What Is A Tummy Tuck Scar Tissue

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Are you considering a tummy tuck procedure but getting worried about the subsequent scarring on the abdomen? It's normal to have concerns when undergoing any surgical procedure. While scars are an inevitable result of most surgical procedures, being well-informed can help you set realistic expectations for your cosmetic outcome and also for your recovery. 

This article goes into the evidence to simplify and show you the types of scars that can form after a tummy tuck surgery, what influences their appearance, evidence-based scar management tips, patient experiences, and more. Read on for a deeper understanding of tummy tuck scar tissue formation.

Introduction

A tummy tuck (also called abdominoplasty) is a surgical procedure that removes excess skin and fat from the abdominal region and tightens the underlying muscles. It is important to note that it is not medically ideal for everyone, and it is a procedure that is only recommended for people with a healthy body mass index (BMI).

The procedure however results in a desired and more aesthetically pleasing, slim and toned look. But this reshaping surgery comes with incisions that will heal and form permanent scars. The good news is that these scars can fade and flatten over time, and learning about the wound healing process provides insight into how to properly care for your scars to help them do just that. With realistic expectations and proper aftercare, the visibility of tummy tuck scars can be minimized for optimal cosmetic results.

Definition of tummy tuck scar tissue

The process of a tummy tuck requires incisions to be made to the lower abdomen that will heal as scars on the surface of the skin. This scar tissue is no different from what forms during the body's natural wound-healing response when you have a normal injury.1

Importance of understanding tummy tuck scar tissue

It is advisable to have adequate knowledge of preparedness and diligent scar aftercare, which would help you to effectively manage scarring for the best possible cosmetic outcome.

This article will provide you with the appropriate knowledge on tummy tuck scarring to help you with your pre-operative planning, recovery expectations, and scar management.

Tummy tuck surgery overview

Explanation of tummy tuck procedure

A full tummy tuck involves an incision from one hip to the other hip, just above the pubic area. The navel is detached and repositioned. Excess skin is removed and abdominal muscles are tightened. The navel is then placed and sutured, and the remaining skin edges are then sutured together.2

Common reasons for undergoing tummy tuck

Common reasons include:3

  • To remove loose, sagging skin after major weight loss, pregnancy, or for aesthetic reasons
  • To repair abdominal muscles diastasis
  • To remove stretch marks
  • To alleviate pain in rare cases

Prevalence of tummy tuck surgeries

The trends in the rates of tummy tucks being performed around the world are on the rise. Between 2019 and 2020, the rate of occurrence of cosmetic surgeries including tummy tucks in America increased by 19%.4 Between 2010 and 2022, it was also one of the top-performed surgical procedures in the UK.5

Who should avoid a tummy tuck procedure?

While abdominoplasty can improve aesthetics, the surgery is not appropriate for everyone. It may not be appropriate for you if;6

  1. You are overweight or with a higher BMI than the normal range
  2. People with certain medical conditions that impair wound healing like diabetes may be advised to postpone surgery as well
  3. Women planning future pregnancies are typically encouraged to wait until after childbearing to undergo a tummy tuck as subsequent pregnancies can reverse the results
  4. Lastly, individuals struggling with body dysmorphic disorder, eating disorders, depression, or adjusting to large weight loss may not be suitable candidates psychologically

How scar tissue forms

Wound healing process

Inflammatory phase

In the beginning, when your body's healing process starts, it brings more blood to the area, which may cause some swelling. This is your body's way of cleaning the wound and preventing infection.

Proliferative phase

After that, your body starts building new tissue with tiny blood vessels and collagen. This is called granulation tissue.1 This is best thought of like your body is knitting together to repair the wound. As it does this, the wound becomes smaller.

Remodelling phase

Finally, collagen continues remodelling to maximum strength over months to years.1

How scar tissue differs from normal skin

The resulting scar tissue that is formed is like a patch-up job. It is made of a kind of collagen that's packed closely together, and it doesn't have things like hair follicles or other normal skin structures.7 Therefore, it might look and feel a bit different from the rest of your skin.

Tummy tuck scar types

Hypertrophic scars

These are scars that become thickened, discoloured and raised above the skin surface.7 These scars have a poor cosmetic appearance.

Keloid scars

These are scars that aggressively grow beyond the original boundaries of the initial wound.7 These have also had a poor cosmetic outcome.

Linear scars

These are planned straight incision lines made during surgery, which typically heal well and fade away with time, providing good cosmetic outcomes.7

Widespread scarring

Extensive scarring can occur with complications like wound separation/dehiscence.7

Factors affecting scar tissue formation

Genetics

It has been discovered that some people have a propensity for hypertrophic or keloid scarring due to their genetic links.7

Skin type and colour

People with darker skin have been shown to be more prone to hyperpigmentation and keloid scarring.7

Surgical technique

Part of what forms the outcome of the surgical scar is the technique that is used by the surgeon in closing the wound. Closure methods affect the outcome, while more precise technique minimizes scarring.7

Postoperative care

Proper incision management encourages optimal, minimal scarring.7

Management and prevention

Scar management techniques

  1. Silicone sheets - Silicone sheets hydrate and compress scars, making for a better cosmetic appearance8
  2. Topical steroid Creams and Injections - Steroid creams/injections can flatten hypertrophic and keloid scars8
  3. Laser therapy - Vascular lasers can reduce the redness and thickness of the scar8

Prevention strategies

  1. Proper incision care - Scars are to be kept clean, aseptic, and protected with dressings8
  2. Sun protection - Sun exposure can worsen scars. The use of sunscreen and protective clothing are therefore advisable preventative measures8
  3. Nutritional support - Foods rich in vitamin C (such as citrus fruits) and vitamin E (such as avocados and seafood) support healthy wound healing8
  4. Follow-up with surgeon - See your surgeon to monitor your scars and to intervene if needed8

Long-term effects of tummy tuck scar tissue

Physical implications

  1. Scar tightness - Scar tissue contracts over time and this can cause tightness or discomfort, especially with activity9
  2. Numbness - Nerve damage during surgery causes permanent numbness in scarred areas9
  3. Discomfort - Some patients experience ongoing pain or itching of the scars9 

Psychological implications

  1. Body image concerns - Having very visible scars can negatively impact self-image, requiring emotional adjustment10
  2. Self-esteem - Coping with scarring elicits complex feelings that may affect confidence and self-worth10
  3. Emotional well-being - Anxiety, depression or other issues may arise when scars worsen in appearance10 

Summary

Recap of tummy tuck scar tissue

Scars are an unavoidable result of the incisions made during abdominoplasty procedures. Understanding the processes involved in the formation of scars will help you to properly care for scar tissue and would impact cosmetic outcomes both in the long term and short term.

Importance of informed decision-making

Having realistic expectations of scarring, and all the possible complications and possible outcomes helps patients to be more adequately prepared both emotionally and physically for the procedure, and life after the procedure.

Encouragement for seeking professional advice

It is however very important to note that consulting a board-certified plastic surgeon to discuss strategies for minimizing your scars through surgical technique, prevention strategies, and scar management is the safest and most highly recommended course of action.

References

  1. Alhajj M, Goyal A. Physiology, granulation tissue. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Oct 25]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK554402/
  2. Choo AMH, Ong YS, Issa F. Scar assessment tools: how do they compare? Frontiers in Surgery [Internet]. 2021 [cited 2023 Oct 25];8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8260845/
  3. Bayat A, McGrouther DA, Ferguson MWJ. Skin scarring. BMJ [Internet]. 2003 Jan 11 [cited 2023 Oct 25];326(7380):88–92. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1125033/
  4. Rosen RD, Manna B. Wound dehiscence. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Oct 25]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK551712/
  5. He Y, Deng Z, Alghamdi M, Lu L, Fear MW, He L. From genetics to epigenetics: new insights into keloid scarring. Cell Prolif [Internet]. 2017 Jan 5 [cited 2023 Oct 25];50(2):e12326. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6529126/
  6. Markiewicz E, Karaman-Jurukovska N, Mammone T, Idowu OC. Post-inflammatory hyperpigmentation in dark skin: molecular mechanism and skincare implications. Clin Cosmet Investig Dermatol [Internet]. 2022 Nov 25 [cited 2023 Oct 25];15:2555–65. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9709857/
  7. Azmat CE, Council M. Wound closure techniques. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Oct 25]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK470598/
  8. Son D, Harijan A. Overview of surgical scar prevention and management. J Korean Med Sci [Internet]. 2014 Jun [cited 2023 Oct 25];29(6):751–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4055805/
  9. Meaume S, Le Pillouer-Prost A, Richert B, Roseeuw D, Vadoud J. Management of scars: updated practical guidelines and use of silicones. Eur J Dermatol [Internet]. 2014 Jul 1 [cited 2023 Oct 25];24(4):435–43. Available from: https://doi.org/10.1684/ejd.2014.2356
  10. Ziolkowski N, Kitto SC, Jeong D, Zuccaro J, Adams-Webber T, Miroshnychenko A, et al. Psychosocial and quality of life impact of scars in the surgical, traumatic and burn populations: a scoping review protocol. BMJ Open [Internet]. 2019 Jun 1 [cited 2023 Oct 26];9(6):e021289. Available from: https://bmjopen.bmj.com/content/9/6/e021289

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Babasola Olaoluwa David

MBBS Babcock, University, Nigeria
MPH, University Of York, UK

David is a seasoned and compassionate medical professional with several years of experience providing exemplary patient care. While earning his medical degree in Nigeria, he honed his skills
during internships in India. As a licensed physician in Nigeria, David has worked in leading hospitals and clinics in the country. In his pursuit for further knowledge, he gained a Master’s degree in Public Health from the University of York.

David is passionate about using his medical knowledge to equip people with the ability to boost the quality of their lives by taking control of their health.

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