What is an abdominoplasty?
Abdominoplasty is also called a ‘tummy tuck’ and is an operation designed to rejuvenate the abdominal area and removes excess fat and skin. It is often performed for patients who have either lost a lot of weight or to remove the excess loose tissue following childbirth. In most cases it restores weakened or separated muscles creating an improved abdominal contour.
What to expect during your consultation?
The success of the consultation depends on your openness and honesty in relation to what troubles you and your expectations of surgery. You will be asked questions about your health, desires and lifestyle. Different operations can be tailored to your needs and the potential outcomes and the risks and complications will be discussed with you. The operation removes excess tissue from the abdominal area and the type of abdominoplasty needs to be tailored to the individual. Various types of abdominoplasty procedures are available and may be combined with liposuction. It may involve lifting the whole abdominal skin, repositioning of the belly button and tightening of the abdominal muscles. For patients following significant weight loss other adjunctive procedures may be required. A consultation regarding the risks and limitations of surgery will help you to choose a procedure that will meet with your expectations.
Preparing for tummy tuck surgery
The majority of abdominal rejuvenation procedures on the abdomen require general anaesthetic. Your health is a prime importance and any cosmetic surgery should be postponed if you are unwell for any reason. It is important that if anything changes with your health that you make contact with us. You should ideally stop smoking 6 weeks prior to surgery and stop taking aspirin, anti-inflammatory drugs and herbal supplements before surgery you may need preoperative tests prior to surgery, which we will arrange if required. You will generally experience abdominal discomfort following the surgery and should aim to be off work for at least 2 weeks depending on the type of work you do.
Abdominoplasty often takes between 1.5 and 2.5 hours. Usually an incision is made just above the pubic region and can often extend from hipbone to hipbone. The skin is separated from the underlying tissue from the pubic region up to the ribs. The fascia or lining above the tummy muscles is tightened providing a much firmer abdomen without direct damage to the muscles. This provides an improved abdominal contour. Classically the skin is then stretched down and the excess removed. It is usual to relocate the tummy button through a separate incision. If there is not a lot of excess skin in the lower abdomen it may be necessary to place a small vertical incision in the lower tummy. For patients with minimal excess in the lower tummy one may need to divide the tummy button and reposition it internally and/or remove excess skin via the lower incision. Where excess exists in the upper abdomen a vertical scar may be required to remove this access in combination with the lower incision – called a fleur-de-lys abdominoplasty. The incisions are closed with dissolvable stitches and the skin is repositioned. It is unusual to require drains and a compressive dressing is almost always required.
The following series of photos shows a lady who has underwent a tummy tuck (preop). She has had liposuction of the upper abdomen and flanks and relocation of the tummy button and plication of her abdominal wall. At 1 week she is still bruised and often this bruising and swelling is most noticeable above the scar and the flanks. At 4 weeks the scar is healing but is still a little lumpy and requires massage. By this time she is able to do everything she would normally do although she should be reserved in the amount of abdominal exercises at this time and build back up gradually. The view at 3 months is seen and the scar will continue to improve over the coming months with massage.
You will usually return to the ward within an hour following surgery and you will be encouraged to mobilize. You will not have a catheter in place and it is unusual to require drains. You will be able to eat / drink and and mobilize as soon as the anaesthetic wears off. You will feel swollen and have abdominal discomfort that will usually require analgesia. You will be able to go home the next day and should keep the wounds dry for the next week. You should arrange for someone to pick you up following surgery and have some support at home on discharge. You will be reviewed in clinic and the wounds checked at a week. You should avoid excessive straining in the first week and should continue to wear a support garment for 4-6 weeks after surgery. You will be able to resume light exercises after a week and normal exercise by 4-6 weeks. You should begin massage to the scar once healed.
Risks and Complications
The vast majority of patients are delighted with the procedure although common complaints include numbness, bruising, swelling especially around the scar line and often there is a slight difference between the two sides of the abdomen. Uncommon complications include infection, haematoma, delayed healing/skin necrosis/skin loss, seroma formation and thickened scar. Around 4-6 weeks it is relatively common to have a little discharge from dissolving stitches (see picture) and this will resolve (see picture). There are uncommon risks of general anaesthesia such as respiratory / cardiac compromise and deep vein thrombosis.
Sensation usually changes following abdominoplasty. Although permanent numbness is uncommon, sensation can take a number of months to return. The scars following abdominoplasty can be red for a number of weeks / months after surgery and it can take some time before the scars start turning purple / pink and then start fading into a white line. It is unusual to develop abnormal scars and unusual to have irregularities requiring scar revision. Any revisions to the scars should not be considered for at least a year following surgery. The scar is often not symmetrical and the scar can move slightly with time. The abdomen can become lax with time and the result can fluctuate with fluctuations in weight. Dog ears occasionally occur at the end of the scar as can be seen from the long term photo showing a dog ear on the left side.
Urological, bowel and sexual function may be altered in the immediate postoperative period. It is very uncommon for any long-term functional problems