Abdominoplasty or tummy tuck, is an operation designed to remove excess skin and fat from the abdomen and at the same time if required, tighten the abdominal muscles. This operation is indicated in cases where there is laxity of the abdomen resulting in bulging due to abnormal stretching of the abdominal muscles and skin, particularly in those who have had one or more full term pregnancies with subsequent loss of youthful tone of the abdomen or fluctuating weight loss or gain.
How does Abdominoplasty differ from liposuction?
Unlike liposuction surgery, which only removes fat by suction, abdominoplasty involves surgical removal of skin and fat, with tightening of the abdominal muscles. For this reason, the procedure is more extensive than liposuction. The actual extent of surgery will depend on the amount of excess skin and the laxity of the abdominal muscles. In many cases a Lipoabdominoplasty, ie liposuction in conjunction with abdominoplasty is performed.
If marked weight loss has occurred, large skin folds may make skin care and quality of life very difficult. In this case a procedure called a panniculectomy may be more appropriate. Body contouring procedures are not designed to totally correct obesity and a stable weight must be achieved before undertaking either of these procedures.
Who is the Ideal candidate?
Adults with the above abdominal problems, of any age who are in good health, moderately fit and overall have good muscle tone. Candidate should not have any serious medical conditions. Non smokers have an increased risk of complications. Previous abdominal surgery may limit the potential results of tummy tuck. Women who have undergone caesarean section have the opportunity to have the existing scar revised. Patients whose weight has been stabilised after weight loss program or feel they are at their ideal weight are also good candidates for a tummy tuck.
Can there be reasons not to proceed with an abdominoplasty?
Abdominal scars above the umbilicus (restricts blood supply to distal flap)
Likely or planned future pregnancy
Medical conditions prohibiting elective surgery
Benefits of a tummy tuck
A tummy tuck will enhance your figure and your self-confidence, it is not likely to change your life or the way people treat you. A tummy tuck is not a substitute for weight loss or exercise program. Patients who are planning substantial weight loss or women who are considering future pregnancies may be advised to postpone a tummy tuck.
The Primary Consultation
A consultation with your Aesthetic surgeon will help to evaluate your general health condition and understand your expectations for abdominoplasty surgery. You will be fully educated about the benefits and risks of the procedure and the likely outcomes of the operation. You should honestly share your expectations, fully disclose your health history, current medications, allergies and the use of drugs and smoking. You will be made to undergo some blood tests & other investigations. A pre-operative anaesthetic assessment is carried out to ascertain fitness for surgery under anaesthesia. Pre operative photographs will be taken to help in planning the procedure and to allow you to compare the results after surgery.
General Guidelines prior to surgery for patients to follow prior to their abdominoplasty procedure.:
Detailed Abdominal examination and measurements
Pre-Operative Photographs will be taken.
Obtain laboratory testing or a medical evaluation
Pre-operative Anaesthetic assessment for fitness for surgery
Agreement to proceed with the surgery by signing an informed Consent Form
Take certain medications or adjust your current medications
Stop smoking well in advance of surgery
Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they increase risk of bleeding.
Maintain a stable weight for 6 months prior to the date of surgery
The Operative Procedure
Your abdominoplasty operation should ideally be performed in an accredited major hospital under general anaesthesia . Abdominoplasty is a procedure in which the protruding, loose, sagging or pendulous skin of the abdomen is corrected by surgical excision. The area to be treated usually addresses the lower and central abdomen but occasionally may extend to the rib cage sides. A low transverse incision, similar to a caesarean incision is used to lift the excess fat and skin off the abdominal muscles. The length of the incision, which extends laterally toward the pelvic bones, depends largely on the amount of skin to be removed. The incision scar is hidden within the panty lines, but please note that this may not always be possible.
1. Traditional Abdominoplasty
Where excess skin and fat both below and above the umbilicus has to be removed a full abdominoplasty is performed and then the umbilicus is re-sited. Once the skin and fat of the abdomen is lifted up, the muscles of the abdomen are tightened to improve the contour.
2. Mini Abdominoplasty
When excess skin and fat below the umbilicus is removed without disturbing the position of the umblicus.
3. Fleur delis Abdominoplasty
Where abdominoplasty involves excision of excess skin and fat from the abdomen both in a vertical and horizontal dimension it is known as Fleur delis Abdominoplasty. This surgery is indicated for severely obese patients or for those after massive weight loss.
4. Reverse Abdominoplasty
When excess skin and fat above the umbilicus is removed without disturbing its position.
When liposuction is combined with a tummy tuck to improve contour. Liposuction will help remove excess flank or hip fat with the objective of providing a flatter and more 'hour glass' shape figure.
Post Operative Care
Patients are sent home 2-3 days after the procedure, to follow up at around 5th day for removal of any drains. There might be bruising, swelling and discomfort after surgery that should subside in 2- 4 weeks. Your abdominal skin will be tight after surgery and you may have to walk stooped for a few days till the existing skin stretches. Wounds normally heal in 1- 2 weeks. It is recommended to wear an abdominal support for the first 6 weeks. Once all swelling and bruising has subsided you should expect a flatter, more shapely abdomen.
Patients will experience a numb feeling from their abdomen for many months after their surgery. Typically patients can return to work approximately 2-3 weeks after the surgery but should wait for approximately 2 months before exercising/lifting weights. Abdominoplasty scars normally take 3 months to a year for healing, and usually heal well. The extent of scarring depends on the extent of the surgery that is performed. The scars are kept hidden well within the bikini line in most cases barring rare exceptions. At times, the scar may get thickened and itchy (hypertrophic scar) for which treatment is given.
The removal and re-draping of abdominal skin sometimes requires the permanent repositioning of the belly button. This may leave a scar around the belly button.
For most patients the final results of the abdominoplasty will not be apparent for up to 6-12 months after the procedure. During this period it is important that scars are not exposed to excessive sunlight, which could lead to darkening and increased visibility of the scar tissue.
Risks and Potential Complications
Possible complications include bleeding and collection of blood under the skin (hematoma), fluid accumulation(seroma), infection or poor healing at the incision site. These risks are common to many operations and can be dealt with easily. Blood clots in the deep veins of the leg is a problem associated with lying still for too long for which adequate prophylaxis is taken prior to surgery. Rarely pulmonary and Fat embolism are risks associated with any major prolonged surgery. Any surgery carries risks associated with anaesthesia. These risks will be fully discussed with you prior to your consent for surgery. It is important that you understand these aspects of your surgery and that you seek clarification from your surgeon.
During the Operation: Reactions to Drugs, Bleeding
Later: Painful Scars, Abnormal Scars, Persistent Lower Abdomen Numbness and Swelling and Umbilical Deformity
Please note: that with all procedures there is a possibility of patient dissatisfaction with the outcome.