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Tubal Reversal and Scar Tissue: Should You Be Concerned?

Tubal Reversal and Scar Tissue
Will scar tissue be a problem?

Tubal reversal surgery and scar tissue: Will your reversal be successful?


Laparoscopic instrument showing normal uterus without scar tissue present.

Tubal reversal surgery can be more difficult when scar tissue is present. The most common cause of scar tissue is C-section surgery.

Most women who have C-sections will not have scar tissue; however, some women can develop significant scar tissue after c-section surgery. The more C-sections a woman has then the greater the chance of forming scar tissue.

Scar tissue caused by  C-sections can make tubal reversal surgery much more difficult.

In our experience, most women with a history of C-section are good candidates for tubal reversal surgery.

To increase the success of reversal surgery, we offer patients screening laparoscopy. A screening laparoscopy is a nice insurance policy when planning tubal reversal surgery and scar tissue is possible.

Tubal reversal and scar tissue: What is the chance of scar tissue after a C-section?


Arrow demonstrates uterus scarred to abdominal muscles

C-sections and tubal ligations are common surgeries. Having a C-section increases your risk of having scar tissue.

Scar tissue can be external (immediately underneath the skin incision) or internal (between the uterus and the muscles).

External scar tissue is almost never a problem during tubal reversal surgery, but internal scar tissue can make reversal more difficult.

Internal scar tissue is referred to as adhesions. Internal adhesions (scar tissue) are often described as being:

  • thin and filmy (easy to remove)
  • thick and severe (harder to remove)

Thin adhesions will not increase the risk of surgery. Severe adhesions can increase the difficulty of tubal reversal surgery and may increase the chance one or both tubes cannot be repaired.

Black arrow demonstrates uterus adherent to muscles. Red arrow demonstrates intestines adherent to muscles

Black arrow demonstrates uterus adherent to muscles. Red arrow demonstrates intestinal adhesions.

Most women with C-sections will not have severe scar tissue but as the number of C-sections increases then the chance of having severe scar tissue increases.

Although it is possible to have severe scar tissue with only one C-section it usually takes multiple C-sections to increase the chance of scar tissue formation. Multiple C-sections is defined as having three (3) or more C-sections.

We estimate about 1 out of 15 women with multiple C-sections will have severe scar tissue complicating reversal surgery.

We have performed tubal reversal on women with as many as nine (9) C-sections and have not seen any scar tissue but we have seen severe scar tissue in patients who have had only one (1) C-section.

What increases the risk of scar tissue after a C-section?

The risks of developing severe scar tissue after a C-section are increased by several factors:

  • Having multiple (3 or more) C-sections
  • Classical Cesarean delivery (vertical incision on the uterus)
  • High transverse Cesarean delivery (high transverse incision on the uterus)
  • Pre-existing severe scar tissue diagnosed during Cesarean
  • Poor surgical technique
  • Internal bleeding after Cesarean
  • Infection after Cesarean
  • Maternal obesity (BMI>30)

Most women with a history of C-section will not have severe scar tissue and will be able to have a successful and safe tubal reversal and pregnancy.

Tubal reversal and scar tissue: Our recommendations in patients with a history of C-sections

We recommend patients with a history of C-section send us their C-section and tubal ligation operative report for review.

More information: Who should consider laparoscopy during tubal reversal?


No scar tissue around uterus

Although we can never be certain how a patient heals after their last C-section, a patient has a greater chance of having severe scar tissue if it was present at the time of their C-section/tubal ligation.

We encourage patients with a history of C-section to have a screening laparoscopy during their tubal reversal surgery.

Laparoscopy: Nice insurance policy with tubal reversal and scar tissue

Tubal reversal and scar tissue? A screening laparoscopy is a helpful insurance policy. A screening laparoscopy allows us to examine the uterus and tubes with a small camera inserted through a small incision made inside the umbilicus (belly button).


Black arrow demonstrating uterus adherent to abdominal wall muscles

If the tubes are not repairable then screening laparoscopy patients are offered a refund of their tubal reversal surgical fee.

If severe scar tissue is discovered then a more appropriately placed abdominal  incision can be made to help avoid the scar tissue.

A screening laparoscopy procedure allows patients to obtain a refund if tubal reversal is not possible and can increase the chance of successful reversal if severe scar tissue is diagnosed before making and incision.

For more information on how screening laparoscopy helps increase the chance of reversal success: Tubal Reversal Insurance: Laparoscopy A Great Insurance Policy



Have a Question? Drop Us A Line!

If you are considering reversal surgery and have questions about the procedure, fill in the form below and we'll get back to you as soon as we can! If you would like to speak with a nurse for a Free Consultation then feel free to call us at (919) 977-5050.

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