Tummy Tuck (Abdominoplasty)
An abdominoplasty, or tummy tuck, as it is commonly known, is an excellent procedure for improving the aesthetic appearance of the abdomen. A variety of problems can be addressed by this surgical procedure- stretch marks, loose skin, excess fat, and flabby muscles.
Many women, as a result of pregnancy, will experience loss of both skin and muscle tone of the abdomen and often this cannot be entirely reversed by even vigorous exercise. Stretch marks, or striae, are a result of overstretching of the skin to the point where small tears occur in the deeper layer of the skin. These produce the thin, shiny, silvery stripes and “crumpled tissue paper” texture of the skin. At this time, the only effective way to tighten skin, tighten the loose muscles, and remove stretch marks is by surgically excising the skin, i.e. a tummy tuck.
People who have lost lots of weight will sometimes develop a fold of loose skin and fat in the lower abdomen. In more severe cases, this fold can be deep enough that the skin is always irritated by moisture and rubbing and this can lead to chronic irritation and even yeast infections. Correction of this requires that the loose and hanging skin be cut out.
We perform most abdominoplasties in our surgical suite. After a consultation and examination have determined that you are a candidate for this a date for surgery will be scheduled. The procedure is done under a general anesthetic and takes about two and a half hours to perform.
An incision is made in the lower abdomen. The more skin available for removal, the longer the incision must be to avoid unsightly puckering of the skin at the ends. The decision is designed to curve along the lower abdomen in such a fashion that it can be covered by even a small panty or bikini bottom. We will sometimes ask patients to wear something as small as they might dare to the office on the day of surgery and we’ll use this to outline where the scar will be placed.
Once the incision is made, the skin and underlying fat are released from the muscle all the way up to the bottom of the rib cage. The belly button is cut free of the skin and remains as a narrow stalk attached to the muscles in the midline of the abdomen. At this time, if the muscles need tightening, stitches will be placed to cinch them up. Once the freeing of the skin is completed, and muscles tightened if necessary, the patient is flexed at the waist, and the loosened skin is pulled down toward the feet to tighten it. Everything that overlaps the incision is excess and is trimmed away. A new hole is made in the skin to which the belly button is stitched. The incision is then closed with stitches. One or more small drain tubes are placed to suction any fluid which might build up from under the skin. Small catheters (tubes) for a pain pump are placed as well, and the pump will bathe the area with an anesthetic solution for 2-3 days after surgery.
Patients are placed into an elastic abdominal binder, and this completes the procedure. After recovery, patients are released to return home in the care of a responsible adult. Prescriptions for pain medications, antibiotics, and any other necessary medications are given before the day of surgery so that they will be readily available upon discharge from the office.
Patients are concerned about postoperative pain and care of their surgical site. Although there will be some tightness, stiffness, and discomfort, the routine use of a pain pump, together with prescription pain medications will keep patients surprisingly comfortable. You will be able to get up and about at home as you wish but will probably spend the first day or two mostly in bed or on a couch. The stitches require no care and will be covered with a waterproof dressing. The drain must be emptied about three times a day and the output recorded. This is very simple and painless to do, and you will be shown how before leaving the office.
Your first postoperative visit will usually be on the fourth or fifth day after surgery. Dressings may be changed, and the drain will be removed if there is little output. In any event, it will be removed in seven days or less. Most, if not all, sutures will dissolve and need not be removed. You will receive instructions at each visit on what you can or cannot do.
Most patients can resume routine day to day activities within a few days, and many can return to work in 2 weeks or less so long as strenuous physical activity is not required. Full, unrestricted physical activity such as exercise or manual labor should wait until about four weeks after surgery.
All of our patients are carefully followed for from 4 to 6 months after surgery. This is because there is a gradual settling process of healing before the tissues return to a normal state. During this time swelling will subside, scars will soften and fade, areas of numbness will regain feeling, and sense of tightness will diminish. It may take six months or more to see the final result. Satisfaction rates are very high.
In occasional patients, the problems in the abdominal area are so severe and disfiguring that insurance coverage for surgery may be possible. We will let you know at your consultation if you might fall into this category and if so, we will submit a letter to your insurance company requesting pre-approval for the surgery if you wish.
The benefits of a tummy tuck are life long. As long as you don’t get pregnant again, or lose (or gain) substantial amounts of weight after surgery, the results should be evident years later. There are risks for tummy tucks, as with all operations, but complications are infrequent. Your surgeon will discuss these in detail with you at the time of your consultation.