Introduction: What is an Abdominoplasty?
An abdominoplasty, also known as a tummy tuck, helps to remove excess skin and fat from the abdomen, tighten the abdominal musculature and redrape the remaining skin over a firmer and more toned abdomen.
Many patients are unable to achieve a flat and toned abdomen even with proper diet and exercise. Tissues become loose and sag after losing their elasticity, especially after pregnancy , major weight loss, aging or prior surgery. In some instances the rectus muscles are separated or weakened. Patients may also have exercise resistant fat on the tummy and flanks as well. All of these concerns can be addressed with an abdominoplasty or a tummy tuck.
It is important to note that an abdominoplasty is not a weight loss procedure, and it is not a substitute for diet and exercise.
Deep internal fat cannot be addressed by a tummy tuck and must be lost only by diet and exercise. A tummy tuck also does not correct stretch marks, although a benefit of tummy tuck is that many of your stretch marks may be removed with skin excision especially if they are below the level of the belly button.
Who is an Ideal Candidate for an Abdominoplasty?
Abdominoplasty is suggested for people who have good overall health, but are worried about excess skin and fat deposits on their stomach that do not respond to lifestyle modifications. It is best if they do not have an excess of deep abdominal fat as this cannot be addressed by a tummy tuck and if present may still give the appearance of a rounded abdomen even after tummy tuck. Patients should be non-smokers, physically active and have realistic expectations of surgery. A tummy tuck can be performed on men and women who have excess fat or loose skin, this may include massive weight loss patients or women after pregnancy. Patients should be at their goal weight and have been stable there for some time as this will help minimize weight fluctuations post operatively to produce long lasting surgical results.
A tummy tuck may not be advisable if you are planning for a future pregnancy and is not a weight reduction procedure.
Preoperative Assessment
Before your procedure, a detailed medical history is obtained, and a thorough physical examination is performed. During your consultation, your doctor will advise you to stop smoking, if you smoke, to avoid post-surgical complications and delayed healing. You should eat a healthy diet and avoid any restrictive dieting during this time. You should inform your doctor of all medications that you are taking and about significant medical conditions, allergies and previous surgeries if any.
Photographs will also be taken during pre-operative consultation to submit for insurance, to be used in surgical planning and for before and after comparison. Your goals will be discussed, and realistic expectations will be set. After discussing surgical options, we will make an individualized surgical plan together that best suits your goals.
This is the best time to ask all your questions so that you can feel comfortable and confident going into surgery.
Procedure: Abdominoplasty
Abdominoplasty is performed under general anesthesia. There are multiple variations of this procedure that can be offered including: standard abdominoplasty, lipoabdominoplasty, partial or mini abdominoplasty, and fleur de lis abdominoplasty.
- Standard abdominoplasty involves the following steps:
- A horizontal incision is made from hipbone to hipbone along the bikini line.
- Dissection along the abdominal wall muscles up to the level of the ribs
- The abdominal wall muscles are tightened (rectus plication)
- Excess skin and fat are removed, and the belly button is relocated with respect to the abdominal skin after the skin has been pulled down and redraped.
- A lipoabdominoplasty includes the above procedure with additional liposuction to be performed usually around the flanks to improve the overall resulting contour.
- Partial or mini abdominoplasty involves
- Smaller incision made at the bikini line (more like a C-section incision)
- Removal ofes pockets of excess skin and fat and tightens the abdominal muscles but only below the belly button.
- The belly button will usually not need to be moved but depends on the case.
- A Fleur de Lis abdominoplasty is performed on patients who have significant excess skin in the vertical and horizontal direction and involves:
- a horizontal incision from hipbone to hipbone along the bikini line in addition to a midline vertical incision to remove additional excess skin to further contour and cinch the waistline in those who have had massive weight loss
- the abdominal muscles may be tightened (rectus plication)
- skin is redraped and excess is removed from the midline and lower abdomen
- the belly button is relocated with respect to the abdominal skin through the midline incision.
For the most part in each of these procedures your incisions will be closed with dissolvable sutures that will be under the skin and you will have either surgical glue or surgical tape over your incisions which take about 1-2 weeks to fall off.
You will have drains in place after surgery that will be removed in 1-2 weeks.
Risks and Complications of Abdominoplasty
Abdominoplasty is a relatively safe surgery. However, as in any surgery, there are chances of potential complications including:
- Anesthesia risks
- Bleeding
- Blood clots in the lungs or legs, cardiac and pulmonary complications
- Delayed healing
- Fluid collections (seroma)
- Fat necrosis
- Numbness or changes in skin sensation
- Asymmetries or suboptimal aesthetic results
- Recurrence of loose skin
- Scarring
- Infection
- Possibility of revision surgery
Recovery after Abdominoplasty Procedure
After abdominoplasty there will be some temporary pain, discomfort, and swelling. Medications will be prescribed to relieve pain. You will be advised to rest with your hips and knees bent to minimize tension on the repair. You will wear a contoured elastic garment for extra support around the abdomen. Most patients can undergo abdominoplasty as an outpatient procedure. Some patients may stay overnight for observation which will be discussed in your pre-operative appointment. Upon discharge, patients will be instructed about proper wound care and how to manage their drains at home. Stitches are usually dissolving and internal. Specific post-operative care regimen to minimize scarring will be discussed with each patient. Strenuous physical activity and heavy lifting over five pounds is discouraged for six weeks post-operatively – details of this limitation will be discussed with you specific to the surgery that you will be having. You will likely be able to resume work in 2 to 3 weeks depending on what kind of job you have and how you are feeling. Full recovery may take a couple of months and you need to have follow-up appointments to ensure a positive surgical outcome.
Summary
Abdominoplasty is an elective surgery that provides aesthetic enhancement to the abdominal region. Proper exercise and a healthy diet regimen are necessary to maintain the results of the tummy tuck.
