Tummy Tuck (Abdominoplasty)
In today's figure conscious society, greater attention is directed to the size and shape of our bodies. In an attempt therefore to control any bodily changes which may occur in this respect, we try to make use of exercise and diet to the best of our abilities. However certain areas of our body, in particular the abdomen, can become stubbornly resistant to any improvements. In some individuals the localised deposits of fat in the abdominal region combined with muscle laxity can make any hopes of a "flat tummy" very difficult to achieve. In women this becomes all the more difficult if stretched and loose skin appears following pregnancy. The children are, of course, worth every inconvenience. Nonetheless this does not stop us from thinking whether or not anything can be done to improve this.
Alternatively there are individuals who may have lost a large amount of weight and subsequently find as a result that they have an "apron" of skin which hangs down in front of the abdomen. This occasionally can lead to problems of chafing and rashes appearing under this "apron".
Surgical procedures can selectively be employed to improve situations in which these problems arise. These operations however are not directed toward weight reduction, which is still primarily a dietary problem. In cases where improvements can not be made despite even the most diligent efforts, an abdominoplasty may be appropriate. Abdominoplasty or "tummy tuck" as it is commonly known is an operation to tighten the muscles of the abdominal wall and to remove excess skin folds and fatty tissues from the middle and lower abdominal region. As such it can dramatically reduce the appearance of a protruding abdomen and lead to a flatter, firmer, tighter stomach and a thinner waist as well.
Am I suitable for this type of surgery?
This will be decided at your consultation. During your consultation the Specialist will ask you about your general medical history including details about any previous abdominal surgery, or childbirth(where appropriate!). Women who plan to become pregnant imminently should usually postpone the operation until after their family is complete.
If you are a smoker you will be asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin and certain anti-inflammatory drugs and other medications can cause increased bleeding, so you must avoid these.
A physical examination will determine if you are a candidate for an abdominoplasty procedure. Abdominoplasty should not be performed to correct obesity. Heavier patients will be disappointed even if measures such as extending the incision and liposuction are performed. This is because there will still be substantial fullness in the flanks, upper torso and buttocks which will contrast with a tighter abdomen. To avoid this disappointment and to minimise the need for a secondary procedure, the best candidates are men and women who are within several pounds of their ideal weight.
As mentioned there are a number of variations in the technique of abdominoplasty. The decision will be based on the quality of your skin, the presence of stretch marks, the laxity of your muscles, and the amount and distribution of fat. A definite decision can only be made at the consultation after a proper examination. However, broadly speaking, if you have loose muscle and excess skin in both the upper and lower abdominal areas with only modest fat deposits you will most likely require a full abdominoplasty.
What does the Operation involve?
In the full abdominoplasty, you must understand that there is a long incision made within the so called "bikini line" just above the pubic area, from hip to hip. The skin and fat is then peeled off the abdominal wall up to the umbilicus. At this point a second incision is made around the umbilicus, in a measure to free this from the surrounding tissue. Once this is done, the skin and fat flap of tissue initially lifted, is continued to be peeled off the abdominal muscles, leaving the umbilicus on a stalk all the way up to the border of the lower rib cage. The exposed muscles are then tightened as necessary by stitching them together creating a firmer abdominal wall and a narrower waist.
In the "mini tuck" technique the skin is separated only between the lower incision line just above the pubic region, and an incision just below the umbilicus. The umbilicus is left in place without the need for a further incision. Liposuction may be combined with this procedure if the distribution of fat calls for this.
What type of anaesthetic is used?
Abdominoplasty is usually performed under general anaesthesia(completely asleep). You will usually require an overnight stay at the hospital.
How long does the surgery take?
Depending on the technique used, and whether this is combined with any other surgery such as liposuction, it usually takes between 1-2 hours.
What happens immediately after the Operation?
Once you've recovered, you will notice a compression garment around your waist and abdomen. This is to provide compression of the surgical site to reduce the postoperative swelling and bleeding. In addition you will notice the presence of 2 tubes or drains which are usually placed under the skin to evacuate any fluid build up following the surgery. These usually come out the following day although in situations where there is increased drainage these stay in for an extra day.
You will find that the abdominal area will be quite uncomfortable and that you will have 1-2 pillows placed behind your knees in order to keep these bent to reduce the tension in your abdominal muscles. Likewise you will need to walk slightly bent forwards once you are up and about, for the first few days. You may gradually straighten up as the days pass. You will have a row of metal clips in the incision site, which will need to be removed in 6 days.
Is it Painful?
Pain and discomfort are subjective sensations but it is true to say that an abdominoplasty is considered one of the more painful procedures. This is probably more noticeable when standing or and walking in the first few days following surgery. Thus for the first week or so you will need to take regular painkillers in order to minimise this.
What kind of after effects should I expect?
Following surgery you will experience considerable swelling and bruising of the abdomen. This will be even more noticeable if the abdominoplasty was accompanied by liposuction. The bruising usually lasts about 3 weeks. While most of the swelling will have dissipated by this time, some subtle swelling will still be present for up to 3 months.
In addition you will notice that the abdomen will feel firm to touch, particularly along the edges of the incision site. This will be as a result of the normal healing process laying down elements of scar tissue to facilitate healing. When this occurs, massage as instructed by the Specialist will speed up the recovery. It gradually resolves in time but may take a few months to complete. You should expect the sensation to the skin over the lower abdomen to be reduced after surgery. This is as a result of surgical trauma to the nerves in the region. Although this usually recovers in a few months, permanent numbness in the region can ensue.
What are the Scars like?
As explained the scar length will be substantial. These normally extend from hip to hip above the pubic area as a horizontal line. At times it may be necessary to add a small vertical component to this and therefore the appearance may be likened to an upside down T. Although all surgeons try to suture the incision as neatly as possible, it is ultimately impossible to predict a scars' eventual appearance. In fact very rarely can abdominoplasty scars be described as hairline. You must understand that due to the normal healing response these always appear red, raised and lumpy in the first few months after surgery, but do tend to settle with time. However it may take up to 18 months to do so. Stretching and prominence of all or parts of the scar however can occur. If necessary, and when deemed appropriate, it may be necessary to revise a scar to try to improve its appearance. This will be discussed at the follow up consultations.
What could go wrong?
Whilst it is true that when an abdominoplasty is performed by a qualified plastic surgeon the risks are small, nonetheless, specific complications with this procedure can and do occur.
As in any procedure the risk of significant infection is always possible. This is minimised by careful surgical technique and the preventative administration of antibiotics both at the time of surgery and after. However despite these measures mild infection is relatively common and can occur around the incision site, but usually subsides over a period of about 2 weeks.
Risks such as blood clots are rare. Early mobilisation by moving around as soon after the surgery as possible reduces this considerably.
As mentioned earlier, swelling should be expected after this operation. When mild or moderate swelling is present, the body rapidly reabsorbs this. Very occasionally, increased bleeding can lead to more significant swelling and the development of a haematoma (a collection of blood under the skin). If this were to happen, surgical drainage to evacuate this would be required. Ultimately however this should not affect the final outcome.
Another possible complication is the formation of a collection of fluid called a "seroma". This fluid is clear and yellow in colour. It is seen as a swelling in the lower abdominal region, and many times patients report that they can feel this fluid moving under the skin. It is usually noticed at about 10 days after surgery. The treatment will depend on the amount of fluid present. If this is deemed to be small and is not causing any discomfort, then only a pressure garment is applied and the body reabsorbs this, usually by about a months time. If however the amount of seroma is significant and causes pain or discomfort, then the initial treatment is to draw out this fluid with a needle (called aspiration). Following aspiration the swelling rapidly disappears. If necessary this procedure may be repeated in a weeks time.
During the first 2 -3 weeks after surgery, some patients may experience a minor loss of wound adhesion at any point of the incision site. This is a temporary complication, which will require regular dressing changes initially. Eventually a scab develops over this, which subsequently separates after 3-4 weeks. However some distortion of the skin around the scar may ensue particularly if this has occurred over the hip region. Further revision surgery may be required if necessary.
How long before I get back to normal?
Abdominoplasty is a major operation and should always be respected as such. Therefore you should expect a few weeks to pass before you feel yourself again. Remember variations do occur in the time individuals take to heal. Although many people go back to light work duties by 2 weeks others find it more appropriate to take a further 1-2 weeks to rest. Walking is helpful in the first 3-4 weeks as this improves the circulation and helps reduce the swelling, and the chance of blood clots developing. Heavy lifting or Strenuous activity is prohibited in the first 6 weeks after surgery. Overall common sense rules in the recovery period. If what your doing is uncomfortable then don't do it!
Abdominoplasty has always been a popular cosmetic surgery request. It is an excellent solution to difficult situations in which individuals are troubled by redundant abdominal skin, lax muscles and excess fat. Providing one accepts the lengthy scar and recovery period, the results are quite pleasing. The procedure will give confidence to the individual and allow them to wear clothes that were previously unsuitable. The effects are generally long lasting provided you follow a balanced diet and exercise regularly.