Women and men who have loose abdominal skin and fat that is concentrated in the abdominal wall can benefit from an abdominoplasty/tummy tuck. Sometimes these conditions are inherited. In other instances, substantial weight loss may cause abdominal skin to become flaccid. An abdominoplasty procedure can also tighten the stomach muscles that have been separated and weakened by pregnancy. The procedure may somewhat improve the appearance of stretch marks, especially those located below the navel.

 If you are a smoker, you should try to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your medical history is also important to discuss to decrease the risk of complications.

Your abdomen will be examined while you are standing as well as lying down. The skin tone and the amount of fat in the abdominal wall will be assessed as well as the laxity of the stomach muscles. This will help to tailor the operation to suite your needs.
If you plan to become pregnant or lose weight in the future, it will probably be better to wait until after you have finished your family before having an abdominoplasty. This will optimise the results and negate the possible need for another abdominoplasty after having more children.

Abdominoplasty will enhance your body contour by making your abdomen firmer and flatter. You will find that you feel more comfortable in your clothing and you will feel more confident about your appearance.

INDICATIONS

You may be a good candidate for abdominoplasty if you have one or more of the following conditions:

    Excess or sagging abdominal skin
    An abdomen that protrudes and is out of proportion to the rest of your body
    Abdominal muscles that have been separated and weakened
    Excess fatty tissue that is concentrated in your abdomen

PROCEDURE

Generally, a horizontal incision is placed just within or above the pubic area. The length of the incision, which extends laterally toward the hip bones, depends largely on the amount of skin to be removed. I always try to conceal the scar within your bathing suit lines, but this may not always be possible.

In most cases, a second incision is made around the navel so that the redundant skin above it can be pulled down over it. The excess abdominal skin is then removed. The position of the navel remains unchanged but it is brought out through another opening in the abdominal wall after the loose skin is pulled down.

To tighten the abdominal wall, the stomach muscles are stitched together in the midline because they have often drifted apart especially after pregnancy.

Skin of the lower abdomen that contains stretch marks is removed. Any remaining stretch marks may be somewhat flattened and improved, but you should not expect a dramatic change in their appearance.
There are many variations both to the design of the incisions and the technique itself. In some instances, it may be possible to avoid an incision around the navel. When the amount of loose skin is minimal and the excess fat deposits are located below the navel, a short horizontal incision is all that is necessary. This procedure is called a partial, or "mini," abdominoplasty. Liposuction is often performed in conjunction with a “mini” tummy tuck.

Drain tubes will have been placed within the abdominal tissues to help avoid accumulation of fluids. Gauze or other dressings may be applied to your abdomen and covered with tape or an elastic bandage.

You will remain in hospital for at least 24 hours after the surgery. You should get out of bed the day after the surgery and walk to the toilet to encourage blood circulation. Although you may not be able to stand up completely straight, it is best if you do not sit for long periods of time during the first several days. Straining, bending and lifting must be avoided, since these activities might cause increased swelling or even bleeding. It is best if you sleep on your back with a pillow under your knees.
Any surgical drains will be removed within two weeks after the surgery. In certain types of abdominoplasty procedures, I prefer you to wear support garments for several weeks.

You will notice swelling and bruising, which is to be expected. The bruising and much of the swelling will disappear over a period of weeks. You may also notice some numbness over portions of the abdominal area, and this may persist for several months. You should take care and avoid using hot water bottles during this time. Incisions will initially be red or pink in colour and the width of the scar may become slightly larger. This is normal for the wound healing process but the scar tends to improve with time. During this time, I will explain the scar management protocol that I like you to follow and will supply you with scar creams. Unfortunately, the scar will never disappear completely but we will make attempts to make them as inconspicuous as possible.
It is important to realize that the amount of time it takes for recovery varies greatly among individuals. Depending on the extent of your abdominoplasty and your general physical condition, you may be able to return to non-strenuous work anywhere from one to two weeks after surgery. Mild forms of exercise can usually be resumed after four to six weeks.

Unless you gain or lose a significant amount of weight or become pregnant, your abdomen should remain firmer and flatter for many years. However, gravity and the effects of aging will eventually take their toll. If you become unhappy with your abdomen again you can undergo a second procedure to restore a more youthful body contour.


DISADVANTAGES / COMPLICATIONS

Fortunately, significant complications from abdominoplasty are infrequent. Anyone considering surgery, however, should be aware of both the benefits and risks. It is important to understand that any surgical procedure has potential risks.
Some of the potential complications that may be discussed with you include:

Systemic complications

    Resp decompensation (due to the tight tummy pushing up onto the diaphragm)
    Deep vein thrombosis or blood clot (due to the tight tummy slowing blood flow from the legs back to the heart)
    Pulmonaery embolus (blood clot which has developed in the deep veins may dislodge and move to the lungs; this could be fatal)
    Fat embolus
    Anaesthetic complications
    Infection and Toxic shock syndrome

Local Complications

    Skin necrosis and wound dehiscence occurs in 1-5% of cases (more common in patients who smoke or have medical conditions such as diabetes)
    Infection  5% (antibiotics, drainage, debridement)
    Haematomas or blood collection (this may require surgical drainage)
    Seromas or fluid collection (this may require surgical drainage or weekly aspirates with a needle and syringe)
    Intra-abdominal perforation
    Nerve injury (lateral femoral cutaneous nerve  problematic if cut d/t pain etc)

Aesthetic complications

    Umbilical deformities or necrosis
    Poor low transverse scar (hypertrophic etc)
    Malposition of low transverse scar
    Malposition of umbilicus
    Contour irregularities
    Permanent pigmentary changes

This list of complications may frighten you but they are very rare. It is however important for you to be well informed about your operation.

In essence, a tummy-tuck procedure is very rewarding and you will gain confidence and feel markedly better about yourself.


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