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ABDOMINOPLASTY (Tummy-Tuck)

Abdominoplasty is the medical name for a "tummy tuck". This procedure aims to flatten the abdomen by removing the excess skin and fat and also tightening the muscles underneath. It is most often indicated for female patients who have had children and the tummy has been stretched by the pregnancies but does not return to its previous state. Often such patients cannot alter the shape of their abdomen despite exercise or going to the gym regularly. Abdominoplasty aims to correct both the excess skin and the stretching of the underlying muscles. Furthermore, it is possible to carry out some liposuction to the flank areas at the same time, improving the appearance at the waist. Patients should normally have completed their families before embarking on this operation, as further pregnancies after the operation are likely to undo the benefits. Abdominoplasty is not an operation designed for weight loss and ideal patients are relatively slim with skin laxity/excess and poor muscle tone. Such patients usually get an excellent result. Average-sized patients can also do very well from the operation. However, very large patients may be counselled that a body contouring operation or liposuction would be more appropriate.

Before the operation

There is nothing special or complicated to be done by the patient. If you are on the oral contraceptive pill or HRT you should continue to keep taking it, and inform your surgeon and anaesthetist in the hospital. If you smoke it would be a good idea to try to stop for a month before and two weeks after surgery, as this will significantly improve wound healing and your post-operative recovery. It would be advisable to stop any herbal medicines and avoid aspirin or ibuprofen-like drugs for 2 weeks before the operation.

The Surgery

You will come into the hospital on the morning of surgery. The operation is performed under general anaesthetic and takes between 2 and 3 hours. Drains may be placed which are usually removed the following day. When you wake up you will have a dressing over the abdomen and be wearing an abdominal binder (this is a tight garment dressing similar to a corset).

Post-operative follow-up and after care.

You will need to stay in hospital overnight and possibly two nights and you will be discharged home with some painkillers. It is import to leave the dressing alone and wear the abdominal binder 24 hours a day. You may feel the abdomen a little “tight” and you should take life easy for the first few days at home. It is important to stay mobile once you have been discharged from hospital to improve the circulation in the legs and minimise the risks of a DVT (blood clot in your legs). You should arrange 2 weeks off work and avoid strenuous activity during this period. The binder needs to be worn day and night for a month and at night for a further month. Vigorous sport such as jogging or the gym should be avoided for 6 weeks. You will be seen in the clinic 5-8 days following your surgery for dressing removal and wound checking. A further clinic appointment at 6 and 12 weeks following the surgery will be arranged for you.

Possible complications

All operations carry the risk of complications. However, the risk of serious complications following abdominoplasty is rare. The risk of infection and significant bleeding are between 1 and 2 % and precautions are taken to avoid this with antibiotics and careful operative technique. In a small group of patients, a collection of fluid (seroma) persists under the skin. This is harmless and in the majority of cases if it arises, will disappear without the need for further treatment and does not affect the final outcome. If the seroma is obvious and persists, it can be removed in clinic with a syringe. An abdominoplasty operation will leave a scar which runs from one side of the lower abdomen to the other ideally in the bikini-line. Because of the way the excess skin is removed there is sometimes a little bunching at either end of the scar referred to as a “dog-ear”. If necessary, these can be removed later as a quick local anaesthetic procedure. Occasionally, scars may be red and thick for a few months but they usually settle down by themselves without any treatment.

During a full abdominoplasty, the umbilicus (belly-button) has to be repositioned and therefore the shape of it may change and you will have a scar around the inside edge of it. During this part of the operation, the blood supply to the umbilicus can be compromised and very occasionally this leads to partial or complete loss of it. This would normally be treated with dressings alone. Occasionally and most often around the umbilicus, a small hernia is discovered during the procedure; this can easily be repaired at the same time.

Following removal of the excess skin, the remaining skin is pulled quite tightly to achieve the optimum appearance. This does not usually cause problems in healthy patients. However, in some patients such as those who are diabetic, or smoke or are obese, this skin tension can cause wound healing problems or even skin necrosis. Small areas of skin that have not healed well can be treated with dressings in the clinic. Rarely, a further operation to clean the wound or perform a skin graft is required.

The most serious and relatively common problem in all forms of major surgery is a deep venous thrombosis (DVT) in the leg and possible pulmonary embolus in the post-operative period. Great care is taken to avoid this problem by using compression stockings and inflatable calf pumps in theatre. In addition, these calf pumps are continued overnight and early mobilization is encouraged.

Where appropriately indicated and well performed, an abdominoplasty operation provides very pleasing results, leaving most patients and surgeons extremely happy with the outcome.

Plastic & Reconstructive Surgery

FACTS AT A GLANCE

SURGERY TIME
2-3 hours

HOSPITAL STAY
1-2 nights

ANAESTHETIC ASSESSMENT
Possibly

PRE ADMISSION TESTS
Yes

REASONABLY MOBILE
4-5 days

WASHING
Shower after 1 day

DRIVING
2 weeks

SPORT & EXERCISE
6 weeks contact sport 8 weeks

SEXUAL ACTIVITY
6 weeks

FULL RECOVERY
4-6 weeks

TIME OFF WORK
2-3 weeks

GARMENTS
Binder day and night one month, then night for further month