Tummy Tuck (Abdominoplasty)

The tummy tuck is a cosmetic surgery designed to remove excess skin from the abdomen while also tightening the abdominal muscles. It is indicated for patients with a lax abdominal skin and weakness of the stomach muscles that results in bulging due to underlying fatty tissue and abnormal stretching of the abdominal muscles. This occurs frequently following pregnancy or significant weight loss. Unlike liposuction surgery, which just removes fat, this is a more extensive procedure. Liposuction and the abdominoplasty are frequently combined to maximize results. The actual extent of surgery will depend on the amount of excess skin and fat and the laxity of the stomach muscles.

The Procedure

This procedure is performed under general anesthesia in the hospital. Patients are typically admitted overnight for observation and pain control and then discharged the following day.

An incision is made in the bikini line, the excess skin is pulled down and inward and is removed along with underlying fatty tissue. The stomach muscles are tightened as required. The skin is carefully re-draped and the incision closed with several layers of dissolvable suture. In most cases, the belly button will have an incision around it in a circular fashion to facilitate placement in its new position. It is not true that the belly button is removed during the operation. You keep your existing belly button, however it may look different because the surrounding skin is now tighter after the tummy tuck. Wound drains are placed to collect extra fluid accumulation. The wounds are dressed with cloth and foam tape and a compressive garment is placed.

Recovery

The drains and tape are usually removed one week after surgery. Sometimes the drains may need to stay in longer if your body is producing excess fluid from inflammation after surgery. The compression garment may need to be worn for up to four weeks.

Pain is typically well controlled on oral pain medications. Expected recovery is two weeks. Because of the risk of possible blood clots deep in the legs that can spread to the lungs and cause partial lung collapse, it is important for patients to begin movement promptly after surgery even if it is uncomfortable. You can resume light exercise after two weeks and more vigorous exercise after six weeks.

Some bruising is normal after surgery. This usually goes away in the first few weeks. Your incisions will be noticeable immediately following surgery but they will gradually fade and flatten for up to a year after surgery. You will also have some puckering around the incision after surgery. This will smooth out over a month or two. If your skin has a lot of stretch marks or is extremely thin, this is a sign of poor skin elasticity. Patients with poor skin elasticity may be more prone to widening of the scar after surgery. A small percentage of patients will require a scar revision to improve the appearance of the scars. Your skin will also be firm and numb at the outset. It will soften and normal sensation will return gradually over the following weeks to months.

Possible Complications

There are potential complications associated with having any surgery including bleeding, prolonged bruising and swelling, infection, temporary or permanent numbness, weakness and unfavorable scarring as previously mentioned. Infection or collections of blood or fluid in the wound may delay recovery and could result in skin loss, fat wasting or pronounced scarring. This could result in the need for additional corrective surgery. The abdominal skin is stretched during surgery and post-operatively during function. The blood supply to the skin may be compromised or damaged as a result which could lead to wound breakdown or skin loss. If this happens and the wound does not heal favorably on its own, scar revision or a skin graft may be needed.

Although these complications are relatively rare, wound problems are much more likely with patients who smoke, especially wound breakdown and skin loss. Therefore, we require patients who use tobacco or nicotine substitute products to completely quit for a minimum of four-to-six weeks before and after abdominoplasty surgery.

In spite of these considerations, the operation is generally very gratifying. On top of the immediate cosmetic improvement, many patients realize relief of functional symptoms such as low back pain, rash and abdominal discomfort following the surgery.