Abdominoplasty

 

Introduction

Abdominoplasty, or a “tummy tuck,” is a procedure to remove excess skin and fat from the abdomen and, if required, tighten the muscles as well.

It can achieve a dramatic improvement to the appearance of the abdomen. It leaves a scar hidden in the lower abdomen like a long caesarian scar. There may be a scar around the umbilicus as well.

Suitable candidates are people with

  • A large lower abdomen not improving with diet and exercise even after losing significant weight.
  • Lax abdomen after multiple pregnancies and stretch marks.
  • Excess redundant skin after excessive weight loss.

The procedure is recommended only when the ideal weight has been achieved. Also, the family should have been completed, as further pregnancies will re-introduce the laxity of the abdomen.

 

Consultation      

A general assessment of health is done by history and examination.

During the physical examination the tone of abdominal muscles and skin is assessed as a whole.

Options of surgery will be discussed which can vary from, liposuction only, mini abdominoplasty to a combination of liposuction and abdominoplasty. The type of operation required will depend on the needs to achieve the optimum outcome.  

An information sheet for the consent of abdominoplasty and time will be provided to think about proceeding with the procedure or requesting a second consultation.

 

Preparation for surgery

It is recommended to stop smoking a few weeks (6-8) before and following surgery. This significantly reduces complications with anaesthesia, wound healing and post operative chest infections etc.

It is preferable to avoid aspirin and other non-steroidal anti-inflammatory drugs such as Ibuprofen, Voltarol etc. for at least a week prior to surgery to reduce the risk of bleeding during and after surgery.

The operation usually involves an overnight stay and may require some tubes placed in the wounds to drain excess fluid to prevent a collection. These will be removed either at the time of discharge or a few days later by the nurse.

It is important, travel arrangements are made and help is available at home for a few days after the procedure.

 

The Operation

A typical abdominoplasty involves an incision in the bikini line from one side of the hip bone to the other. Depending on the type of procedure planned, a vertical incision going up to and beyond the umbilicus may occasionally be required as well. This will have been discussed at the time of the consultation.

Its usually a two to three hours’ procedure.

Most of the abdomen skin and fat is undermined to a level above the umbilicus. If the abdominal tone needs improving, this is done by plicating muscles with sutures to make for a flatter abdomen. The excess skin and fat is removed and remaining tissue is sutured back at the site of the incision. The procedure also involves making a new position for the belly button so you will notice sutures in this area as well.

 

Anaesthesia

The procedure is done under a general anaesthetic.

 

Postoperative care

An overnight stay is required after the procedure and drains may be placed which require removal a few days later.

In the initial couple of weeks, the abdomen will be mildly swollen with moderate discomfort. This will be easily controllable with regular painkillers.

There will be perceived tightness in the lower abdomen especially in the suprapubic area but this should settle in a few weeks.

To improve the comfort, it may be helpful to wear a postoperative compressing garment. Advice on this will be provided in your consultation and preoperative assessment.

It is usual to recommend showering about 4-5 days postoperatively. Walking is allowed immediately after surgery but tightness in lower abdomen may prevent you from straightening up completely for the first few days until the swelling improves.

Stitches are usually absorbable.

Depending on the type of work and the speed of recovery, general expectation is to start work in a couple of weeks. Occasionally it may take longer.

 

Scars

The scars are prominent for a few weeks. Once completely healed (4-6 weeks), they rapidly start improving in appearance and fade. Occasionally there may be residual prominent lumpy scars. This is unpredictable but happens if there have been healing problems or just the makeup of the body (ethnicity). These also settle but after a longer period. Rarely revision surgery of scar may be required.

 

Risks

Although abdominoplasty is a common procedure, there are risks, as with any surgery.

Infection, bleeding and haematoma (clot formation) in the wound are potential problems. These can be managed with antibiotics and dressing changes but rarely could require drainage with needles or an operation.

Poor healing, in form of delayed healing, breakdown or prominent scars are other variables. These may require corrective surgery or, more likely, heal on their own. Smokers are particularly at risk of these problems and are advised to stop at least 6-8 weeks prior to surgery.

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