The operation of abdominoplasty (or tummy tuck as it is colloquially known), is designed to remove excess abdominal skin and tissue which has most commonly resulted from pregnancy or weight loss. Whilst diet and exercise are very helpful in improving your general health, this excess tissue is almost impossible to remove by these methods alone. In fact significant weight loss can make the lower abdominal tissue excess or “overhang” appear worse as the skin becomes deflated and hangs down further. This is often a great source of discomfort and causes difficulty in wearing suitable clothing.
For some women a significant bulge may appear following pregnancy (particularly twin or multiple pregnancies) in the lower or central portion of the abdomen even though they may be quite slim. This “bulge” does not respond to abdominal exercise and can actually be made worse by exercises to tighten the rectus muscles. The “bulge” is in fact a divarication or hernia of the rectus muscles, resulting from these muscles being pushed apart by an enlarging uterus and baby. The muscles may not return to their normal position after pregnancy, leading to weakness and a bulge in the central abdomen.
Fortunately abdominoplasty is extremely effective at addressing these issues and improving the abdominal contour to a much more youthful shape. Depending on the design of the abdominoplasty, it is sometimes possible to remove a significant amount, if not the majority, of “stretch marks” at the same time. In terms of patient satisfaction, I would consider this operation one of the best in plastic surgery.
Depending on the amount of abdominal tissue to be removed, the procedure may be performed either as a “mini” or a “full” abdominoplasty. A mini-abdominoplasty results in a scar that is similar is size and location to a Caesarean section incision and the umbilicus is not moved. The full abdominoplasty removes significantly more skin and the umbilicus is repositioned back to its normal location after removal of the excess skin. At the same time, the abdominal muscle tightening is essential to obtaining a youthful and pleasing abdominal shape. I would almost always add some liposculpture to the upper abomen and flank areas to get the best possible shape and transition across the various parts of the abdomen and waist.
I routinely use dissolving sutures to minimise postoperative discomfort and obtain the finest possible scar in the long term.
Preparation for Surgery
It is advisable to stop taking Aspirin and other non-steroidal anti-inflammatory medications (such as Voltaren, Brufen, or Neurofen) two weeks prior to surgery as these mediations can all increase bleeding and bruising following surgery. Paracetamol is absolutely safe to take should you need it prior to surgery.
A number of nutritional supplements such as garlic, fish oils, and Vitamin E can also increase bleeding and should be stopped. Needless to say, smoking does increase the potential for several complications such as wound infection and healing problems and should ideally be stopped at least 4 weeks prior to and 2 weeks after surgery.
The Operation and Postoperative Care
Abdominoplasty is performed under general anaesthesia and takes 2.5-3 hours. When you wake up from surgery, you will have pillows under your knees to keep the hips flexed and minimize tension on the tummy. I also place a local anaesthetic infusion system in the abdomen which is extremely effective at keeping the postoperative discomfort to a minimum. There will be one or two surgical drains for 24 hours and a well-padded surgical dressing on the wound which can stay in place for a week until you return for your first postoperative visit. You will be able to walk around the day after surgery. I strongly advise wearing an abdominal binder for 2 to 4 weeks particular if significant muscle tightening or liposculpture has been performed.
Most patients stay for 24 to 48 hours in hospital. You will receive a full set of instructions on discharge with followup appointments. The recovery time is around 2 weeks for most day-to-day activities, including driving short distances. More strenuous acitivity and exercise can be commence at 4-6 weeks after surgery.
It is important to realize that every surgical operation has risks. Fortunately significant complications following a well-designed and executed abdominoplasty are rare. Most represent a temporary nuisance and have little effect on the long-term outcome. Infection and haematoma can occur as can minor delays in wound healing. Sometimes fluid (seroma) collects in the abdomen for a few weeks after surgery which requires drainage with a syringe. Numbness over the lower abdomen is common and tends to return to normal after 6 or so months.
Deep venous thrombosis (DVT) is a potential complication and every care is taken to minimize this risk. This includes calf compression devices during surgery and postoperatively to encourage circulation. Early mobilization after surgery is also important. In some patients, a blood thinner may be recommended for a few days after surgery.
Abdominoplasty is an operation which in the correct patient can produce an impressive and long-lasting aesthetic enhancement of the abdomen, not achievable by exercise or diet alone. I would say that it has one of the highest patient satisfaction rates of all aesthetic procedures and it is not uncommon to hear patients say “I finally have my body back” or “I don’t have to hide my ‘secret’ anymore”…
Procedure Time 2.5-3 hours
Anaesthetic General anaesthesia
Nights in Hospital 1-2 nights
Time off Work 14 days
Time to daily activities including driving 10-14 days
Time to sport and exercise 4-6 weeks