This is also called an abdominoplasty or “tummy tuck”. In this procedure excess skin and fat can be removed, abdominal contours and scars improved, and the muscles tightened.
The standard abdominoplasty
The excess skin and fat of the abdominal wall between the pubic area and the umbilicus is removed leaving the umbilicus in place. The skin of the abdominal wall at the level of the umbilicus is then drawn down to suture it at the pubic level. You will be left with a long, usually curved scar across the lower part of the abdominal wall at the level of the pubic hair. There is also a scar around the umbilicus. Any looseness of the muscles of the abdominal wall or hernia is repaired at the same time.
The mini abdominoplasty
Surplus skin below the umbilicus is removed leaving a lower abdominal scar at the level of the pubic hair. The umbilicus is not disturbed but liposuction is usually carried out at the same time as the procedure to reduce the thickness of fat in the abdominal wall and any laxity or hernia of the abdominal wall can be repaired at the same time.
In the extended abdominoplasty, surplus skin and fat of the loins and back are also removed so that the scar extends around the flanks on to the lower back.
Modifications to the abdominoplasty skin incision are made when the patient has particular problems associated with scars from previous operations. An alternative procedure which should always be considered, instead of those already described, is liposuction on its own. This reduces the volume of fat and causes just a little retraction of the skin.
Removal of a much larger amount of abdominal tissue, usually as a result of massive weight loss for example after gastric band or bi-pass surgery.
Fleur de Lys
This involves an extra, vertical scar to improve the waist contour, usually after massive weight loss.
Are you a good candidate?
Anyone who has excess abdominal skin and fat may be a candidate. With women the problem is usually caused by pregnancy, but is greatly aggravated by weight loss. The muscles of the abdominal wall may be weakened by pregnancy and actually become separated in the middle. Men are similarly affected by weight loss. Stretch marks (striae) are simply the scars which are left after extreme stretching of the skin. They are usually most apparent on the lower part of the abdominal wall. There is no specific treatment for the stretch marks, but many of them are removed in an abdominal reduction and those that are left are tightened, which makes them look less obvious. Patients who are unable to tighten the abdominal wall skin with exercise or who wish to achieve a smooth or flatter abdomen will also benefit.
What are the consequences?
You will be left with noticeable scars. The main scar runs across the lower part of the abdomen and in a standard abdominal reduction there will be a scar around the umbilicus. Different scars may be left when the patient has particular individual problems, for example, scars from previous abdominal surgery. We will discuss this during your consultation. Some patients produce better scars than others and in any case, all scars are initially red. It is essential that you understand where these scars will be and you should discuss them with me during the consultation. Although we try and hide them beneath underwear and swimwear, fashions can change making previously covered scars visible. There will be numbness in the lower part of the abdominal wall after surgery. This is usually temporary but can occasionally be permanent. Swelling above the scar is usually present due to a collection of tissue fluid which migrates to the groin. This swelling usually settles within a few months.
What are the limitations?
The skin is usually tightened downwards and this does not tighten the waist. If this is desired then one can consider removing skin vertically, but one should bear in mind that vertical scars of the abdomen are less good as they are more conspicuous. The tissue of the abdominal wall is generally fatter than the groin and if liposuction is not carried out a fatty bulge may remain above the scar.
The beneficial effects of the operation will last well, however the effects will be maintained better if you continue to exercise the muscles and keep a steady weight. A further pregnancy will of course stretch the skin again, although probably not to the same degree
What are the risks?
The standard abdominoplasty is a procedure requiring two to four days hospitalisation. The drains will be removed when they stop draining blood and serum, usually two or three days after the procedure. This fluid sometimes reaccumulates after the drains are removed and sometimes requires drainage or aspiration. Healing can be slow, particularly in the tighter central part of the wound and sometimes dressings are needed for a few weeks. This is more common in patients who are overweight, or smoke. This tends to leave more obvious scars which are tethered – these can be revised. Secondary procedures are sometimes carried out to tidy up the results and will involve scar revision and sometimes limited liposuction. Displacement of the umbilicus to one side or the other has been over publicised and is rare. Deep-vein thrombosis and pulmonary embolus are rare complications of any operation, including this one.
What should you do before the operation?
If you are overweight you would be well advised to diet as best results are obtained in people who are the correct weight for their height. We can discuss this before your surgery if you wish. If you are taking the contraceptive pill, you should stop doing so for six weeks before surgery and use an alternative method, in order to reduce the risk of thrombosis. If you smoke there is a greater risk of a chest infection and in particular, healing of the abdominal wound is less good.
What should you expect after the operation?
You will need to be in hospital for two or three days. When you wake up after the operation it is likely that you will be receiving intravenous fluids. This is quite normal and is to provide you with the fluid that you need while you are not drinking. You will have drainage tubes coming out of each side of the lower abdomen which are there to drain any collection of blood or serum. You should expect some pain for which you shall be given pain-killing tablets or injections and I will inject some long-acting local anaesthetic at the end of the operation, just before you wake up. When you return to the ward you will be asked to keep your knees and hips bent to take the strain off your stitches. The nurses will place several pillows under your knees so that you are comfortable in this position. Your stitches will be buried beneath the skin surface and will dissolve over a period of three to four weeks. I will arrange several review appointments for you after you are discharged from hospital. The first will be after one week and that is for your first dressing change. After that you will be able to have a shower if your wound appears to be healing satisfactorily.
Over activity in the early days reduces healing and increases fluid accumulation. Light activity, such as swimming, is usually comfortable in 10 to 20 days. Sports will not be possible for six weeks, particularly when the muscles have been strengthened with sutures. You should be alright to drive after approximately 10 days. A corset or pressure garment is usually helpful in reducing swelling and improving comfort in the first month.