Body Contouring - Tummy Tuck (Abdominoplasty)
A TUMMY TUCK, or abdominoplasty, is an operation performed to improve the shape and contour of your anterior abdominal wall. The operation can remove excess skin, unwanted scars, stretch marks, fat and can tighten the stomach muscles. There are a variety of different abdominoplasty procedures and depending on your particular problem(s), the operation will be individualised and tailored to suit you.
Younger patients, who have not been pregnant before, who have good quality elastic skin and whose main problem is an excess of fat, are best suited to simple liposuction of the tummy. These patients typically have a little “pot belly” - a slight excess of fat in the lower tummy. Liposuction of the tummy can be performed under sedation and local anaesthesia, although general anaesthesia is most commonly used. These cases are often performed as day case surgery. Often, other areas are also treated with liposuction simultaneously. Small incisions are made, excess fat is removed and the wounds closed. Not only will fat be removed, but some degree of skin tightening or shrinkage can be expected as well.
Slightly older or middle aged patients who might have had previous pregnancies (causing the muscles to splay apart a little) and who have a slight excess of skin and fat, especially below the belly button, may be best suited for a modified/mini-tummy tuck. These procedures are performed under general anaesthesia. A wedge or ellipse of skin and fat is excised from the lower tummy leaving a scar horizontally above the pubic hair, similar to the scar from a Cesarean Section. In addition liposuction can be performed of the upper tummy and waist, and the muscles can be tightened. Usually no scar is left around the belly button which is stretched slightly to become more elongated, or moved downwards a short distance. Occasionally it is necessary to replace the belly button in a new place, and this can leave a small vertical scar. These various operation options will be discussed during your consultation.
Some patients have an even greater degree of skin laxity, excess fat and splaying of the muscles. These patients require a classic tummy tuck. This operation is usually performed under general anaesthesia and usually requires hospitalisation of 2 days. An incision is made from hip to hip and around the belly button. A large wedge of skin and fat is excised from the belly button to just above the pubic hair. Some areas may be treated with liposuction and the muscles above and below the belly button are tightened. Although this operation does leave the biggest scar, it does provide the greatest degree of improvement in shape. There are variations of full lower trunk rejuvenation possible. The standard ‘tummy tuck’ leaves a scar from hip to hip. The Fleur-de-Lys abdominoplasty provides circumferential tightening too but leaves an additional scar up the middle of the abdomen. Patients with flank and upper buttock laxity can opt to have circumferential tissue removal for flank and lower back/upper buttock tightening.
Patients still planning pregnancies should wait until completion of their family.
What can be expected at the initial consultation?
At the initial consultation you will be assessed as to whether you are a good candidate for abdominoplasty. Your abdomen will be carefully examined to assess the skin quality, the quantity of fat and the muscle tone. Your general fitness for the procedure will be evaluated and the potential for problems sought. It is important to know about previous abdominal surgery, pregnancies, medication that you are on, previous leg or lung clots and whether or not you smoke.
Your reasons for wanting the procedure will also be discussed. It is important that your expectations concerning the outcome of the procedure are realistic. If they are, you can expect to be happier with the result.
Once you have been fully assessed, an operative plan tailored to your individual needs will be formulated. The incision to be used, the amount of skin and fat to be excised, whether muscle tightening and navel repositioning is to be performed, and whether liposuction will be used as an adjunct will be discussed with you.
Do not be hesitant to ask questions, now or at any other time.
Medical aids or health insurance companies do not usually provide cover for this kind of surgery although occasionally a motivation can be done especially if you have lost large amounts of weight, or have a hernia.
Preparing for surgery
Ideally surgery is performed when you are fit and healthy. No special diet or exercise program is required prior to abdominoplasty, but you should be close to your ideal weight. It is a good idea to have a good fluid intake for a few days before your operation. You should also clean the areas close to those undergoing surgery (the umbilicus and perineum). You should not have been on a long-haul flight for 2 weeks prior to surgery.
It is advisable to stop smoking at least six weeks prior to surgery and not to smoke until your wounds have healed - usually about six weeks after the operation. It is well known that there is a higher frequency of complications in patients who smoke.
On the morning of surgery you should shower or wash well. Do not shave your pubic hair specifically. Prior to surgery, the incision lines will be marked with a pen in your room. Ms Grob usually takes photographs for your records immediately before surgery.
Surgery will be performed in an operating theatre usually under general anaesthesia. A full tummy tuck takes between two and half and three hours, a mini between one and one and a half and liposuction of the tummy alone, about an hour. Occasionally a urinary catheter may be needed.
Following surgery the wounds are closed with dissolving sutures, and drains may well be left in place for a few days. Dressings and an elasticised garment will be applied.
What can be expected after the operation?
Following the operation you should be relatively pain free although you may feel some discomfort with movement. Post-operatively, you will be given painkillers that will control any discomfort. You will be allowed to eat and drink once you are awake. If you are an in-patient, you will be well looked after in hospital and gentle mobilisation will be started as soon as you are awake. Daily showers are encouraged.
If you are to have surgery as a day case, you will only be allowed home once you are fully awake, able to walk and talk and once you have had something to eat and drink and have passed urine. Someone will need to drive you home and look after you. You will be given painkillers to take home with you. At home you should rest for the first night. It is a good idea to have some extra pillows to place under your knees, as you will find it most comfortable to sleep on your back with your knees up. On the first day after surgery, you should try to get up into a comfortable chair and would be encouraged to walk around within the house.
How long does it take to get back to normal?
Healing is a variable process and it may take you a month to feel like your old self again. People vary enormously in their recovery period.
The scars are healed by 6-8 weeks, but continue to mature for up to 18 months to 2 years, by which stage they should be thin, fine, inconspicuous lines. Massage of the scars with an aqueous cream helps, but should only be started after 1 month.
The drains are usually removed a day or two after surgery when the drainage has diminished to acceptable levels.
Bruising takes about 2 weeks to settle. Swelling can take months to settle. To help diminish swelling and bruising abdominal support should be worn for 24 hours a day for 6-8 weeks. You can take it off for regular showering.
You will find that contrary to what you expect, your mood may be down following surgery. This is a normal occurrence and as the swelling and bruising subside and your body heals, so your mood will elevate and improve.
Mobilisation should be gentle, but begun early. Immediately after surgery you should start with wiggling your toes and ankle and knee movements to help prevent leg clots. Avoid crossing your legs in bed. On the first postoperative day you should mobilise to a chair, walk to the bathroom and a little around your room. Thereafter mobilisation should progress so that gentle exercises can be begun about one month after surgery. Vigorous exercise should be avoided for 6-8 weeks, until you feel comfortable – your body will tell you if you are pushing it too hard.
At home you need to take it easy but do not take to your bed. You will need help if you have small children for 1-2 weeks. Gradually increase your walking day by day. Do not drive until you really feel well – usually 2 weeks. Shower daily to stay clean. If your corset becomes blood-stained wash and dry it before reapplying it.
Depending on the procedure you have, you may be able to begin work after about one week (liposuction), 2-3 weeks (mini/modified tummy tuck) and longer, possibly up to three weeks or more for a full tummy tuck.
It is advised that you are able to fly short haul 2 weeks after the operation and that you can fly long haul 4-6 weeks post-operatively.
What are the risks?
When performed by a qualified plastic surgeon, abdominoplasty is normally safe and the results predictable. Nevertheless, as with any surgery, there is always a possibility of complications, including the following:
Bruising, Bleeding, Haematoma and Seroma: Bruising of the tissues is the norm and can be expected to last for 2-3 weeks after operation. Occasionally, after the operation, a vessel may start to bleed. This can result in a collection of blood (haematoma). The commonest time for this to occur is early after the operation and if the amount of blood is excessive, a small operation will be required to control the bleeding. Seroma refers to the accumulation of serous fluid (a pale straw coloured fluid) that leaks out from damaged capillaries and lymph vessels. Sometimes a seroma requires repeated drainage with a needle and syringe. This is usually relatively painless and is done in the outpatient rooms.
Infection, Wound Breakdown, Skin Necrosis: Infection is not uncommon with abdominoplasties and can result in swelling, redness and tenderness at any time up to three weeks after surgery. This usually responds well to a course of antibiotics. Occasionally however, it can result in some opening of the wounds or loss of tissue (skin necrosis), especially low down, near the scar or of the belly button. This can occur as the operation interferes with the blood supply of the tissues. It is usually small and managed by regular wound dressings and heals in about 6-8 weeks.
Sensory Problems and Numbness below the belly button occurs in nearly all patients but is usually transient. It can take up to two years to resolve.
Scarring - All patients will have scars and these must be expected after the operation. In the majority of patients by 18 months to two years after surgery the scars settle down to thin lines, which are soft and not very noticeable. If you have other scars on your body from previous surgery or trauma, these may give an indication as to the quality of scar you can expect. To minimise scarring, you will be expected to support the scars with tape for about 6 months after the operation. You will be advised as to how to do this. Massage and sun avoidance also help. Occasionally scars may become abnormally large, red, stretched and raised or even form a keloid, which may require further treatment.
Asymmetries, Irregularities in Contour and Dog-ears: Dog-ears are small folds of skin that occur at either end of the scar, caused by a natural folding of the skin when the wound is closed. Great care is taken during the operation to avoid producing dog-ears, but sometimes they cannot be avoided. Small dog-ears seen in the early postoperative period will eventually settle on their own in the first 6-9 months after surgery. If they do not settle after this time, they can be simply excised in a small operation under local anaesthetic to correct them.
General surgical complications such as deep vein thrombosis. This is a rare but serious complication of surgery and anaesthesia, where a blot clot forms in the veins, usually the legs and may migrate to the lungs (pulmonary embolism) interfering with their normal function resulting in possible life threatening consequences.
Problems with anaesthesia, drugs, fluid balance, urine output, etc. These should be rare and the risks will be explained to you by your anaesthetist.
Will the new look last?
Abdominoplasty, whether mini, classic, or Fleur-de-Lys produces excellent results for patients with weakened abdominal muscles or excess skin and fat. In most cases the results are long lasting, especially if after the operation you avoid weight gain, follow a balanced diet and exercise regularly.
Checklist before coming into hospital
- Make sure I know all the medications you are taking before surgery.
- Do not take any Aspirin or blood thinning drugs (which include some homeopathic supplements) for at least 2 weeks prior to surgery. Paracetamol is safe.
- Oral contraceptives can increase the risk of Deep Vein Thrombosis or Pulmonary Embolism. The contraceptive "pill" should ideally be stopped a month prior to surgery but please use some alternative form of contraception.
- It is advisable not to smoke six weeks prior to surgery and until complete healing has taken place. Nicotine reduces oxygen levels required for wound healing.
- Please have a shower in the morning of surgery and do not apply deodorant or any other products (e.g. body lotion, perfume etc.)
- Please do not have anything to eat (including chewing gum) 6 hours prior to surgery. You are able to drink still clear water up to 2 hours prior to your admission.
- Please bring your elasticated pressure garment (snug fitting but not too tight) with you to hospital. You have to wear this support for 6-8 weeks after surgery.