The goal of abdominoplasty, also known as a "tummy tuck," is to improve one’s body contour specifically by reducing abdominal bulging. Excessive skin and fat from the lower abdomen is removed and the underlying muscles are approximated and tightened. There should be improvement in appearance both in and out of clothing, although in any given patient, these goals may be only partially met.
Limitations of the Procedure
Generalized obesity cannot be improved by this procedure even though the abdominal contour itself may be improved by surgery. If there are significant amounts of fat underneath the skin, removing the lower abdominal fat and excessive skin will improve, but not necessarily flatten the abdominal outline. Muscle strength will not be improved, but the resting tone of the abdominal wall may be improved. If there are extensive stretch marks present, particularly above the umbilicus (belly button), stretch marks will remain following surgery. The results of the surgery are not necessarily permanent --subsequent alterations of body contour may occur as a result of aging, weight gain/ loss and pregnancy.
Alternatives to the Procedure
If no surgical treatment is undertaken, there is usually a persistent abdominal deformity despite exercise and diet. However, both vigorous exercise and diet can help to improve the abdominal contour somewhat. However, lax skin such as that resulting from pregnancy or excessive weight loss will not be improved through exercise alone. In some patients liposuction alone may be used to remove excessive abdominal wall fat. However, the underlying muscle and overlying skin may be a problem with patients who have a wide muscle separation or unusually loose skin.
Surgical Techniques / Anesthesia / Recovery
Abdominoplasty is a major surgical operation, which is usually performed under a general anesthetic requiring at least a one-night stay in the hospital or ambulatory surgical center. A long incision is made above the pubic area, which generally extends from one hip bone to the other. Excessive skin and fat from the level of the belly button to this incision are removed. The upper abdominal skin is lifted and brought down to the level of the pubic area. A small incision is made for the belly button to be repositioned (the belly button is not severed during this surgery). Therefore, sutures will be placed around the belly button and in the long incision above the pubic area. Scars will necessarily result from these incisions. In general, abdominoplasty incisions are quite tight and the scars tend to heal with a wider appearance than many other surgical incisions. However, the scar is well positioned in an area to be hidden with most styles of bathing suits or underwear.
The surgery itself takes several hours with a moderate amount of blood loss. Blood transfusion is usually not required, and we do not require blood be available for the surgery. However, if you wish to donate your own blood or have a designated donor provide blood, our office can help you arrange this preoperatively.
Following surgery, drains are placed which exit through the corners of the incision. In some instances you will be discharged with these drains in place and given instructions to empty them at regular intervals. An abdominal binder or compression garment is required for several weeks following surgery to help prevent swelling and assist healing. Lifting and carrying objects greater than 10 pounds is discouraged. Vigorous physical exercise, particularly sit ups and truncal rotation exercises are also prohibited for 6 weeks following surgery. Immediately following surgery it is recommended that the patient sleep with the head of the bed elevated (or on several pillows) with supports under the knees. Likewise, for the first weeks following surgery walking should be performed slightly bent at the waist.
Risks / Complications
The most common complication following this surgery is a collection of blood or fluid underneath the abdominal flap. If this is a large amount of fluid it may be necessary to evacuate the fluid by needle aspiration or in rare cases by reopening the incision in the operating room.
As noted previously, the incisions may lead to adverse scarring which might improve over time, but will remain permanent. Some asymmetry or unevenness of the abdominal skin can be expected, particularly in the lower abdominal area. There may be numbness particularly below the belly button, which may be permanent. There may be lumps or irregularities in the underlying fatty tissue, which may improve, but in some instances may be permanent. There may be temporary discoloration in the operated areas. Wound infections are rare, but can lead to separation of the wound requiring special dressings, antibiotic preparations or in rare instances secondary surgical procedures. In very rare instances phlebitis or venous thrombosis may occur in the legs or other veins. In extremely rare instances a blood clot may “travel” to the lungs (pulmonary embolus). Finally, there may be an alteration in the position or appearance of the umbilicus.
Even though the risks and complications cited above occur infrequently, they are the ones that are peculiar to the operation or of greatest concern -- other complications and risks can occur, but are even more uncommon.