Abdominoplasty or "tummy tuck"
is a surgical procedure to remove excess skin
and fatty tissue from the middle and lower abdomen and to tighten muscles of
the abdominal wall. It is not a treatment for being overweight. Obese
individuals who intend to lose weight should postpone all forms of body
contouring until they have been able to maintain their weight loss.
There are a variety of different techniques used by plastic surgeons for
abdominoplasty. These should be discussed at consultation.
The Standard Abdominoplasty
In this operation, the excess
skin and fat of the abdomen between the pubic
area and the umbilicus (navel) is removed, the whole area up to the ribs is
freed and pulled down tight and then sewn back. The navel is repositioned.
You are left with a long scar across the lower part of the abdomen, above
the pubic hair. There is also a scar around the umbilicus and sometimes a
small vertical scar. Any loose muscles of the abdominal wall, or any hernia
are
usually repaired at the same time.
The Mini Abdominoplasty
In cases where there is
relatively small amount of excess skin below the
umbilicus, it is possible to do a smaller operation where the umbilicus is
left alone, and the excess skin is just removed and then the abdomen is sewn
back, leaving a smaller scar above the pubic hair.
The Apronectomy
The apronectomy is a modification of the
mini-abdominoplasty for patients
who have a large overhang of skin and fat, "the apron". This often follows
massive weight loss or large babies. The scar produced is longer than with
the mini- abdominoplasty and the operation consists of just removing the
overhang of tissue.
The Extended Abdominoplasty
Sometimes, particularly where there has been massive weight loss, the
surplus skin and fat extends all the way round to the back. In those cases
it is possible to extend the operation to remove this excess all around the
lower trunk and back. This is major surgery.
Alternative Treatments
Alternative forms of management consist of not excising surgically the areas
of loose skin and fatty deposits. Liposuction may be a surgical alternative
to abdominoplasty if there is good skin tone and localized deposits of fat
in a person of normal weight. In addition, diet and exercise programmes may
be of benefit.
Who benefits from an abdominoplasty?
Anyone who has excess skin and fat may benefit. This
excess tissue usually
results from pregnancy and/or weight loss. Any stretch marks below the
umbilicus will be removed. The ones above the umbilicus will become
slightly less noticeable as the abdomen looks tighter.
If the muscles of the abdominal wall are weakened, or separated in the
middle (divarication of the recti) they can be repaired at the time of the
abdominoplasty.
RECOVERY
It is important to realize that an abdominoplasty is a
relatively major
operation. It is performed under general anaesthetic, so you are put to
sleep. You wake up with a drip and one to two drains. You normally stay
two to three nights in hospital. You should expect some moderately severe
pain for which you will be given pain killers. Once home you will be
advised to
carry out only light activities for three to four weeks. Sports are not
advisable for
six weeks to allow the tissues to settle down. You can resume driving when
your
insurance company is happy, on average three to four weeks after surgery.
You will have scars. There is no getting away from this. The wounds are
sutured as neatly as possible, and usually in the bikini line. The scars
however are long, are red initially, and take a year or two to mature
completely into a pale line. How the scar fades depends very
much on your own body healing mechanisms. Wound healing is influenced by
other medication you may take, by your state of nutrition and by smoking.
Risks Of Abdominoplasty
Every surgical procedure involves a certain amount of
risk and it is
important that you understand the risks involved with abdominoplasty.
Although the majority of patients do not experience the following
complications, you should discuss them to make sure you understand them
before undergoing surgery.
Bleeding
Should post operative bleeding
occur it may require drainage in
theatre otherwise problems with the wound can occur later on. Do not take
any aspirin or anti-inflammatory medications for ten days before surgery, as
this may increase the risk of bleeding.
Infection
If you notice increasing
redness of your wound and it is painful, seek medical
advice as soon as possible as infections caught early are easier to treat.
Antibiotics or additional surgery may be necessary. Infection and poor wound
healing are more common in smokers, so I ask patients to stop smoking one
month before surgery.
Change in skin sensation
Diminished (or loss of) skin
sensation in the lower abdominal area is usual after
this surgery and may not totally resolve.
Scarring
The scars are noticeable. The
main scar extends from one hip bone to the other.
There will also be a scar around the umbilicus. Some people make better
scars than
others. In all cases scars are red and firm initially. Then over the
course of about
eighteen months they mature and become pale and soft. Sometimes there is
delay
in wound healing and even loss of skin near the scar. This risk is greater
in
smokers (again!).
Seroma
Occasionally fluid accumulates
under the skin of the abdomen and
may need to be drained.
DVT
Deep vein thrombosis and
pulmonary embolus are rare complications. I advise you
to stop the oral contraceptive pill for six weeks before surgery, and an
alternative
method of contraception used, in order to reduce the risk of thrombosis.
Secondary procedures are sometimes carried out to tidy up the results and
can involve
scar revision and limited liposuction.
