Wednesday, 09 June 2010 22:07

Abdominoplasty(Tummy tuck)

Abdominoplasty (Tummy Tuck)

Two of the most common reasons for wanting to have an abdominoplasty, or tummy tuck as it is affectionately called, is after pregnancy or after losing weight, both of which may result in what is, to many people, an unsightly bulge and/ or loose skin around the lower tummy area. Abdominoplasty is, nevertheless, a major procedure and, as with any other invasive surgery, it carries the normal risks associated with any other surgical procedures. Nevertheless, this surgery is particularly effective and, when done for the right reasons, can make a considerable difference to a person’s self-image and self-confidence. The surgery involves making a horizontal, or smile line, incision from hip-bone to hip-bone and excising surplus skin and associated fat from the middle and lower abdomen while, at the same time, tightening up the muscles that might have become slack through the process of child-bearing.

What an Abdominoplasty Will Do

Quite often, following child-bearing the groups of muscles in the abdomen become slack, weak and, in some cases, separated. With an overhang of loosened skin this often produces a sagging abdomen that can be quite upsetting and in some cases, the cause of considerable backache due to poor posture. The most common reasons people seek a tummy tuck procedure is due to:

  • Pregnancy
  • Fluctuations in weight – usually quite significant
  • Prior surgery
  • Aging
  • Heredity

In many cases the six main abdominal muscles have become so weak and slack that they have stretched too much to repair themselves, despite adequate exercise and healthy living. When your youngest child is at school and people think you still look pregnant, it is extremely demoralizing. This is often due to herniated abdominal muscles. Aside from being unsightly, if the intestines begin to emerge through the weakened muscles, surgical repair would become necessary. When abdominal muscles have reached such a weakened condition they need a little help to recover. Left alone, the muscles will simply become worse with age, leading the way to potential back pain due to poor posture as a result of too little support from unresponsive abdominal muscles.

Usually, private health insurance won't pay for childbirth-related problems, so when loose abdominal muscles and skin are the isue, the only hope for repair is a good cosmetic surgeon.

What an Abdominoplasty Will Not Do

If you need to lose weight, an abdominoplasty will not do anything to help you lose the weight, nor will it substitute for lack of exercise. Before you consider an abdominoplasty you need to ensure that you have dieted to the weight most appropriate for your height, taking into account your BMI. If your weight fluctuates radically it will reduce the efficacy of your tummy tuck. Furthermore, if you have a lot of weight to lose, it is better to lose that first before setting a date for your abdominoplasty surgery. Similarly, you would be best advised to complete your family before undergoing a tummy tuck operation. If you have stretch marks, those in the area of the abdominal apron due to be removed will, of course, be eradicated. However, a tummy tuck will have no effect on those stretch marks not directly in the area of the excision.

Who is a Suitable Candidate?

A tummy tuck will certainly improve your appearance and will do wonders for your self-esteem. However, you do need to have a realistic image of the results afterwards.

The most suitable candidates for abdominoplasty are those who:

  • Are at their optimum weight for height
  • Have completed their child-bearing
  • Are physically fit
  • Preferably non-smokers
  • Have realistic expectations

If you fit into the above category and are upset that your tummy is too big or droopy, despite an inordinate amount of exercise, then you may be a good candidate for abdominoplasty.

Pre-Surgery Consultation

The consultation with your surgeon is important so that your skin tone can be evaluated as well as the amount of fat deposits in the area of your abdomen. The surgeon will take into account your current health, whether you smoke and whether you are taking any medication. You need to be completely honest with your surgeon about whether you smoke or are taking any recreational drugs as these need to be taken into account prior to and during your operation, for your own safety. Your surgeon also needs to know if you are diabetic as the stress from surgery can have an effect on your blood glucose and could effect wound healing. You will need to monitor this more closely as your surgery day approaches as well as after your surgery has been completed.

Your surgeon will describe the operation to you in detail, advising you of your best options and what the risks associated with each are. You may just need a mini-tummy tuck, also known as a partial abdominoplasty. If this is the case it can often be done on an outpatient basis since it is more straightforward than a complete abdominoplasty. An abdominoplasty with liposuction that removes deposits of fat from your hips can create a better contour in some cases while in others, you might simply benefit from liposuction alone. Your surgeon will explain all the benefits of each procedure to you and then advise you on the best option for you.

Very few health insurance policies will fund abdominoplasty: neither with the NHS in the UK unless the herniated muscles have resulted in intestinal prolapse. Basically, despite the procedure being widely practiced, there is always the chance of hemorrhage, thrombosis or embolism, as with any operation. It is also considered to be one of the more painful operations, although many patients say that the end result is worth it. The operation is not inexpensive, but there are private funding options available should you be eligible. Your surgeon will give you advice on how to prepare for the operation. To ensure your safety during the operation and afterwards you should follow this advice.

What is Involved with the Surgery?

The full abdominoplasty lasts for around 90 minutes, although it can take up to 5 hours if the repair is quite extensive. The surgeon makes a horizontal, smile line incision from hip to hip, cutting along the bikini line. The skin is then lifted and any damaged or sagging muscles are repaired. These tend to be the rectus abdominus muscles that run vertically, almost at right angles to the surgeon’s incision. The surgeon pulls the sagging lengths together and secures them with thick thread and elaborate embroidery work before pulling down the excess skin and trimming away the excess. The final part of the operation is to fashion the new navel and reposition it.

Usually you will be asked to arrive early in the morning at the hospital or private clinic where you are having your surgery. Once you are settled in as comfortably as you can be the surgeon will come and visit you and have a chat before marking your abdomen for surgery. The lines are the surgeon’s guide to matching up your skin midline and helps when repositioning your belly button. Then you will have a curved line to be pulled down once the muscles have been repaired: the surgeon's intention is to pull the skin down sufficiently to hide the operation scar in your bikini line.

Immediately After Surgery

When waking up after your surgery, you will notice a sensation of a leaden weight on your tummy. The surgeon will have ensured you have sufficient pain relief to literally relieve all the pain at the surgery site, often injecting anesthetic directly into the incision prior to stitching. When you are sufficiently awake and aware, you will notice you are wrapped in an abdominal binder bandage around your midsection. In fact, the discomfort from the surgery will be reduced by the snug and secure binder that is providing support for your newly repaired muscles.

You will also have plastic tubes draining fluid into small containers, removing any surplus fluid from the surgery site. You will need to remain in your binder for at least three weeks, day and night, followed by another three weeks wearing the corset during the daytime only. This should give sufficient time for your body to have taken control of the healing process and given your muscles time to recover.  You might also be required to wear compression stockings on your legs to ensure that you don’t become subject to DVT.  So, when you wake up, you will find your legs are likely to be encased in sheaths that gently compress and release the muscles in your legs to prevent sluggish blood flow from developing clots.

You will probably sleep most of the first day and, when you do wake, be aware of a sore throat from the endo-tracheal tube used as a breathing tube to keep your airways open during your operation. Most of that first day you sleep amidst a medication induced haze of discomfort. The second day you are a bit more composed and better able to cope but need to give yourself plenty of time for your body to heal itself. You can usually go home at the end of the second day, recuperating amidst a pile of pillows. By the fourth or fifth day the pain of the operation is subsiding and the need for painkillers diminishes. Most people feel tender rather than in serious discomfort and often only need over the counter medications to ease the pain.

Your drains will be removed by the sixth day and you will be totally amazed at the length of piping you have been carrying around coiled up inside you. This is not so much a painful experience as a sensation of tugging –  and one of surprise that the tubing really is that long! Once the drains are removed you will find the bandages are removed, revealing your surgical scar gently held together by dissolvable stitches and surgi-tape strips.

Recovery from Surgery

This is now the rehabilitation process. Your dressings are off, your drains are out and the pain is diminishing, leaving odd tweaking sensations from your slightly bruised abdominal muscles. This tends to be when patients forget they are rehabilitating and try to do too much. The result is exhaustion and, quite often, a swollen tummy. Everybody heals at different rates but you can’t rush the healing. Even a week after the operation, just take short walks, put your feet up and enjoy being taken care of while you can. By the ninth or tenth day you will notice that your tummy doesn’t swell up so much. However, although your external scars have probably healed beautifully, your abdominal muscles are much slower to repair themselves and you will still tire and ache. However, you can drive your car again.

By the third week you are out of your corset support and your body is now taking over, although you will still feel a bit bruised. The full recovery period is around six weeks by which time your surgeon should be able to recommend a return to your normal daily activities, including a gentle workout at the gym. The overall results, if you have followed your post-operative advice, should be a much firmer abdominal area and a much flatter tummy in proportion with the rest of your body shape, BMI and height. In fact, after years of being overweight and losing the weight, pregnancies and completing your family – after having a tummy tuck, many people admit to having a better waistline and figure than they had in the first place!

Risks Involved

There are risks involved, but these are similar to the normal surgical risks that accompany every operation. The most common complication of abdominoplasty is poor healing. This can be minimized, however, by carefully following your post-operative advice and allowing your body to recover from the operation in its own time. Too much too soon can result in a longer healing process. Generally, however, abdominoplasty is a remarkably safe procedure that, although associated with risks of hemorrhage and DVT, has many satisfied patients who have been delighted with the result of their tummy tuck.


In the News