Abdominoplasty - "tummy tuck"
Abdominoplasty (also known as "tummy tuck") is not a treatment for obesity, but instead aims to reduce the redundant or excess skin and fat that so often accumulates with age in the lower part of the abdomen of some people. This excess often appears most prominently as a lower abdominal "roll" when seated, and can be difficult or impossible to diet away. In some patients who are slim, the problem is purely one of excess skin, often wrinkled and possibly containing stretch marks. In others both skin and underlying fat are present to excess in the lower abdomen, and may even form an unsightly fold of tissue that droops downward, and is particularly emphasised when sitting. Abdominoplasty (" tummy tuck ") techniques are very similar in principle for each of these problems, and it is a very satisfactory procedure in the appropriate circumstances, producing a very pleasing improvement in a patients appearance and sense of well being. It is however a complex and delicate operation, and like all operations has the potential for complications that can be minor or not so minor. I believe that all potential patients should be aware of these problems before they can make a sensible and informed decision about surgery. It should be stressed that in the vast majority of patients no significant complication occurs, but in any surgeons hands problems can arise, and before embarking on surgery you should ask yourself whether you feel you could cope with that eventuality.
In general the operation is conducted under general anaesthesia, and involves a hospital stay of 48 hours on average. Surgery is conducted through an incision across the lowest part of the front of the abdomen, just above the pubic hairline and extending out to the sides to a variable extent. Every effort is made to place this incision in such a way that it can be hidden by the patients preferred style of underwear or beachwear. In some cases however this is not always possible. Through that incision the skin and underlying fat is raised gently off the muscles of the abdominal wall, often extending well above the level of the umbilicus or tummy button. For this purpose the umbilicus is detached from the surrounding skin with an incision, (and so subsequently a scar), that completely encircles it. Having raised the skin in this way it may then be gently drawn downward and re-draped over the abdominal wall, allowing the considerable excess that is often present to be removed from the lower end of the re-draped skin. A new site is then fashioned to accommodate the umbilicus, and the lower wound may then be closed. Usually this is possible within the confines of a single transverse scar as discussed, but occasionally a small vertical scar in the lower abdomen will be necessary or desirable to limit the extent of the transverse scar. Before closing the wound, however, it is very common to undertake some tightening of the central portion of the abdominal muscles, which are especially prone to stretching during pregnancy, and which cannot then be remedied by exercise alone. This eventuality will usually be predictable and discussed with you before surgery.
Abdominoplasty and Liposuction
Another possible adjunct to the abdominoplasty ("tummy tuck") procedure is liposuction in which discrete areas of abdominal fat are removed in order to provide a more pleasing contour to the new abdomen. This is usually confined to the anterior abdominal wall (to re-create the natural slight hollows above and around the umbilicus) but may be appropriate for other areas like hips and thighs, (Lipsuctiont is dealt with elsewhere on plastic-surg.co.uk). The lower abdominal wound is closed with either absorbable or non-absorbable stitches, and one or more drainage tubes will be placed to remove excess blood. If the operation has been extensive some patients may benefit from a urinary catheter to avoid the necessity to use bedpans or the lavatory for the first 24 hours. Again this will usually be discussed prior to surgery. Abdominoplasty (" tummy tuck ") is a very reliable and successful operation, but as with all surgery bleeding can occur in the postoperative period and require a brief return to the operating theatre if it is troublesome. Blood transfusion is extremely unusual even in these circumstances. Likewise, infection is a risk common to all surgery. Again precautions re taken against this by using standard aseptic techniques and sometimes by giving a preventative dose of antibiotics during surgery. Nonetheless infections can occur and cause delay in healing of the lower abdominal wound. In very rare circumstances this wound may require further surgery to close it after an infection. Again this is very unusual. Delay in healing the wound is more likely in smokers, and for this reason you should stop smoking 2 weeks prior to surgery and for 2 weeks after surgery. You may also be advised to halt the oral contraceptive but this will be discussed at the time.
After the operation
After abdominoplasty ("tummy tuck") surgery, significant pain is uncommon, but pain relief is always available. Usually drainage tubes are removed on or about the 2nd day, and you will normally be fit for discharge at that time. You should rest at home and return for wound care at one week and for suture removal at 2 weeks. If muscle tightening has been undertaken you should avoid heavy lifting for 6 weeks after surgery, but return to work is usually possible by 3 - 4 weeks, allowing you time to overcome the tiredness and lethargy that follows most surgery. Problems post-operatively are unusual, although a very few patients experience a short lived accumulation of fluid (seroma) beneath the skin that may need to be withdrawn once or twice with a needle. The scarring (see above) gradually matures to become white and soft, and the numbness that is felt in the lower part of the abdomen gradually recedes, although some alteration in the sensation of the skin may persist. General health problems following aesthetic (cosmetic) surgery are uncommon. The most serious of these is venous thromboembolism. Here clots of blood form in the legs and break loose to travel through the blood stream to lodge in the lungs where they can do serious, even fatal, damage. The risk of such a complication is increased in smokers, those on the pill, those in whom pelvic surgery is undertaken, or in whom post operative immobility increases the risk. Preventative measures can be taken and these include special pneumatic calf compressor devices during and after surgery, specialised supporting stockings during periods of enforced rest, and some pharmacological treatments to reduce the tendency of blood to clot. The latter treatments will be discussed with you prior to surgery but have the potential side effect of slightly increasing bleeding during and immediately after surgery.
Scarring after abdominoplasty
The exact placement of scars after abdominoplasty varies depending on the pattern of fat and skin to be removed, but the diagram shows the commonest pattern. The quality of the scar may vary and should be discussed with the surgeon prior to deciding to proceed with correction.
Abdominoplasty (" tummy tuck " )is generally a very pleasing operation that helps a lot of people. As I said earlier, significant problems are rare, but clearly you must appreciate what could occur. If after consultation or reading this fact sheet you have any questions to ask, I suggest you write them down and then discuss them with your surgeon at the next consultation.
Professor Simon Kay, Consultant Plastic Surgeon