Abdomen

A tummy tuck or abdominoplasty removes excess fat and skin from the abdomen and restores weakened muscles. Excess skin and relaxation of the abdominal wall is quite commonly found among patients who have experienced weight fluctuations or in women who have had several pregnancies. Abdominoplasty will create a flatter, firmer abdominal contour and a thinner waist.

The procedure is performed under general anaesthetics. An incision is made above the pubic hairline and towards the hips. The abdominal skin is lifted and the abdominal muscles are repaired with stitches, if necessary.  The excess skin is pulled down and trimmed.

During the recovery, the patient may have to wear a compression garment and in some cases as well a support bandage. The scars arond the navel and in the lower abdomen will heal over time. However, in some cases a scar check-up under local anaesthetics can be necessary. The saying “the surgeon makes the stitch, the patient makes the scar” it is more true for this cosmetic surgery procedure than any other.

As possible but rare complications, we can find the loss of vitality (necrosis) in the skin above the pubic area, which might require a longer postoperative treatment. Likewise, semoras and/or hematomas requiring further surgery might appear.

A tummy tuck or abdominoplasty is a surgical procedure that removes excess fat and skin in the lower and middle part of the abdomen and restores weakened muscles in the abdominal wall. This procedure will dramatically reduce the bloated appearance of the abdomen (colloquially known as “belly”). It will leave a permanent scar, the length of which will depend both both on the original problem and the surgery chosen to correct it. If you are thinking of undergoing an abdominoplasty, you will get some basic information about the surgery, like when it is indicated, how it is performed and what results to expect. However, it is unlikely that you get answers to all your questions, as they mostly depend both on personal factors and the plastic surgeon’s preferences.

The ideal candidates to undergo an abdominoplasty are male or female patients with a relatively good body contour but who are concerned about the accumulation of fat or excess skin in the abdomen, an accumulation that does not improve thanks to diet or physical exercise. This surgery is especially useful in women who have had several pregnancies, after which their skin and muscles have relaxed and have not recovered their usual state. It can also improve skin elasticity in older people, a situation normally associated to moderate overweight. Those patients who need to lose a lot of weight or who are thinking of becoming pregnant in the future must postpone this surgery, as it strengthens the vertical muscles in the abdomen that might relax again after a weight loss or a pregnancy. If there are previous scars in the abdomen, this surgery is not indicated as the scars might shift. In other cases, this surgery can get rid of them.

In the first visit, the plastic surgeon will evaluate your health, determine the extent of fat deposits in your abdominal region, and assess your skin tone. You must let your surgeon know if you are a smoker or if you are taking any medication or vitamins. You must speak sincerely and frankly about your expectations, so that the surgeon can also be frank and discuss with you the available alternatives for your problem, informing you about the risks and limitations of each and every one of them. You will also be informed about the kind of anaesthetics that will be used, about the need of being admitted in the clinic where the surgery will be performed and about the cost of the procedure. If, for example, your fat deposits are located in the area below the navel, a less complex procedure called mini-abdominoplasty might be enough. This involves a shorter stay in the clinic and it takes a shorter time to be performed. In other cases, whether you are undergoing a full tummy tuck or a mini-abdominoplasty, it can be associated to a liposuction in the hips to make your body contour look more harmonious. In some cases, the problem can be simply solved with a liposuction in the abdomen. In any case, the plastic surgeon will discuss with you what procedure is best to obtain the appropriate body contour. During the consultation, you will also be informed about the kind of anaesthetics that will be used, about the need of being admitted in the clinic where the surgery will be performed and about the cost of the procedure. Abdominoplasty is not included in the procedures covered by the National Health Service, except in severe disabling cases.

Abdominoplasty and mini-abdominoplasty are always performed in an operating room in a clinic or hospital. These procedures must not be performed in the physician’s office. Liposuction must also be performed in an operating room under strictly aseptic conditions.

General anaesthesia is normally preferred in tummy tucks. The patient will be asleep through the procedure. In some cases, especially in mini-abdominoplasty and abdominal liposuction, local anaesthetics with sedation might be used. Then, during the surgery, the patient will be awake but relaxed, and the abdominal area being treated will be numb to pain (although in some occasions you might feel some discomfort).

A full tummy tuck normally lasts between 2 and 4 hours, depending on the extent of the correction. A mini-abdominoplasty normally lasts between 1 and 2 hours. A full tummy tuck requires a long horizontal incision just above the pubic hairline. A second incision around the navel will be necessary to separate the surrounding tissues.

In a mini-abdominoplasty the incision above the pubic hairline is much smaller. It is not necessary to perform the second incision around the navel, which might be lowered when stretching the skin.

Next, the skin is separated from the abdominal wall towards the ribcage to expose the abdominal muscles. The muscles are then tightenend and joined obtaining this way a firmer abdominal wall and a thinner waist. The skin is pulled down towards the pubis and excess skin is removed. The navel is repositioned. Finally, it is stitched. Sutures close the inscisions. A bandage will be applied as well as temporary tubes to drain any excess fluid that may collect in the incision site. In mini-abdominoplasties, the skin is separated only in the area between the incision and the navel. Excess skin is then removed and sutures close the incision.

During the first days, the abdomen tends to be a little swollen and you might feel some discomfort or pain that can be relieved with medication. Depending on the extent of the surgery, you will be discharged after a few hours or you might have to remain in the clinic for 2 or 3 days. Your plastic surgeon will give you instructions on how to bathe and change the bandages. Although at the beginning you must not stand in a complete upright position, you must start perambulating as soon as possible. External skin stitches will be removed after 5 to 7 days. Internal stitches, the edges of which will stick out at the ends of the incision, will be removed after 2 to 3 weeks. A compression garment will replace the bandage.

It might take you a few weeks or even months to feel like you did before the surgery. If your physical status before the surgery is good and you have strong abdominal muscles, the recovery after a tummy tuck will be faster. Some people go back to work after 2 weeks, whereas others may need to rest for 3 or 4 weeks. Physical exercise will help you recover faster. Even those patients who did not use to do exercise before the surgery must carry out an exercsie program to reduce the swelling, prevent the occurrance of venous clotting and tone-up their muscles. However, strenuous physical exercise must be avoided until you feel up to it. Often, the scars might seem to look worse during the first 3 to 6 months while healing. You must wait between 9 months and a year for the scar to flatten and tone down. Although the scars will never disappear, they will become inconspicuous, even when you wear a bikini or swimming trunks.

Hundreds of tummy tucks are performed every year. When carried out by a qualified plastic surgeon, the results can be very good. However, as in any other surgery, there are some risks and complications associated to the procedure. There might be complications after the surgery, such as infections or venous clotting, but they rarely happen. Infections can be healed with antibiotics, but you will have to remain at the clinic for a longer time. Venous clotting can be prevented perambulating and standing upright as soon as you feel up to it. Bad scarring may produce a bad quality scar, which will sometimes require further surgery. Smokers must refrain from up smoking a few weeks before the surgery and must be warned that smoking increases the possibility of complications and delays in the scars development. The risk of complications can be minimized by carefully following your plastic surgeon’s instructions before and after the surgery, especially those regarding physical activity.

Both full and mini- abdominoplasties provide excellent results in patients whose abdominal muscles are weakened and have excess skin and fat. In most cases the results are permanent as long as you keep up a healthy diet and do regular exercise. If you have a realistic outlook and can tolerate a long recovery and the presence of a permanent but easily concealded abdominal scar, this procedure might be appropriate for you.

– Information obtained from www.secpre.org.