Tummy Tuck – Abdominoplasty
The abdominoplasty, or tummy tuck operation, is designed to remove excess skin from the abdomen and at the same time if required, tighten the abdominal muscles. This operation is indicated in cases where there is laxity of the abdomen resulting in bulging due to abnormal stretching of the abdominal muscles and skin. Marked weight change or multiple pregnancies are the most common reasons a person requests this procedure.
It is advisable that you first discuss this procedure with your General Practitioner (GP), who may then refer you to the Consultant Plastic Surgeon of your choice. Sharing your expectations with your GP and surgeon is the best way to increase the possibility of achieving your desired outcomes.
Unlike liposuction surgery, which only removes fat, abdominoplasty involves removal of skin and fat, with tightening of the abdominal muscles. For this reason, the procedure is more extensive than liposuction. The actual extent of surgery will depend on the amount of excess skin and the laxity of the abdominal muscles. In many cases liposuction is performed in conjunction with abdominoplasty.
Prior to abdominoplasty surgery, the amount of skin that is to be removed is carefully marked. An incision is made in the lower abdomen and the excess skin is pulled down and inward, and is removed along with underlying fatty tissue. The muscles are tightened as required and the skin is then carefully re-draped and the incision closed with several layers of sutures.
If marked weight loss has occurred, large skin folds may make skin care very difficult. In this case a procedure called a panniculectomy may be more appropriate. Body contouring procedures are not designed to correct obesity and a stable weight must be achieved before undertaking either of these procedures.
An abdominoplasty is usually performed under general anaesthesia in an operating theatre, and usually requires at least one overnight stay.
Abdominal scars above the umbilicus (restricts blood supply to distal flap)
- Likely or planned future pregnancy
- Medical conditions prohibiting elective surgery
- Unrealistic expectations
The purpose of your discussion with a Consultant Plastic Surgeon is to evaluate your general health condition and understand your expectations for abdominoplasty surgery. The surgeon will ensure that you are well informed of the benefits, possible risks and potential complications of the operation.
The following is a list of important general guidelines for patients to follow prior to their abdominoplasty procedure. Abdominoplasty candidates should:
- Maintain a stable weight for 9-12 months prior to the date of surgery
- Abstain from alcohol for 7 days prior to surgery
- Stop smoking 2-3 months prior to surgery
- Not take anti inflammatory medicines for 14 days prior to surgery due to the increased risk of increased blood loss during surgery.
- Inform your Consultant Plastic Surgeon of all medicines you are taking and for what condition(s) you have been prescribed these medicines.
If you decide to proceed with the operation you will be required to confirm your understanding of all aspects of the surgery and agreement to proceed with the operation by signing a Patient Consent Form.
Your abdominoplasty operation should ideally be performed in a major hospital.
Medications are administered for your comfort during the surgical procedure. This procedure always requires general anaesthesia. For your safety, the attending Anaesthetist uses various monitors to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
The surgery begins with a horizontal incision being placed just within or above the pubic area. The length of the incision, which extends laterally toward the pelvic bones, depends largely on the amount of skin to be removed. The contour of this incision will vary somewhat according to the structure of your abdomen and the style of bathing suit or undergarments that you prefer. Your Consultant Plastic Surgeon will try to keep the incision within your bathing suit lines, but please note that this may not always be possible.
Some patients have loose skin above the navel. In such cases, the Consultant Plastic Surgeon may make a second incision around the navel so that the redundant skin above it can be pulled down. The excess abdominal skin is then removed. The position of the navel remains unchanged. To tighten the abdominal wall, the Consultant Plastic Surgeon brings loose underlying tissue and muscle together with sutures.
Skin of the lower abdomen that contains stretch marks may be removed as well. Any remaining stretch marks may be somewhat flattened and improved, but you should not expect a dramatic change in their appearance.
Abdominal skin is pulled downward, and the excess is removed. A small opening is made to bring the navel through. The procedure may include tightening of the underlying abdominal muscles using sutures.
The abdominoplasty procedure removes large amounts of abdominal fat and skin below the belly button thereby reshaping the stomach and thoracic area. Unlike liposuction alone, the excision of a notable amount of skin below the belly button (umbilicus) greatly assists patients who have excess skin in this area. The removal of redundant damaged skin results in a tightening of the remaining skin and an improved shape.
It is important to consider that loose skin cannot be removed without incisions, and these incisions will lead to the creation of scars. The required scars may be longer than you initially expect.
Ask your Consultant Plastic Surgeon about the possibility of scars, their size and visibility. Consultant Plastic surgeons will strive to create scars as small as possible but given the nature of the procedure scars are inevitable. Please note that scars generally fade over time, assuming they are not exposed to excessive sun light, but never fully disappear.
The removal and re-draping of abdominal skin sometimes requires the permanent repositioning of the belly button. Mostly the belly button is left in its original position and is brought out through the skin after it is redraped in its new position. This leaves a scar around the belly button.
Some cases may require liposuction in conjunction with the abdominoplasty procedure. Liposuction will help remove excess flank or hip fat with the objective of providing a flatter and more ‘hour glass’ shape figure.
A patient who has undergone abdominoplasty will usually feel uncomfortable for 7-10 days after the procedure which is partly due to swelling of the surgical site. It is critical that patients wear an abdominal support that is recommended and specified by the Consultant Plastic Surgeon. Similarly patients may have to temporarily manage with a closed suction drain which is used to reduce the risk of hematoma (a collection of blood under the skin) which is one of the most common post-operative complications of an abdominoplasty.
Patients will experience a numb feeling from their abdomen for many months after their surgery. Typically patients can return to work approximately 2-3 weeks after the surgery but should wait for approximately 2 months before exercising. It is very important that you follow the post-operative advice of your Consultant Plastic Surgeon.
For most patients the final results of the abdominoplasty will not be apparent for up to 12 months after the procedure. It is critical that during the total recovery time the scars are not exposed to excessive sun light, which could lead to darkening and increased visibility of the scar tissue.
As with any surgical procedure there are potential risks and possible complications. It is critical that you understand these aspects of your surgery and that you seek clarification from your surgeon.
- During the Operation: Reactions to Drugs, Bleeding
- Immediately after the operation: Bleeding, Haematoma, Seroma, Tissue Necrosis, Pulmonary Embolism, Fat Necrosis, Phlebitis and Wound Healing Problems, and Death.
- Later: Painful Scars, Abnormal Scars, Persistent Lower Abdomen Numbness and Swelling and Umbilical Deformity
Please note: that with all procedures there is a possibility of patient dissatisfaction with the outcome.
Allergic reaction to anaesthetic
In very rare cases anaesthetics can cause allergic reactions. The best current estimate is that a life-threatening allergic reaction (also known as anaphylaxis) happens during one in 10,000 to one in 20,000 anaesthetics. Your anaesthetist will choose the drugs for your anaesthetic by taking into account many different factors, in particular, the type of operation, your physical condition, and whether you are allergic to anything.
Most people make a full recovery from anaphylaxis. It isn’t known how many anaphylactic reactions during anaesthesia lead to death or permanent disability. One review article suggests that one in 20 serious reactions can lead to death. This in effect implies that the chance of dying as a result of an anaphylactic reaction during anaesthesia is between one in 200,000 and one in 400,000 anaesthetic procedures.
For additional information regarding this procedure please consult with your Consultant Plastic Surgeon.