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Tummy Tuck (Abdominoplasty)

Women and men who have loose abdominal skin and fat that is concentrated in the abdomen can benefit from abdominoplasty. Sometimes these conditions are inherited. In other instances, substantial weight loss may cause abdominal skin to become flaccid. Abdominoplasty also can tighten muscles that have been separated and weakened by pregnancy. The procedure may partially improve stretchmarks, especially those located below the navel.

EVALUATION

You may be a good candidate for abdominoplasty if you have one or more of the following conditions:

-excess or sagging abdominal skin

-an abdomen that protrudes and is out of proportion to the rest of your body

-abdominal muscles that have been separated and weakened

-excess fatty tissue that is concentrated in your abdomen.

Certain individuals who carry excessive fatty deposits inside their abdomen may have a protuberant and firm abdomen. These persons may not be a good candidate for abdominoplasty.

Your plastic surgeon will examine you while you are standing. Your skin tone and the degree of loose skin in the abdominal region will be assessed. The amount of excess fat, the location of the fat (just below the skin or deep beneath the muscles), and the condition of your abdominal muscles will be assessed.

You should come prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries, and medications that you currently take. It is important for you to provide complete information.

SURGICAL TECHNIQUE

Individual factors and personal preferences will determine the specific technique selected to smooth and flatten your abdomen. Generally, a horizontal incision is placed just within or above the pubic area. The length of the incision will vary somewhat according to the structure of your abdomen and the style of bathing suit or undergarments that you prefer. Your plastic surgeon will try to keep the incision within your bathing suit lines, but this may not always be possible.

Some patients have loose skin above the navel. In such cases, the surgeon may make a second incision around the navel so that the redundant skin above it can be pulled down. The excess abdominal skin is then removed. The position of the navel remains unchanged,

Skin of the lower abdomen that contains stretch marks may be removed as well. Any remaining stretch marks may be repositioned into the lower abdomen, possibly improving their appearance.

The underlying muscle is frequently tightened, especially in women who have had children. Usually strong permanent sutures are used to bring the muscle back into the midline. This tightening of the muscles can help to improve the overall flatness of the abdomen.

There are many variations both to the design of the incisions and the technique itself. In some instances, it may be possible to avoid an incision around the navel when there is minimal laxity of skin above the navel. In this situation, liposuction is frequently employed to reduce the fatty deposits above and around the navel. This is known as a mini or modified abdominoplasty.

RISKS AND COMPLICATIONS

Fortunately, significant complications from breast lifting surgery are infrequent. Every year, many thousands of women undergo successful breast lifting surgery, experience no major problems and are pleased with the results.

Some of the potential complications that may be discussed with you include bleeding, infection and reactions to anesthesia. Tissue loss along portions of the horizontal incision is a possibility when the abdominoplasty is very extensive. This complication, which delays healing and prolongs recovery, is more common in patients who smoke or have medical conditions such as diabetes. Revisionary surgery is sometimes helpful in certain instances where incisions may have healed poorly.

Following surgery, occasionally, fluid may accumulate under the skin. Removal of this serum is a painless process but may require several visits to the plastic surgeon’s office.

You can help lessen certain risks by following the advice and instructions of your plastic surgeon, both before and after surgery.

PREPARATION FOR SURGERY

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Abdominoplasty surgery will be performed on an outpatient basis. You will need someone to drive you home and stay with you overnight and the next day to drive you to your surgeon’s office. Alternatively, there are aftercare facilities available that specialize in the care of plastic surgery patients for one or more days after their surgery. These facilities are operated inside hotels located nearby the surgery center, and staffed by registered nurses.

SURGERY

The goal of your plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

Your surgery will be performed in a fully accredited outpatient surgery center in the same building as your surgeon’s office. A general anesthetic is administered, so that you will be asleep throughout the procedure. Afterward, you will be taken into a recovery area where you will continue to be closely monitored for about one to two hours.

Small drain tubes will have been placed below the abdominal skin to help avoid accumulation of fluids. Gauze dressings will be applied to your abdomen and covered with tape and an elastic binder. You will have a second set of smaller tubes that have also been placed under the skin. Attached to these tubes is a pump that will continuously administer an anesthetic medication for three days, significantly decreasing discomfort. Once cleared by the recovery room nurse, you will be allowed to go home or to an aftercare facility overnight.

RECOVERY

The day after surgery, you will be encouraged to get out of bed for short walks to promote blood circulation. Although you may not be able to stand up completely straight, it is best if you do not sit for long periods of time during the first several days. Straining, bending, and lifting must be avoided, since these activities might cause increased swelling or even bleeding. You may be instructed to sleep on your back with a pillow under your knees.

On your first day after surgery, you will return to your plastic surgeon’s office to remove your dressings and general evaluation. Thin tape will cover your incisions only. On your third day after surgery, you will return to your plastic surgeon’s office for removal of the anesthetic pump catheter, which is a painless procedure. The remaining drain tubes usually are removed 7 to 9 days after surgery. You will keep your compression binder on for one to two weeks after that. Paper tape will cover your incisions for 3 to 4 weeks. All sutures are buried, and need not be removed.

You will notice swelling, which is to be expected. Much of the swelling will disappear over a period of weeks, however, it may be months before all swelling subsides and you see the final result of your abdominoplasty. You may also notice some numbness over portions of the abdominal area, and this may persist for several months. Incisions will initially be red of pink in color. They will remain this way for many months following surgery and may even appear to worsen before they finally begin to fade.

The amount of time it takes for recovery varies greatly among individuals. Depending on the extent of your abdominoplasty and your general physical condition, you may be able to return to non-strenuous work anywhere from one to three weeks after surgery. In many instances, you can resume most of your normal activities, including some form of mild exercise, after a few weeks. You may continue to experience some mild, periodic discomfort and swelling during this time, but such feelings are normal. Severe pain should be reported to your doctor.

RESULTS

Abdominoplasty will enhance your body contour by making your abdomen firmer and flatter. You may find that you feel more comfortable in your clothing and are more confident about your appearance.

The incisions from the procedure will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible. In some instances, they will eventually be only faint lines. Certain individuals may have incision lines that are more noticeable. Fortunately, the incisionsyou’re your abdominoplasty are usually in locations concealed by most bathing suits and undergarments.

Unless you gain or lose a significant amount of weight or become pregnant, your abdomen should remain firmer and flatter for many years. However, gravity and the effects of aging will eventually take their toll. If, after a period of years, you become dissatisfied with the appearance of your abdomen, you may choose to undergo a second procedure to restore a more youthful body contour.