Abdominoplasty
What is an abdominoplasty?
An abdominoplasty ('tummy tuck') involves the removal of excess skin and fat from the lower abdomen. This results in a slimmer waistline and an improved body contour. Tightening of the abdominal wall muscles may be performed in conjunction with this, to enhance the abdominal contour.
This procedure is frequently used on its own, but is also used in combination with other procedures, such as liposuction or buttock, thigh, and arm lifts in those who have lost large amounts of weight. The abdominoplasty may also be extended to a circumferential body lift to remove excess tissue from the flank and back.
Why have it?
With increasing age, the skin's elasticity is reduced and its ability to take up its former taught shape is lost. Despite diet and exercise, unwanted fat and excess skin may remain in the lower abdomen. Changes in weight and pregnancy (particularly those who have had multiple pregnancies) can also lead to excess lower abdominal tissue.
Pregnancy can stretch the skin beyond its ability to return to the pre-pregnant state. If skin retraction has not taken place by one year then it is unlikely that this will occur. In addition to the skin being stretched, pregnancy can also lead to be separation of the rectus muscles, which may weaken the abdominal wall and in some cases produce bulging.
Reasons not to have it
Abdominoplasty is not in itself a treatment for obesity. It may though be used as an additional part of a long term structured program to reduce weight and achieve a good end result.
Being overweight and smoking can increase the incidence of complications from an abdominoplasty. It may be wise to delay surgery until smoking is stopped or cut down, and a proportion of excess weight lost. It may not be wise to proceed if you have future plans for pregnancy. Previous abdominal surgery may not permit an abdominoplasty.
Aspirin increases the risk of bleeding by preventing blood from clotting. If you are taking aspirin, you will be asked to stop this for at least ten days before the procedure.
Further information
Consultation
Mr Roblin will examine you, looking in particular for excess tissue and its extent, and for bulging or hernias. In addition the strength of your abdominal wall will be tested.
You will first be asked about your general health, particularly information regarding heart disease, diabetes, and deep vein thrombosis (clots in the leg). Mr Roblin will want information about your medical history and any previous surgical procedures. Also additional information about changes in weight, previous pregnancies and future planned pregnancies.
In line with your aims, he will discuss which procedure is the most appropriate to achieve the optimal result in your individual case.
Procedure
Types of abdominoplasty
Standard abdominoplasty
In this procedure most or all of the skin below the umbilicus is removed. The remaining skin is pulled down and redraped over the abdomen. A low abdominal scar is placed in the panty line to camouflage it. Occasionally, a short vertical scar maybe necessary. The umbilicus remains in position in the overlying skin at its original site. The resulting scar around the umbilicus is usually concealed.
Mini-abdominoplasty
In this procedure a reduced amount of abdominal tissue is removed, which may be augmented with a moderate degree of liposuction to remove fat from the flank and upper abdomen. A shorter abdominal scar is left and the umbilicus remains in its original position with no scar surrounding it. This procedure is only suitable for a small proportion of patients in whom the majority of excess tissue and fat is found below the umbilicus.
Extended or Circumferential abdominoplasty
This procedure is used for those who require more extensive tissue removal, including tissue from the flank and back. It results in a longer scar (onto the back) and may necessitate a vertical scar in the midline. This is most commonly used in those who have undergone weight-reducing surgery, and/or have lost large amounts of weight.
Tightening muscles
In addition to the removal of skin and fat, the abdominal muscles may be lax. These can be tightened, which helps to give the abdomen a more flattened appearance. This can be combined with any of the types of abdominoplasty.
Anaesthetic
The operation is performed under general anaesthesia and takes approximately 2 hours.
Length of stay
1-2 nights following the operation.
Risks/Possible complications
Early (1-2 days):
- Discomfort
- Bruising
- Swelling
- Infrequent
- Bleeding (haematoma)
- Infection
- Wound breakdown
Later (after one week):
- Scars - can be lumpy, may stretch and widen
- Seroma formation
- Residual deformity (occasionally a second smaller procedure is required)
- Asymmetry
- Misaligned of umbilicus
- Contour irregularity
- Delayed wound healing
- Temporarily reduced sensation in lower abdomen
- Fat necrosis
- Skin or umbilical necrosis
General anaesthetic
- Deep vein thrombosis
- Chest infection
- Allergic reaction to drugs or tape
Recovery
Immediately after the operation
- You will feel bruised and sore and there will be some swelling
- Pain is usually moderate and controlled with standard painkillers
- Two drains will be in place that may stay in when you go home
- A compression garment is to be worn day and night for the next 2 weeks
- Walking is encouraged, but no heavy lifting or straining
After return home
- Return to work at 2-3 weeks
- Driving at 2-3 weeks
- Swelling and bruising up to 6-8 weeks
- Wear compression garment in daytime for 6-8 weeks
- Return to gym and strenuous activity 3 months
- Final result 4-6 months