion, the wrong thing to do because: 1) Antibiotics when used carelessly are responsible for the emergence of resistant organisms and 2) the manipulation of tissues struggling to survive when blood supply is precarious will lead to further tissue death. I have personally reviewed too many cases where this unfortunate cycle of misguided steps has happened, to the detriment of the patient.
One can argue that if on the other hand an infection is missed, the consequences can be as dire. This is true. Other than the unmistakable signs of systemic infection, the only safeguard against this happening is the surgeon's experience and clinical accumen. This is where trust plays its fundamental role as the approach to the two conditions (infection on one hand and to fat necrosis on the other) are diametrically opposite.
Dr. Anous is a board-certified plastic surgeon who has developed a unique type of abdominoplasty and is considered one of the best Tummy Tuck surgeons. Use this website to learn all about this procedure.