Abdominoplasty

Abdominoplasty, commonly called a tummy tuck, is a surgical procedure performed by a plastic surgeon on the abdomen for removing excess skin and fat from the abdomen, tightening and flattening the abdominal muscles, and improving scars in the lower abdomen. It is often combined with liposuction of the flanks or other areas.

Loose abdominal skin and muscle can develop following pregnancies. Weight gain followed by weight loss can also result in a layer of loose skin and thinned muscles. Abdominoplasty is designed to improve these conditions. Abdominal wall hernias can also be corrected. Abdominoplasty is not a weight loss technique nor a substitute for a healthy diet and sensible exercise. The best candidates are near their ideal body weight.

The abdominoplasty operation can be performed at the same time as intra-abdominal procedures such as a hysterectomy or tubal ligation or with cosmetic operations on other parts of the body.

The Operation

A complete abdominoplasty is used if maximum correction is required. A horizontal incision is made at the level of the pubic hair, the abdominal muscles are tightened, the umbilicus (belly button) is circumscribed and remains in the same position on the abdominal wall but is brought out through a new skin opening after excess skin and fat are removed. If less correction is needed, a mini-abdominoplasty is performed with a shorter incision and no incision around the umbilicus.

Surgery lasts from one and a half to four hours, depending on the amount of correction required. I perform this type of surgery in a hospital outpatient surgery center or an ambulatory surgical center.

Anesthesia General anesthesia is usually used for these procedures although more limited mini-abdominoplasties can be done under local anesthesia with sedation.

After Surgery

A complete abdominoplasty requires an overnight stay in the hospital. Most patients with more limited abdominoplasties are able to leave the surgical facility several hours after surgery. A friend or relative will need to accompany you and stay with you for the fist 24 hours after surgery.

Drains

One to two drains are used and remain in for 5-10 days following surgery.

Support garments

A compression garment or abdominal binder is used for 3-4 weeks after surgery.

Pain

There is pain in the incision and lower abdomen but this is usually well controlled with the pain medication. The most severe pain subsides within a few days to a week. Some soreness can persist for several weeks. Occasionally some discomfort can last two to three months.

Swelling

Swelling is normal following surgery. The swelling begins to resolve during the second week and is about 75% gone by one month but some swelling may persist above the scar. The remainder mostly recedes in another two months, however, the final result can take six months to achieve.

Scars

After a complete abdominoplasty there is a scar across the lower abdomen and a circular scar around the umbilicus. The scar can also be designed to angle up so it is hidden under a “French cut” bathing suit. There is a more limited scar following a mini-abdominoplasty. The scars tend to fade with time and are usually not troublesome. It usually takes 6-12 months for the scars to mature and reach their final result. Occasionally the scars can become thick and darkly colored and this is not predictable.

Diminished Sensibility

Small nerves to the abdominal skin are disrupted during abdominoplasty and the skin of the lower abdomen will initially feel numb. The sensibility generally returns over several months but some diminished feeling can be permanent.

Physical Restrictions/Return to Work

For the first week or two after surgery some fatigue is usual and more rest than usual is needed. Most people return to regular light activities and work two weeks after surgery. Return to strenuous work will take longer. Heavy lifting and strenuous exercises or sports are not allowed until 6-8 weeks following surgery.

Follow-up

I like to see patients back within the first week after surgery, than at two weeks, four to six weeks and a final check five to six months following surgery.

Complications

All types of surgery have associated complications. The most common complication following abdominoplasty is a hematoma or blood collection under the skin. This occurs about 5% of the time and may require a return to the operating room. A seroma (fluid collection) can also occur and this is usually drained in the office.

Infection and wound healing complications occur less often. Contour irregularities and scar thickening can occur.

Uncommon complications

Serious complications have been reported in the medical literature following abdominoplasty, but fortunately these are infrequent. Pulmonary embolism (a blood clot from the legs traveling to the lung) has been reported to occur one in 400 operations. Obesity is the most common predisposing factor. I use anti-embolism leg or foot pumps to decrease the incidence of this problem, and fortunately we have not seen it in our practice. Skin loss can also occur rarely.

Cigarette smoking

Smoking markedly increases the risk of wound healing problems and other complications. Smokers must stop at least two weeks prior to surgery and not start again for four weeks after surgery.

Following additional pregnancies the abdominal wall can stretch considerably. Therefore, women should wait until they have completed their family before undergoing an abdominoplasty.

The results of an abdominoplasty are generally quite positive when the procedure is used appropriately. Most patients are very pleased with a smoother, flatter, unwrinkled stomach, albeit with a low abdominal scar.

Specific questions and concerns can be addressed with me at the time of the consultation.