This second operation may be motivated by a complication of the surgical procedure, or by an imperfect result.
Complications of the surgical procedure
Any surgical intervention, whether performed for reconstruction purposes or for aesthetic reasons, involves the risks associated with any medical procedure, however minimal it may be.
A distinction must be made between immediate or early complications that appear during or immediately after the surgical procedure (the same day, night or the day after your operation) and which may require your surgeon to re-intervene in emergency and delayed complications that appear with a delay compared to the initial procedure (from a few days to a few months) and for which the re-intervention is usually deferred compared to the surgical procedure.
Immediate or early complications
They require reoperation and are most often complications that must be treated urgently for medical reasons. The reoperation is then necessary for your health.
To ensure your safety, your surgeon and/or anaesthetist may decide to transfer you to a health care facility that is more suitable for the management of this complication than the one where you were initially operated on.
It is necessary to distinguish between complications that can then be reoperated and treated exclusively by your plastic surgeon and those for which he will eventually use the help of a colleague from another specialty.
The main immediate or early complication that can be reoperated by your plastic surgeon is hematoma:
Hematoma: this is an accumulation of blood in the operated area. Hematoma is related to the bleeding of one or more vessels at the operating site that may begin to bleed after the end of the procedure, even if all hemostasis precautions have been taken during the procedure. Signs of a hematoma are excessive tension in the operated area, severe pain and abnormally large blood flow into the drains if drains have been placed. There is no need for additional tests to diagnose a hematoma. Your surgeon will then evaluate whether the bleeding can be stopped and if this hematoma can be evacuated without a reoperation being necessary (stop the bleeding by compression, evacuation of the hematoma through stitches or through the drains in place) or if a reoperation is necessary. In the latter case, the reoperation will be done as soon as possible to stop the bleeding and to remove the accumulated blood.
Immediate or early complications for which your surgeon may need the help of a colleague from another specialty are complications that occur either in the anatomical area operated on by your surgeon or in an organ whose treatment is part of another specialty.
Pneumothorax: it can be observed after surgery on the mammary and thoracic area, or after abdominal or dorsal liposuction.
This is the abnormal presence of air in the pleural cavity between the rib cage and the lung that are normally attached together. In a post-surgical context, pneumothorax is associated with an accidental lesion of the pleura (the membrane that lines the virtual space between the lungs and chest wall).
Digestive perforation: it can be observed after an abdominoplasty or abdominal liposuction.
This is the accidental perforation of the digestive tract either through a weak point in the abdominal wall or when the peritoneum is opened in order to cure a hernia in the abdominal wall.
The reoperation can then be postponed in relation to the surgical procedure. A distinction must be made here between complications whose treatment is imperative either for medical reasons or to avoid a subsequent even more serious complication, and complications whose treatment is intended to improve the aesthetic result and for which reoperation is optional and must be discussed with your surgeon according to the benefit/risk ratio.
The complications that may require treatment are mainly:
Infection of the surgical site. An infection of the surgical site may occur in the days or weeks following the procedure. Signs of infection may include fever, redness, pain and/or swelling at the operated site. The diagnosis of infection can be made without additional examination if there is certainty after the clinical examination, but a biological check-up or imaging examinations can also be used. Antibiotic treatment is usually sufficient, but reoperation may sometimes be necessary.
Seroma: This is an accumulation of lymphatic fluid at the operated site. The diagnosis is made by clinical examination and possibly ultrasound. Most of the time, the treatment is a puncture through the skin but in very rare cases a reoperation may be necessary.
Skin necrosis is the result of a lack of tissue oxygenation that can be promoted by excessive tension, hematoma, infection or heavy smoking. Skin necrosis can be treated by "directed healing".
i.e. by appropriate bandages or it may require reoperation to remove it, especially in the presence of implants to avoid the risk of infection.
Complications specific to breast implants: formation of "folds" or "waves", shell, rupture, malposition, displacement, rotation, deformation of the chest wall, late seroma. These specific complications may require remote reoperation.
Complications whose treatment meets the objective of improving the aesthetic result and for which reoperation is optional.
Healing disorders: enlarged, retractable, adherent, hyper or hypopigmented, hypertrophic (swollen) or even keloid scars
Nerve damage leading to paresis or even paralysis.
Duration of hospital stay
1 – 3 days.
your surgeon and the anaesthetist will tell you what type of anaesthesia they think is most appropriate.
Average length of stay
to be defined with the surgeon."
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In the event of a surgical complication whose treatment is imperative, either for medical reasons or to avoid a more serious subsequent complication, and whether immediate, early or delayed, reoperation is necessary for your health, and your surgeon will advise you to have reoperation.
In the event of a surgical complication whose treatment is intended to improve the aesthetic result or in the event of an imperfect result, reoperation is optional and responds to a request from you. The indication of this reoperation will be discussed with your surgeon according to the benefit that can be expected from this reoperation in relation to its risks. Your surgeon may then advise against reoperation.
In the event of a surgical complication requiring urgent reoperation, the preoperative check-up carried out before the first operation is sufficient. It may be supplemented, if necessary, by examinations used to diagnose and assess the complication. There is also no need for a new anaesthesia consultation. In case of extreme emergency, you can be operated again even if you are not fasting.
In case of delayed surgical complication or imperfect results, a new preoperative check-up and a new anaesthesia consultation will be necessary.
No medication containing aspirin should be taken within 10 days of the procedure.
Type of anesthesia
Depending on the context and indication for surgical resumption, the procedure may be performed under general anesthesia, deep local anesthesia with tranquilizers administered intravenously ("vigilant" anesthesia) or under pure local anesthesia.
In case of emergency, your surgeon and the anesthesiologist will advise you on the type of anesthesia that they think is most appropriate and that they recommend.
In the absence of urgency, the choice between these different techniques will be the result of a discussion between you, the surgeon and the anesthesiologist.
Depending on the context and the indication of the surgical recovery, the operation may be performed "externally", i.e. with an entry just before the operation and a discharge just after the operation as an "ambulatory", i.e. with a discharge the same day after a few hours of supervision or with hospitalisation.
Each surgeon adopts procedures that are specific to him/her and that he/she adapts to each case.
Most of the time, the initial incisions will be repeated, but there may be exceptions to this rule, which your surgeon will inform you of before the procedure.
Except in the case of pure local anaesthesia, it is essential to remain fasting 6 to 7 hours before the operation.
The operative consequences after a reoperation depend mainly on the indication of the surgical recovery and cannot be systematized. Your surgeon will describe them to you on a case-by-case basis.
However, in the event of "adjustment" for imperfect results, the postoperative consequences are generally much simpler and faster than during the initial operation.
During a surgical recovery as well as during a first operation, the result is often only perfectly visible and appreciable after a period of 3 to 6 months, or even after a year of evolution.
In the event of a surgical complication, the aesthetic result may be identical to that which would have been expected in the absence of a surgical complication, but may also be temporarily or permanently altered. The purpose of the surgical resumption is to reduce this risk as much as possible, but an alteration of the initial result cannot be ruled out.
MEDICAIM organizes your entire stay for you: post-operative nursing care, biological follow-up, therapeutic, nutritional and psychological support.
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