| | Surgical procedures can selectively be employed to improve situations in which these problems arise. These operations however are not directed toward weight reduction, which is still primarily a dietary problem. In cases
where improvements cannot be made despite even the most diligent efforts, an abdominoplasty may be appropriate. Abdominoplasty or "tummy tuck" as it is commonly known is an operation to tighten the muscles of the abdominal
wall and to remove excess skin folds and fatty tissues from the middle and lower abdominal region. As such it can dramatically reduce the appearance of a protruding abdomen and lead to a flatter, firmer, tighter stomach and
a thinner waist as well. Many times however the problem is basically confined to only localized fat in the abdominal region without any associated skin laxity or stretch marks. In these cases liposuction alone may be suitable.
Other times liposuction can be performed in conjunction with one of the many variations of an abdominoplasty procedure.
Am I suitable for this type of surgery?
This will be decided at your consultation. Women who plan to become pregnant imminently should usually postpone the operation until after their family is complete.
If you are a smoker you will be asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin and certain
anti-inflammatory drugs and other medications can cause increased bleeding, so you must avoid these.
A physical examination will determine if you are a candidate for an abdominoplasty procedure. Abdominoplasty should
not be performed to correct obesity. Heavier patients will be disappointed even if measures such as extending the incision and liposuction are performed. This is because there will still be substantial fullness in the flanks,
upper torso and buttocks which will contrast with a tighter abdomen. To avoid this disappointment and to minimise the need for a secondary procedure, the best candidates are men and women who are within several pounds of their
ideal weight.
As mentioned there are a number of variations in the technique of abdominoplasty. The decision will be based on the quality of your skin, the presence of stretch marks, the laxity of your muscles, and the
amount and distribution of fat. A definite decision can only be made at the consultation after a proper examination. However, broadly speaking, if you have loose muscle and excess skin in both the upper and lower abdominal areas
with only modest fat deposits you will most likely require a full abdominoplasty. If however you have loose skin confined mainly to the lower abdominal area but have retained good skin and muscle tone above the umbilicus with
little or no excess fat, then a "mini tuck" may be used. Alternatively if this is accompanied by modest excess fat in the upper abdomen then liposuction may be used in conjunction with the "mini tuck" to improve the result. It
would be fair to say that the term "mini tuck" is actually a misnomer as the scar is about 10 inches long and cannot be deemed very "mini".
What does the Operation involve?
In the full abdominoplasty, you must understand that there is a long incision made within the so called "bikini line" just above the pubic area, from hip to hip. The skin and fat is then peeled off the abdominal wall up to the
umbilicus. At this point a second incision is made around the umbilicus, in a measure to free this from the surrounding tissue. Once this is done, the skin and fat flap of tissue initially lifted, is continued to be peeled off
the abdominal muscles, leaving the umbilicus on a stalk all the way up to the border of the lower rib cage. The exposed muscles are then tightened as necessary by stitching them together creating a firmer abdominal wall and a
narrower waist. The peeled back flap of skin and fat is then stretched downwards towards the initial incision and any extra tissue is removed. The incision is subsequently sutured closed but not before a new hole has been made
for the umbilicus, which as mentioned is sited on a stalk, to come through. Drainage tubes are usually placed under the skin to collect any excess fluid that may accumulate in the first 24 hours after the operation. These are
removed when fluid production has ceased. In the "mini tuck" technique the skin is separated only between the lower incision line just above the pubic region, and an incision just below the umbilicus. The umbilicus is left in
place without the need for a further incision. Liposuction of the flanks may be combined with this procedure if the distribution of fat calls for this. In some patients with fat deposits at the upper abdominal area a secondary
procedure (liposuction) may be performed at a later stage (three months) to treat this area and produce a completely flat abdomen. You will be informed for this necessity at your preoperative consultation.
What type of anesthetic is used?
Abdominoplasty is usually performed under general anesthesia (completely asleep). You will usually require an overnight stay at the hospital.
How long does the surgery take?
Depending on the technique used, and whether this is combined with any other surgery such as liposuction, it usually takes between 2 hours.
What happens immediately after the Operation?
Once you've recovered, you will notice a compression garment around your waist and abdomen. This is to provide compression of the surgical site to reduce the postoperative swelling and bleeding. In addition you will notice the
presence of 2 tubes or drains, which are usually placed under the skin to evacuate any fluid, build up following the surgery. These usually stay for few days until no drainage can be observed in the drains. You will find that
the abdominal area will be quite uncomfortable and that you will have 1-2 pillows placed behind your knees in order to keep these bent to reduce the tension in your abdominal muscles. Likewise you will need to walk slightly bent
forwards once you are up and about, for the first few days. You may gradually straighten up as the days pass. Instructions about washing will be given to you. You should keep the wound dry for few days (4-5 days) according to the
progress of your healing .
Is it Painful?
Pain and discomfort are subjective sensations. Pain is minor. Thus for the first week or so you will need to take regular painkillers in order to minimize this .You will not be able to stretch completely your body and you will
feel some tension at the incision line. This is probably more noticeable when standing or during walking in the first few days following surgery.
What kind of after effects should I expect?
Following surgery you will experience considerable swelling and bruising of the abdomen. This will be even more noticeable if the abdominoplasty was accompanied by liposuction. The bruising usually lasts about 3 weeks. While most
of the swelling will have dissipated by this time, some subtle swelling will still be present for up to 3 months.
In addition you will notice that the abdomen will feel firm to touch, particularly along the edges of
the incision site. This will be as a result of the normal healing process laying down elements of scar tissue to facilitate healing. When this occurs, massage will speed up the recovery. It gradually resolves in time but may take
a few months to complete. You should expect the sensation to the skin over the lower abdomen to be reduced after surgery. This is as a result of surgical trauma to the nerves in the region. Although this usually recovers
in a few months, permanent numbness in the region can ensue.
What are the Scars like?
As explained the scar length will be substantial. These normally extend from hip to hip above the pubic area as a horizontal line. At times it may be necessary to add a small vertical component to this and therefore the appearance
may be likened to an upside down T. Although all surgeons try to suture the incision as neatly as possible, it is must understand that due to the normal healing response these always appear red, raised and lumpy in the first few
months after surgery ultimately impossible to predict a scars' eventual appearance. In fact very rarely can abdominoplasty scars be described as hairline. You, but do tend to settle with time. However it may take up to 18
months to do so. Stretching and prominence of all or parts of the scar however can occur. If necessary, and when deemed appropriate, it may be necessary to revise a scar to try to improve its appearance. This will be discussed
at the follow up consultations.
What could go wrong?
While it is true that when an abdominoplasty is performed by a qualified plastic surgeon the risks are small, nonetheless, specific complications with this procedure can and do occur.
As in any procedure the risk of significant infection is always possible. This is minimized by careful surgical technique and the preventative administration of antibiotics both at the time of surgery and after. However despite
these measures mild infection is relatively common and can occur around the incision site, but usually subsides over a period of about 2 weeks. Risks such as blood clots are rare. Early mobilization by moving around as soon after
the surgery as possible reduces this considerably.
As mentioned earlier, swelling should be expected after this operation. When mild or moderate swelling is present, the body rapidly reabsorbs this. Very occasionally,
increased bleeding can lead to more significant swelling and the development of a haematoma (a collection of blood under the skin). If this were to happen, surgical drainage to evacuate this would be required. Ultimately however
this should not affect the final outcome.
Another possible complication is the formation of a collection of fluid called a "seroma" (the most frequent complication). This fluid is clear and yellow in colour. It is
seen as a swelling in the lower abdominal region, and many times patients report that they can feel this fluid moving under the skin. It is usually noticed at about 10 days after surgery. The treatment will depend on the
amount of fluid present. If this is deemed to be small and is not causing any discomfort, then only a pressure garment is applied and the body reabsorbs it. You must also limit any strenuous activities and take a good rest) If
however the amount of seroma is significant and causes pain or discomfort, then the initial treatment is to draw out this fluid with a needle (called aspiration). Following aspiration the swelling rapidly disappears. If necessary
this procedure may be repeated.
During the first 2 -3 weeks after surgery, some patients may experience a minor loss of wound adhesion at any point of the incision site. This is a temporary complication, which will
require regular dressing changes initially. Eventually a scab develops over this, which subsequently separates after 3-4 weeks. However some distortion of the skin around the scar may ensue particularly if this has occurred over
the hip region. Further revision surgery may be required if necessary.
How long before I get back to normal?
Abdominoplasty is a major operation and should always be respected as such. Therefore you should expect a few weeks to pass before you feel yourself again. Remember variations do occur in the time individuals take to heal. Although
many people go back to light work duties by 2 weeks others find it more appropriate to take a further 1-2 weeks to rest. Walking is helpful in the first 3-4 weeks as this improves the circulation and helps reduce the swelling, and
the chance of blood clots developing. Heavy lifting or Strenuous activity is prohibited in the first 6 weeks after surgery. Overall common sense rules in the recovery period. If what your doing is uncomfortable then don't do it!
Summary
Abdominoplasty has always been a popular cosmetic surgery request. It will give confidence to the individual and allow them to wear clothes that were previously unsuitable. The effects are generally long lasting provided you follow a
balanced diet and exercise regularly.
 These notes are for guidance but you must realize that every patient is different with a different healing capacity. You should contact your surgeon in case of any specific concerns.
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