Abdominoplasty (Tummy Tuck)
An abdominoplasty, or tummy tuck, is designed to remove excess skin from the abdomen and, if required, tighten the abdominal muscles. This operation is usually requested 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.
The first thing to do is to talk to your GP who can refer you to Mr Meagher. By talking to your GP and your surgeon you are more likely to get the results you want from the surgery.
Unlike liposuction, which only removes fat, abdominoplasty removes both skin and fat and it tightens the abdominal muscles. That’s why this procedure is more extensive than liposuction but in many cases liposuction is performed in conjunction with abdominoplasty.
There are a number of reasons not to proceed with an abdominoplasty, including:
- Likely or planned future pregnancy
- Medical conditions prohibiting elective surgery
- Unrealistic expectations
Before the operation
The most important thing to do is to talk with your surgeon so that there is a clear understanding of your desires and expectations, in light of any biological prerequisites. We want you to be well informed and have realistic expectations of the results.
Mr Meagher will describe the type of abdominoplasty technique he will use, the type of anaesthesia, the hospital, any additional surgery, the pros and cons, benefits, potential complications, possible risks and the costs of the procedure.
You will be asked to discuss your medical history, including information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries and medications that you currently take. You will have to stop taking medication which alters blood viscosity, e.g. aspirin. As for all surgery, patients are requested to stop smoking at least 6 weeks prior to the operation.
Specific individual risks will also be explored especially those related to medical situations such as high blood pressure, a tendency to scar, smoking, medications and any deficiency in blood clotting. As well as assessing your general health your surgeon will assess your mental and emotional attitudes toward the surgery.
Your surgeon will examine your abdomen, taking measurements and photographs for your medical record.
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 by signing a consent form.
During the operation
Your surgery will be performed in a major hospital under a general anaesthetic. It can take between 2 and 4 hours for the operation and, for your safety, the attending anaesthetist will use various monitors to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
Just before the operation the amount of skin that is to be removed is carefully marked using a surgical marking pen. 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 surgeon will try to keep the incision within your bathing suit lines, but this may not always be possible.
Some patients have loose skin above the navel and we 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 and the position of the navel remains unchanged. To tighten the abdominal wall, the surgeon brings loose underlying tissue and muscle together with stitches. The skin is then carefully re-draped and the incision closed with several layers of stitches.
If you have lost a lot of weight, large skin folds may make skin care very difficult. In this case we can do a procedure called a panniculectomy. Body contouring procedures are not designed to correct obesity and a stable weight must be achieved before undertaking either of these procedures.
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.
The abdominoplasty procedure removes large amounts of abdominal fat and skin below the belly button to reshape the stomach and thoracic area. Unlike liposuction alone, we will remove a considerable amount of skin below the belly button to tighten the remaining skin and give an improved shape.
Please remember that loose skin cannot be removed without incisions, which will create scars and these may be longer than you expect. Talk to Mr Meagher about possible scars, their size and visibility. Scars generally fade over time, assuming they are not exposed to excessive sunlight, 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 re-draped in its new position. This leaves a scar around the belly button.
Some cases may require liposuction in conjunction with the tummy tuck to remove excess flank or hip fat to give a flatter and more hourglass shape figure.
After the operation
After the operation you will need to stay in hospital for 2 or 3 nights. You will feel uncomfortable for 7-10 days after the procedure which is partly due to swelling of the surgical site but mostly to the lining of the abdominal muscles . It is critical that you wear an abdominal support specified by the surgeon. You may also have to temporarily manage with a closed suction drain 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.
You will feel numb around your abdomen for many months after surgery. You can return to work 2 to 3 weeks after the tummy tuck but should wait for about 2 months before exercising. It is very important that you follow the post-operative advice of Mr Meagher.
The final results of your abdominoplasty may 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 sunlight, which could lead to darkening and increased visibility of the scar tissue.
Naturally, there are risks associated with any type of operation and this surgery is no exception. Your surgeon will explain the possible risks, which are rare, but may include:
1. Pain: As with any surgical procedure, pain of varying intensity may occur following your surgery. You will be prescribed some pain medicine to take in hospital and at home after your discharge, if you need it.
2. Infection: Infection does not happen very often and you will be given an antibiotic at the time of your surgery to prevent this. If you do develop an infection, see your surgeon as soon as possible. Most infections can be treated with an antibiotic but they can cause serious problems and increased scarring.
3. Haematomas: Haematomas are a solid swelling of clotted blood within the tissue and they can happen after any surgery. The risk of infection is higher if a large haematoma or seroma (a collection of watery fluid within the tissue) collects immediately after surgery. Your surgeon may use a surgical drain to help prevent small haematomas but, in some cases, the surgeon may need to re-operate to remove a large haematoma.
4. Poor wound healing: Healing can take longer in cases of:
- Infection especially around the belly button
- Fluid accumulation
- Overly tight stitches
- Improper support during healing
- Pressure against the scar tissue
Wound healing may also take longer in patients who have diabetes, or other medical conditions, or who smoke.
Because of the very nature of cosmetic surgery, sometimes patients can be dissatisfied with the results.
- Swelling can persist for up to three months if adjunctive liposuction is performed.
- The scar across the lower abdomen may not be perfectly straight. Excess skin known as dog ears may persist at either end of the long transverse scar. In patients, especially those who have a significant amount of skin and fat to be removed a surgery these “dog ears” may persist for some time and very occasionally, less than 1%, need to be removed under local anaesthetic 12-18 months later.
- The abdominal skin may be numb after the surgery.
- A seroma or fluid collection underneath the skin is not uncommon and if it occurs it can be aspirated in the Consultant rooms post operatively.
- Infection around the belly button is quite common but usually settles with normal wound cleansing etc.
- Pain and discomfort sitting up is more commonly a feature after abdominoplasty surgery if the abdominal muscles are tightened.