In today's conscious society, greater attention is directed to the size and shape of our bodies. In an attempt therefore to control any bodily changes which may occur in this respect, we try to make use of exercise and diet to the best of our abilities. However, certain areas of our body, in particular the abdomen, can become stubbornly resistant to any improvements. In some individuals the localized deposits of fat in the abdominal region combined with muscle laxity can make any hopes of a "flat tummy" very difficult to achieve. In women this becomes all the more difficult if stretched and loose skin appears following pregnancy.

Alternatively there are individuals who may have lost a large amount of weight and subsequently find as a result that they have an "apron" of skin which hangs down in front of the abdomen. This occasionally can lead to problems of shaving and rashes appearing under this "apron".

Surgical procedures can selectively be employed to improve situations in which these problems arise. These operations however are not directed toward weight reduction, which is still primarily a dietary problem. In cases where improvements can not be made despite even the most diligent efforts, an abdominoplasty may be appropriate.

Abdominoplasty or "tummy tuck" as it is commonly known is an operation to tighten the muscles of the abdominal wall and to remove excess skin folds and fatty tissues from the middle and lower abdominal region. As such it can dramatically reduce the appearance of a protruding abdomen and lead to a flatter, firmer, tighter stomach and a thinner waist as well. Many times however, the problem is basically confined to localized fat in the abdominal region without any associated skin laxity or stretch marks. In these cases liposuction alone may be suitable. Other times liposuction can be performed in conjunction with one of many variations of an abdominoplasty procedure. Dr. Loeb will assess and advise you which would be more appropriate at your consultation.

Am I suitable for this type of surgery

This will be decided at your consultation. During your consultation Dr. Loeb will ask you about your general medical history including details about any previous abdominal surgery, or childbirth. Women who plan to become pregnant imminently should usually postpone the operation until after their family is complete.

If you are a smoker you will asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin, certain anti-inflammatory drugs and other medications can increase bleeding, so you must avoid these.

A physical examinations will determine if you are a candidate for an abdominoplasty procedure. Abdominoplasty should not perform to correct obesity. Heavier patients will disappointed even if measures such as extending the incision and liposuction are performed. This is because there will still be substantial fullness in the flanks, upper torso and buttocks which will contrast with a tighter abdomen. To avoid this disappointment and to minimize the need for secondary procedure, the best candidates are men and women who within several pounds of their ideal weight.

As mentioned there are a number of variations in the technique of abdominoplasty. The specific technique will be based on the quality of your skin, location of scars and stretch marks, the laxity of your muscles, and the amount and distribution of fat. A definite decision can only be made at the consultation after a proper examination. However, broadly speaking, if you have loose muscle and excess skin in both the upper and lower abdominal areas with only modest fat deposits you will most likely require a full abdominoplasty. If however you have loose skin confined mainly to the lower abdominal areas but have retained good skin and muscle tone above the umbilicus with little or no excess fat, then a "mini-tuck" may be used.

Alternatively if this is accompanied by modest excess fat in the upper abdomen then liposuction may be used in conjunction with the "min-tuck" to improve the result. It would be fair to say that the term "min-tuck" is actually a misnomer as the scar is about 10 inches long and cannot be deemed very "mini".

Remember to be open in discussing your expectations at the consultation. Dr. Loeb will also be frank with you and together you will work at choosing the procedure that is right for you and which will come closest to achieving the desired result.

What does the operation involve

In full abdominoplasty, you must understand that there is a long incision made within the so called "bikini line" just above the pubic area, from hip to hip. The skin and fat is then peeled off the abdominal wall up to the umbilicus. At this point a second incision is made around the umbilicus, in a measure to free this from surrounding tissue. Once this is done the skin and fat flap of tissue initially freed is lifted off the abdominal muscles, leaving the umbilicus on a stalk. The exposed muscles are then tightened as necessary by stitching them together creating a firmer abdominal wall and a narrow waist.

The peeled back flap of skin and fat is then stretched downwards towards the initial incision and any extra tissue is removed. The incision is subsequently sutured closed but not before a new hole has been made for the umbilicus to come through. Drainage tubes are usually placed under the skin to collect any excess fluid that may accumulate in the first 48 hours after the operation. These are removed when fluid production has ceased (usually 48-72 hours).

In the "mini tuck" technique the skin is separated only between the lower incision line just above the pubic region, and an incision just below the umbilicus. The umbilicus is left in place without the need for a further incision. Liposuction may be combined with this procedure.

What type of anesthetic is used

Abdominoplasty is usually performed under general anesthesia (completely asleep). You will usually require an overnight stay at the surgical center.

Do I have to be hospitalized

99% of cases are done as an outpatient. In most cases patients stay overnight at the Surgical Center with a nurse.

How long does the surgery take

Depending on the technique used, and whether this is combined with any other surgery such as liposuction, it usually takes between 3-4 hours.

What happens immediately after the Operation

You will have a compression garment around your waist and abdomen. This is to provide compression of the surgical site to reduce the postoperative swelling and bleeding. In addition you will notice the presence of 2 tubes or drains which are placed under the skin to evacuate any fluid build-up following surgery. These usually come out 2 days following surgery. You will have leg pumps on your calves to keep blood from pooling in your calves.

You will find that the abdominal area will be quite tight and that you will need 1-2 pillows placed behind your knees in order to keep these bent to reduce the tension in your abdominal muscles. Likewise for the first few days you will need to walk slightly bent forward once you are up and about. You may gradually straighten up as the days pass. You will have a row of sutures in the incision site, which will need to be removed in 7 days.

You will usually stay the first night at the Surgical Center with one-on-one nursing. The nurse will teach you positions, drains and how to get on/out of bed.

Is it painful

Pain and discomfort are subjective sensations but it is true to say that an abdominoplasty is considered one of the more demanding recoveries. The discomfort and tightness is most noticeable when getting in and out of bed. For the first week or so after surgery you will need to take regular painkillers in order to minimize this.

What kind of after effects should I expect

Following surgery you will experience considerable swelling and bruising of the abdomen. This will be even more noticeable if the abdominoplasty was accompanied by liposuction. The bruising usually lasts about 3 weeks. While most of the swelling will have dissipated by this time, some subtle swelling will still be present for up to 3 months.

In addition you will notice that the abdomen will feel firm to touch, particular along the edges of the incision site. This will be as a result of the normal healing process laying down elements of scar tissue to facilitate healing. When this occurs, massage as instructed by Dr. Loeb will speed up the recovery. It gradually resolves in time but may take few months to complete. You should expect the sensation to the skin over the lower abdomen to be reduced after surgery. This is a result of surgical trauma to the nerves in the region. Although this usually recovers in a few months, permanent numbness in the region can ensue.

What are the scars like

As explained the scar length will be substantial. These normally extend from hip to hip above the pubic area as a horizontal line. At times it may be necessary to add a small vertical component to this and therefore the appearance may likened to an upside down T. Although all surgeons try to suture the incision as neatly as possible, it is ultimately impossible to predict a scars' eventual appearance. In fact very rarely can abdominoplasty scars be described as hairline. You must understand that due to the normal healing response these always appear red, raised and lumpy in the first few months after surgery, but do tend to settle with time. However it may take up to 18 months to do so. Stretching and prominence of all or parts of the scar however can occur. If necessary, and when deemed appropriate, it may be necessary to revise a scar to try to improve its appearance. This will be discussed at the follow up consultations.

What could go wrong

While it is true that when an abdominoplasty is performed by a qualified plastic surgeon the risks are small, nonetheless, specific complications with this procedure can and do occur.

As in any procedure the risk of significant infection is always possible. This is minimized by careful surgical technique and the preventative administration of antibiotics both at the time of surgery and after. However despite these measures mild infection is relatively common and can occur around the incision site, but usually subsides over a period of about 2 weeks.

Risks such as blood clots are rare. Early mobilization by moving around as soon after the surgery as possible reduces this considerably. You will have leg pumps on the day of surgery to keep the venous blood circulating.

As mentioned earlier, swelling should be expected after this operation. When mild or moderate swelling is present, the body rapidly reabsorbs this. Very occasionally, increased bleeding can lead to more significant swelling and the development of hematoma (a collection of blood under the skin). If this were to happen, surgical drainage to evacuate this would be required. Ultimately however this should not affect the final outcome.

Another possible complication is the formation of a collection of fluid called "seroma". This fluid is clear and yellow in color. It is seen as swelling in the lower abdominal region, and many times patients report that they can feel this fluid moving under the skin.

It is usually noticed at about 10 days after surgery. The treatment will depend on the amount of fluid present. If this is deemed to be small and is not causing any discomfort, then only a pressure garment is applied and the body reabsorbs this, usually by a bout a month's time.

If however the amount of seroma is significant and causes pain or discomfort, then the initial treatment is to draw out this fluid with a needle (called aspiration). Following aspiration the swelling rapidly disappears. If necessary this procedure may be repeated in a week time.

During the first 2-3 weeks after surgery, some patients may experience a minor loss of wound adhesion at any point of the incision site. This is a temporary complication, which will require regular dressing changes initially. Eventually a scab develops over this, which subsequently separates after 3-4 weeks. However some distortion of the skin around the scar may ensue particularly if this has occurred over the hip region. Further revision surgery may be required if necessary.

How long before I get back to normal

Abdominoplasty is a major operation and should always be respected as such. Therefore you should expect a few weeks to pass before you feel yourself again. Remember variations do occur in the time individual take to heal. Although many people go back to light work duties by 2 weeks others find it more appropriate to take a further 1-2 weeks to rest. Walking is helpful in the first 3-4 weeks as this improves the circulation and helps reduce the selling, and the chance of blood clots developing. Heavy lifting or strenuous activity is prohibited in the first 6 weeks after surgery. Overall common sense rules in the recovery period. If what your doing is uncomfortable then don't do it!

Summary