Woman looking at a picture featuring scars from hysterectomy surgery

Scars From Hysterectomy: What Will Yours Look Like?

Surgeries

How your scars from hysterectomy surgery will look depends on two main factors. One is which hysterectomy technique is used because that determines where the surgical incisions will be made. Some techniques place scars on the abdomen while other hysterectomy scars are not visible at all because the procedure is done completely through the vagina. Other techniques use incisions that are made on the abdomen. With these techniques, the quality with which the scars from hysterectomy procedures heal makes all the difference. Will they be flat, thin, and subtle? Or will they be raised, red, and thick? Read on to learn everything you need to know about hysterectomy scars and how yours might heal.

Hysterectomy Scars: Where Will They Be?

In this article, we’ll focus on scars from hysterectomies that are on the abdomen because it’s these that can be of cosmetic concern to patients. There are two main categories of hysterectomy surgeries done through the abdomen: open abdominal hysterectomies and laparoscopic abdominal hysterectomies. Keep in mind that different medical conditions can call for different hysterectomy techniques. It is not necessarily as simple as “choosing” one over the other for either the patient ot the doctor.

Open Abdominal Hysterectomy Scars

Scars from hysterectomy procedures done “open” are around 6 to 12 inches in length and are either placed low down and across the waistline or vertically from the belly button downwards toward the middle of the waistline. These hysterectomies are called “open” because the incisions are made long enough to allow the surgeon’s hands to enter the pelvic cavity.

This approach is generally used if:

  • the operation is intended to also remove the ovaries and fallopian tubes
  • the uterus is enlarged a lot
  • when large fibroids are present
  • when access is needed to the areas around the uterus such as for endometriosis or cancer that has spread outside of the uterus itself

Transverse Versus Vertical Hysterectomy Scars

Scars from hysterectomy surgery placed horizontally are cosmetically preferable to those made vertically especially if they heal less than ideally. This is because the lower incision makes it easier to hide the hysterectomy scar. But a gynecologist may need to use the vertical incision in certain cases. Reasons that a vertical incision may be needed generally relate to a need for greater access into the pelvic cavity. These include:

  • endometriosis or uterine cancer that has spread into the pelvis
  • large fibroids
  • if there is scarring on the abdomen/pelvis from previous surgeries

Laparoscopic Abdominal Hysterectomy Scars

In laparoscopic surgery, very small incisions are made in the skin to allow insertion of a variety of narrow surgical instruments that are used to perform the procedure. The surgeon’s hands never enter the body. Scars from hysterectomy procedures done laparoscopically can vary in number from one to around five depending on the techniques used. Laparoscopic surgeries leave less small scars, have less post-operative pain, and have quicker recoveries compared to open procedures. But laparoscopic surgery can’t be used in all cases, with some potential limitations for cancer surgery in particular.

Animation of laparoscopic hysterectomy scar placement on the abdomen
Laparoscopic hysterectomy scars are smaller than for open procedures. There can be up to 5 scars from hysterectomy surgery done this way.

Robotic Abdominal Hysterectomy Scars

A relatively new technique called robotic hysterectomy is a highly specialized type of laparoscopic abdominal hysterectomy. This procedure uses 3D magnification and extremely narrow instruments that leave between one to five hysterectomy scars depending on the training of the surgeon and the reason the procedure is being done. Robotic hysterectomy requires very specialized training by the surgeon and may also not be applicable to all hysterectomy cases.

Animation of a robotic hysterectomy scar
In very particular cases there can be as few as one robotic hysterectomy scar

How Will Your Scars From Hysterectomy Surgery Heal?

We’ve looked at where hysterectomy scars are left on the abdomen with different surgical techniques. But, incision placement is only half of the scarring equation, the other being scar quality. When it comes to deciphering how your hysterectomy scars will actually look, there are three main factors to consider: surgeon selection, personal healing tendencies, and a complication-free healing process.

Scars From Hysterectomy Surgery: Surgeon Selection

Hysterectomies are performed by specialists designated as obstetrician-gynecologists, gynecologic surgeons, or gynecologic oncologists. If you need a hysterectomy, choosing a board-certified gynecologist that performs a lot of hysterectomies is a must. Take the time to discuss which technique (abdominal, vaginal, open, laparoscopic) is planned and why that choice has been made. Experienced, board-certified surgeons that perform many hysterectomies will know how to minimize risks associated with the procedure. They will also be trained in skin closure techniques that are designed to optimize scars from a hysterectomy surgery.

Personal Healing Tendencies Always Make A Difference

Even the most skilled and experienced surgeons can’t fully control what your scars will look like. This is because scar outcomes rely heavily on an exceedingly complex brew of variables such as skin tone, ethnicity, family history, and many others that are outside of the surgeon’s control. To understand what types of scars from hysterectomy procedures are possible, it’s worth reviewing the four main types of scars people can form from any surgery:

Type Of ScarWhat They Look LikeExample
normal/maturefine, flat and blend well “good scars”Normal breast implant scar that is fine and flat
hypertrophicraised, red and thicker type of scar
keloidconsidered the worst scars extensively raised, thick, discolored; grow far outside the area of the injury to the skinKeloid skin scar that is very raised thick red and raised
widespreadflat, pale, wide, and stretched scarsA wide flat stretched skin scar

Scars from hysterectomy surgeries can turn out normal, hypertrophic, keloid, or widespread. It’s not possible for any surgeon to know for sure how a patient’s scars will turn out because different people can heal so differently. You can use the Hysterectomy Scar Calculator to get a better idea of how your own scars are likely to turn out. Everything else being equal, most surgeons will choose the technique that places the fewest or best-hidden scars. But in some cases, that’s not possible so personal healing tendencies play a bigger role in final hysterectomy scar results.

Scars From Hysterectomy: After-Care

If you want your scars to heal as well as possible, the importance of proper after-care can’t be overstated. Any complication that delays healing, or causes stitches to open can have a very negative impact on final scar quality. So, doing everything you can to ensure a smooth, complication-free healing process will definitely improve your chances of optimal scar outcomes. Gynecologists have differing post-operative protocols, but some important points to keep in mind, according to the Mt Sinai Hospital (Toronto, Canada) Gynecology Program are:

  • watch for signs of infection such as increasing redness and warmth around the incision, wound discharge, and fever
  • don’t do anything strenuous for 6 weeks after surgery including lifting grocery bags, vacuum cleaners, suitcases, and children
  • do not have sexual intercourse or insert anything into the vagina for six weeks or as instructed by your surgeon (including tampons and douches)
  • avoid swimming or tub bathing until you see your doctor 
  • avoiding constipation is important because straining can cause healing complications, especially stitches bursting open internally and on the skin
  • once you go home, eat more dietary fibre and drink lots of water to help prevent constipation

Conclusion:

Hysterectomy is currently one of the most common elective surgical procedures worldwide. While the procedure is not considered “cosmetic”, many women are concerned with the esthetic impact that scars from a hysterectomy surgery will have on their tummies. Where hysterectomy scars will end up on the abdominal wall depends on the technique used which, in turn, depends on the reason the surgery is being performed and the comfort level a surgeon has with performing less invasive techniques such as laparoscopic and robotic hysterectomies. Steps every patient can take toward optimizing their own scarring outcomes include choosing a board-certified gynecologist and following post-operative instructions to a tee. Personal healing tendencies will always play a major role in determining final outcomes with respect to scars from surgery. Due to the complex nature of the healing process, determining how any one individual will scar is a very complex and challenging process.

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