Abdominoplasty (tummy tuck)
Abdominoplasty is a very common operation performed by plastic surgeons to improve the appearance of the tummy. Abdominal deformity most commonly results from previous pregnancies (especially large babies, twins etc.) but also following significant weight loss or surgery. The main reasons for seeking surgery are cosmetic embarrassment e .g. when wearing certain clothing or when undressed in front of their partner. A proportion of patients have physical symptoms such as skin rashes or discomfort related to significant muscle laxity. The deformities vary from a mild skin excess with no muscle laxity to a very severe form with muscle weakness and significant skin excess.
The purpose of a tummy tuck is to therefore remove excess skin and tighten the muscles of the tummy wall. The latter is usually achieved with permanent internal stitches. The exact operation required to give the best results depends on the type of tummy problem Liposuction may be cautiously used with this technique in certain cases.
What will happen during the consultation?
A medical history is taken to detail the cosmetic, functional and psychological symptoms caused by the abdominal problem. Any history of weight change, previous pregnancies or abdominal surgery is documented together with a discussion regarding your general health.
Your tummy is then examined to identify exactly what needs correcting. You will be checked for skin and fat excess, muscle weakness, hernias and skin quality.
The surgeon will then discuss the options for you in detail including the pros and cons of the proposed procedure(s).
I personally find it very useful to give patients the option for a second consultation (free of charge). Many patients are grateful for the opportunity to have the operation explained again and have questions answered. It is important that patients are given sufficient time to think through what has been discussed.
Who is suitable for this operation?
Patients must be medically fit for this operation as it requires a full general anaesthetic. You should stop smoking 4 weeks prior to this operation (to reduce the risks) until at least 2 weeks after surgery or when the wounds have healed.
Abdominoplasty is not a procedure to help achieve weight loss and indeed obese patients (body mass index>30) should be advised to lose weight prior to surgery. This advice is given to minimize potential risks and to optimize cosmetic results.
Where will the scars be situated?
For a standard abdominoplasty, there will normally be a curved scar located in the bikini line running from hip to hip. Sometimes a small vertical scar above the pubic hair region is required particularly when patients have had umbilical (belly button) piercings. There will also be a scar running around the belly button. In patients who have lost a lot of weight a long vertical scar may also be used.
How long will I be in hospital for?
Patients are normally kept in hospital for 2 nights following a full abdominoplasty. This is to allow you to recover to a safe level. Temporary drains are usually inserted at the time of the operation. These are plastic tubes about the size of a drinking straw, which come out of the skin close to the abdominoplasty scar. The drains are kept in for the first 48 hours usually to take away any excess blood or fluid from the wound. If drainage is very excessive these tubes may be kept in slightly longer
What other aftercare will I need?
You will need to have follow-up appointments to check your wounds. I use dissolving sutures in my practice that do not need to be removed. I would normally see you at about 9-10 days after surgery then 1 week, 6 weeks and 6 months later.
A pressure garment is usually advised following this procedure. I normally recommend “control pants” which can be bought over the counter fairly cheaply. These garments should extend right up to the rib cage and are normally applied when the drains are removed. I recommend that this garment is worn for 6 weeks to reduce the risk off fluid accumulating under the skin.
What are the possible risks of this operation?
All operations carry some degree of risk. Most potential problems with abdominoplasty surgery are minor, but it is important that potential risks are discussed with patients. This is to allow them to decide whether the operation is right for them and so they are well-prepared. The exact risks of a procedure depend on the type of abdominoplasty performed and factors related to an individual’s health. Below is a list of some possible complications. This list is not exhaustive and is intended only as a guide:
- Lumpy, raised scars (keloid or hypertrophic scars)
- Bleeding (may require return to the operating theatre during the admission),
- Wound breakdown (dressings may be required for longer than expected)
- Fluid collection under the skin (seroma) – usually absorbs itself or can be removed using a needle and syringe
- Numbness of the skin of the tummy (normal for this procedure), upper thighs (occasional)
- Asymmetry of scars or abdominal skin
- Small areas of excess skin at either end of the scar that can sometimes can require revision
- Very rarely, blood supply of the belly button may be compromised by this procedure,. This process can lead to loss of the belly button.
- Deep vein thrombosis – to try and prevent this, special stockings are worn and a small injection of a blood-thinning agent is given after surgery.
What is the recovery time from this operation?
Recovery from any abdominoplasty, as with any operation, depends on a number of factors including the patient’s fitness level before surgery and the extent of the surgery required. Likewise, time off work depends on these factors and also the demands of the job.
Although you should be able to start walking about on the first day after surgery, during the first 1-2 weeks you will not be able to stand up completely straight. Pain after surgery is usually very well controlled with tablet painkillers. It is advisable that you have somebody at home to help look after you during the first week after surgery.
Wound dressings are normally required during the first 2 weeks, although this can occasionally be longer. I advise patients to apply MicroporeTM tape to the wounds during the subsequent month to support the scars.
Most patients need 3-4 weeks off work. You may tire easier in the first few weeks after surgery. Heavy lifting or strenuous exercise should be avoided during the first 6 weeks. Swelling, particularly in the lower abdomen and pubic hair region may persist for many weeks. Most people are back to normal within 2-3 months of their surgery, however. Scars usually fade month by month but can take 1-2 years before they are maximally faded.
When will I be able to drive?
You will be able to drive when you are able to comfortably move your legs around whilst sitting in the car and when you can perform an emergency stop.
For most people, this is in the region of 3-4 weeks after surgery. It is important to raise this with your surgeon after your abdominoplasty and check with your car insurance company.
A final note…..
Abdominoplasty is a very popular and effective operation. Having this surgery is a big decision, but when patients are properly informed and an operation is tailored to their needs they are usually extremely satisfied with the results. The patient can normally expect to have a flatter tummy with a boost given to their confidence both in and out of clothes.
Pre-operative photographs (patient of Mr. Darren Chester, Consultant Plastic Surgeon at BMI Droitwich Spa Hospital)
12 months following full abdominoplasty
“It was a big decision to go ahead with an abdominoplasty but throughout I was made to feel positive and was kept well informed. It was the best decision I made”
Article by Mr. Darren Chester FRCS(Plast.), Consultant Plastic Surgeon, BMI Droitwich Spa Hospital.
This article has been written by one of our consultants. Each consultant differs in their practice and therefore this article does not reflect the standard approach or practice of all BMI consultants. It is important that you talk to your treating consultant about your own situation and any surgery you may undertake.