If
you're considering abdominoplasty …
Abdominoplasty, known more commonly as a
"tummy tuck," is a major surgical procedure to remove excess
skin and fat from the middle and lower abdomen and to tighten the
muscles of the abdomen wall. The procedure can dramatically reduce the
appearance of a protruding abdomen. But bear in mind, it does produce
a permanent scar, which, depending on the extent of the original
problem and the surgery required to correct it, can extend from hip to
hip.
If you're considering abdominoplasty, this
will give you a basic understanding of the procedure - when it can
help, how it's performed, and what results you can expect. It can't
answer all of your questions, since a lot depends on the individual
patient and the surgeon. Please ask your surgeon about anything you
don't understand.
The best candidates for abdominoplasty
The best candidates for abdominoplasty are
men or women who are in relatively good shape but are bothered by a
large fat deposit or loose abdominal skin that won't respond to diet
or exercise. The surgery is particularly helpful to women who, through
multiple pregnancies, have stretched their abdominal muscles and skin
beyond the point where they can return to normal. Loss of skin
elasticity in older patients, which frequently occurs with slight
obesity, can also be improved.
Patients who intend to lose a lot of weight
should postpone the surgery. Also, women who plan future pregnancies
should wait, as vertical muscles in the abdomen that are tightened
during surgery can separate again during pregnancy. If you have
scarring from previous abdominal surgery, your doctor may recommend
against abdominoplasty or may caution you that scars could be
unusually prominent.
Abdominoplasty can enhance your appearance
and your self-confidence, but it won't necessarily change your looks
to match your ideal or cause other people to treat you differently.
Before you decide to have surgery, think carefully about your
expectations and discuss them with your surgeon.
All surgery carries some uncertainty and
risk
Thousands of abdominoplasties are performed
successfully each year. When done by a qualified plastic surgeon who
is trained in body contouring, the results are generally quite
positive. Nevertheless, there are always risks associated with surgery
and specific complications associated with this procedure.
Post-operative complications, such as
infection and blood clots are rare but can occur. Infection can be
treated with drainage and antibiotics but will prolong your hospital
stay. You can minimize the risk of blood clots by moving around as
soon after the surgery as possible.
Poor healing, which results in conspicuous
scars, may necessitate a second operation. Smokers should be advised
to stop, as smoking may increase the risk of complications and delay
healing.
You can reduce your risk of complications by
closely following your surgeon's instructions before and after the
surgery, especially with regard to when and how you should resume
physical activity.
Planning your surgery
In your initial consultation, your surgeon
will evaluate your health, determine the extent of fat deposits in
your abdominal region, and carefully assess your skin tone. Be sure to
tell your surgeon if you smoke and if you're taking any medications,
vitamins or other drugs.
Be frank in discussing your expectations with
your surgeon. He or she should be equally frank with you, describing
your alternatives, and the risks and limitations of each.
If, for example, your fat deposits are
limited to the area below the navel, you may require a less complex
procedure called a partial abdominoplasty, also known as a
"mini-tummy tuck," which can often be performed on an
outpatient basis. You may, on the other hand, benefit more from
partial or complete abdominoplasty done in conjunction with
liposuction to remove fat deposits from the hips, for a better body
contour. Or maybe liposuction alone would create the best result.
In any case, your surgeon should work with
you to recommend the procedure that is right for you and will come
closest to producing the desired body contour.
During the consultation, your surgeon should
also explain the anesthesia he or she will use, the type of facility
where the surgery will be performed, and the costs involved. In most
cases, health insurance policies do not cover the cost of
abdominoplasty, but you should check your policy to be sure.
Preparing for your surgery
Your surgeon will give you specific
instructions on how to prepare for surgery, including guidelines on
eating and drinking, smoking, and taking or avoiding certain vitamins
and medications.
If you smoke, plan to quit at least one to
two weeks before your surgery and not to resume for at least two weeks
after your surgery. Avoid overexposure to the sun before surgery,
especially to your abdomen, and do not go on a stringent diet, as both
can inhibit your ability to heal. If you develop a cold or infection
of any kind, your surgery will probably be postponed.
Whether your surgery is done on an outpatient
or inpatient basis, you should arrange for someone to drive you home
after your surgery, and to help you out for a day or two after you
leave the hospital, if needed.
Where your surgery will be performed
Many surgeons perform both partial and
complete abdominoplasties in an outpatient surgical center or an
office-based facility. Others prefer the hospital, where their
patients can stay for several days.
Types of anesthesia
Your doctor may select general anesthesia, so
you'll sleep through the operation.
Other surgeons use local anesthesia combined
with a sedative to make you drowsy. You'll be awake but relaxed, and
your abdominal region will be insensitive to pain. (However, you may
feel some tugging or occasional discomfort.)
The surgery
Complete abdominoplasty usually takes two to
five hours, depending on the extent of work required. Partial
abdominoplasty may take an hour or two.
 |
| An
incision just above the pubic area is used to remove
excess skin and fat from the middle and lower abdomen. |
|
Most commonly, the surgeon will make a long
incision from hipbone to hipbone, just above the pubic area. A second
incision is made to free the navel from surrounding tissue. With
partial abdominoplasty, the incision is much shorter and the navel may
not be moved, although it may be pulled into an unnatural shape as the
skin is tightened and stitched.
 |
| Skin
is separated from the abdominal wall all the way up to
the ribs. |
|
Next, the surgeon separates the skin from the
abdominal wall all the way up to your ribs and lifts a large skin flap
to reveal the vertical muscles in your abdomen. These muscles are
tightened by pulling them close together and stitching them into their
new position. This provides a firmer abdominal wall and narrows the
waistline.
 |
| The
surgeon draws underlying muscle and tissue together
and stitches them, thereby narrowing the waistline and
strengthening the abdominal wall. |
|
The skin flap is then stretched down and the
extra skin is removed. A new hole is cut for your navel, which is then
stitched in place. Finally, the incisions will be stitched, dressings
will be applied, and a temporary tube may be inserted to drain excess
fluid from the surgical site.
 |
| Abdominal
skin is drawn down and excess is removed. With
complete abdominoplasty, a new opening is cut for the
navel. Both incisions are stitched closed. |
|
In partial abdominoplasty, the skin is
separated only between the incision line and the navel. This skin flap
is stretched down, the excess is removed, and the flap is stitched
back into place.
After your surgery
For the first few days, your abdomen will
probably be swollen and you're likely to feel some pain and discomfort
that can be controlled by medication. Depending on the extent of the
surgery, you may be released within a few hours or you may have to
remain hospitalized for two to three days.
Your doctor will give you instructions for
showering and changing your dressings. And though you may not be able
to stand straight at first, you should start walking as soon as
possible.
Surface stitches will be removed in five to
seven days, and deeper sutures, with ends that protrude through the
skin, will come out in two to three weeks. The dressing on your
incision may be replaced by a support garment.
Getting back to normal
It may take you weeks or months to feel like
your old self again. If you start out in top physical condition with
strong abdominal muscles, recovery from abdominoplasty will be much
faster. Some people return to work after two weeks, while others take
three or four weeks to rest and recuperate.
Exercise will help you heal better. Even
people who have never exercised before should begin an exercise
program to reduce swelling, lower the chance of blood clots, and tone
muscles. Vigorous exercise, however, should be avoided until you can
do it comfortably.
Your scars may actually appear to worsen
during the first three to six months as they heal, but this is normal.
Expect it to take nine months to a year before your scars flatten out
and lighten in color. While they'll never disappear completely,
abdominal scars will not show under most clothing, even under bathing
suits.
Your new look
Abdominoplasty, whether partial or complete,
produces excellent results for patients with weakened abdominal
muscles or excess skin. And in most cases, the results are long
lasting if you follow a balanced diet and exercise regularly.
 |
| After
surgery, the patient has a flatter, trimmer abdomen.
Scars are permanent but will fade with time. |
|
If you're realistic in your expectations and
prepared for the consequences of a permanent scar and a lengthy
recovery period, abdominoplasty may be just the answer for you.
