Abdominoplasty or "tummy tuck"is an operation to remove excess skin from the abdominal region. It is designed to reduce the rolls of excess skin that result from weight loss or post pregnancy changes. It is also a method of removing stretch marks in the skin of the lower abdomen. The operation does remove some fat as well as skin but should not be thought of as a method of weight loss. The best candidates for this operation are those who have already reached their ideal weight. During the surgery the muscles of the abdominal wall are tightened. The rectus abdominus or "six pack" muscles are often separated following pregnancy, resulting in a weak area between them. Pilates and other physiotherapy will strengthen these muscles but cannot usually re-attach the central connections. A rectus plication during abdominoplasty will reposition these muscles into the mid line thus improving core strength reducing central bulges and defining the waistline.
The operation is performed under general anaesthetic and usually takes 2-3 hours. The skin and fat below the umbilicus is excised and the upper abdominal skin is stretched down to the pubic area. This leaves a low transverse scar that spans from hip to hip and is usually easily hidden in underwear. There is also a scar round the umbilicus as this is brought out through a new opening in the skin. Occasionally it is advantageous to perform liposuction as the same time as abdominoplasty. This can be a useful way to reduce fat in the flanks (love handles) that may appear more prominent when the abdominal contour is flattened.
All the incisions are closed with dissolving sutures which are hidden beneath the skin. The wounds are further supported with a layer of surgical glue and tape. This technique leaves the best scar without the characteristic cross-hatching of external stitches and, of course, no painful sutures/clips to remove. There is usually a fine, soft drain brought out through the end of the scar. This reduces the build up of fluid under the skin and usually can be removed the following day. All the dressings can get wet immediately. Most patients are out of bed and are able to shower the following day. The usual hospital stay is 1 to 2 nights but occasionally people like to stay longer, especially if they have busy families at home!
For 6 weeks following the surgery it is recommended that you keep the scars supported with surgical tape and remain in a support garment. This is an elasticated corset or high riding shorts (Spanks or equivalent work well). These garments help shape the abdomen, support the stitches in the muscle layer and also reduce the accumulation of fluid under the skin.
Following discharge from hospital you should anticipate spending at least 2 weeks doing very little physical exercise or driving. Short walks are fine. It will take at least 6 weeks before the internal stitches have healed sufficiently to go back to the gym or running.
COMPLICATIONS
Most patients are happy with the result of this procedure, despite the occasional annoyance in the post operative period. These include "suture splitting" (one of the dissolvable stitches comes to the surface of the wound in a little red pimple before it has fully dissolved) slow healing around the belly button and seroma formation (accumulation of fluid under the skin of the abdomen). These can all be dealt with in the outpatient setting. The skin of the lower abdomen will be numb following abdominoplasty as the nerves that provide sensation in the skin are divided during the surgery. Patients often report this feeling a bit weird for the first few weeks but gradually the site of the numb area often reduces but also the brain adapts to the new sensation and it is no longer so noticeable. The scar may ride slightly higher on one side leading to some asymmetry. Some people produce thickened, raised scars that may be hypertrophic or keloid.
Other complications include wound infection/breakdown. This may require treatment with dressings or rarely mean a return to the operating theatre for further surgery. As the operation lasts for several hours, there is a small risk of blood clots forming in the legs - deep vein thrombosis (DVT). This can potentially spread to the lung as a pulmonary embolus (PE) which may be very serious. To reduce the chance of this rare complication, everyone is fitted with compression stockings (TEDS) and pneumatic calf massaging devices (SCD) during the surgery and for the following evening. We also administer a drug called Clexane which thins the blood to reduce clot formation. This does mean there is a slightly higher risk of bleeding from the wound. This usually empties through the drain but occasionally can form a haematoma under the skin that will need to be evacuated back in the operating theatre.
Further information about this procedure can be found here
http://www.plasticsurgeryfoundation.org.au/patient-information/procedures/cosmetic-surgery/tummy-tuck/
