Abdominoplasty If you are considering surgery we want you to be thoroughly informed about this procedure. Reading this information is the first step. However, a personal consultation with your surgeon is the best way to obtain any additional information you need.

What is abdominoplasty?

Cosmetic surgery of the abdomen is also called abdominoplasty or “tummy tuck”. It is designed to firm and smooth your abdomen. The procedure removes excess abdominal skin and fat and if appropriate can tighten the muscles of the abdominal wall. The result is a flatter abdominal profile.

Is abdominoplasty for me?

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

Any of the following conditions may make you a good candidate for abdominoplasty:
• 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

Initial consultation During the initial consultation you may be asked to point out exactly what you would like to see improved. This will help your plastic surgeon understand your expectations and determine whether they can realistically be achieved. You will be asked about your medical history including previous operations, past and present medical conditions and current medications. In order to provide you with the best information and safest options, it is important that you give your surgeon complete information. The medical conditions that may increase risks of surgery include high blood pressure, thyroid problems, diabetes and bleeding problems. If you plan to become pregnant or to lose weight in the future, you should discuss this with your plastic surgeon as both have implications for the planning of the operation. Scarring from previous abdominal surgery may limit the results of your Abdominoplasty. Your plastic surgeon may examine your abdomen while you are standing as well as lying down. Your skin tone and the degree of loose skin in the abdominal region will be assessed. Your surgeon will also evaluate the amount of excess fat in your abdomen and the condition of your abdominal muscles. Preoperative photographs may be taken during your initial consultation or at a subsequent visit. Your surgeon will discuss with you the details of the operation and the possible risks and complications associated with the procedure. Preparation for surgery The goal of your plastic surgeon and the staff is to make your surgical experience as easy and comfortable for you as possible. Smokers will be asked to stop smoking 3 weeks before surgery. Aspirin and some anti-inflammatory drugs used for the treatment of arthritis can cause increased bleeding, so you should avoid taking these medications for 2 weeks before surgery. Abdominoplasty is usually performed in a hospital under general anaesthetic and you can expect several days’ stay. In cases of mini-abdominoplasty the operation can be performed in a day surgery centre. If this is the case, make certain you have someone drive you home after surgery and to stay with you at least the first night following surgery. The day of surgery Your surgeon will mark your skin before the operation and if you have not already done so, you will need to sign the consent form for your operation. Your surgery may be performed in a hospital, or in a day surgery facility depending on the extent of the operation you need. Medications are administered for your comfort during the surgical procedure. Various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood during the anaesthetic. Your operation Because of individual factors, not everyone will achieve the same results from abdominoplasty. Your plastic surgeon will select the surgical technique that he or she feels will obtain the best outcome for you. Incision lines will fade over time but will be permanently visible. Abdominoplasty incisions can usually be placed in locations concealed by bathing suits and undergarments. Abdominoplasty can be combined with other procedures, such as liposuction of the flanks and/ or thighs. Some patients request breast surgery at the same time. Individual factors and personal preferences will determine the specific technique selected to smooth and flatten your abdomen. Where will the incisions be? Generally, a horizontal incision is placed just within or above the pubic area. The length of the incision, which extends outwards toward the pelvic bones, depends mainly on the amount of skin to be removed. The exact incision will vary somewhat according to the shape of your abdomen and the underwear style that you prefer. Some patients have loose skin above the navel. In such cases, the surgeon may make a second incision around the navel so that the redundant skin above it can be pulled down. The excess abdominal skin is then removed. The final position of the navel remains unchanged. Skin of the lower abdomen that contains stretch marks may be removed as well. Any remaining stretch marks may be somewhat flattened and improved, but you should not expect a dramatic change in their appearance. The procedure may include tightening of the underlying abdominal muscles using sutures. Some variations 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. Sometimes liposuction may be used alone, or in conjunction with abdominoplasty, to remove abdominal fat. How long does the operation take? The operation takes from 1 to 3 hours, depending on the extent of each case. After Surgery When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. You will have a firm abdominal bandage or a compression garment, which you will have to keep on for 3-6 weeks after surgery as instructed by your surgeon. You will feel drowsy for several hours after the procedure and you will remember very little of this time. It is very important that you get out of bed and walk as soon as possible after the operation to minimise the chance of clots forming in your leg veins. Although you may not be able to stand up completely straight, it is best that 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. You may be instructed to sleep on your back with a pillow under your knees. Although you will find that mobilisation is a little slow at first, you should expect to be walking normally within five days even after extensive surgery. Any surgical drains will probably be removed within a week following surgery, at which time your dressings may also be changed or removed. How will i look and feel initially? It is important to realise that the amount of time it takes for recovery varies greatly among individuals and also depends on the extent of the operation. You will have stitches along the incisions, which usually have to be removed after four to seven days. 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. However, it may be months before all swelling subsides and you see the final result of your abdominoplasty. You may also notice some numbness over portions of the abdominal area, and this may persist for several months. Incisions will initially be red or pink in colour. They will remain this way for many months following surgery and may even appear to worsen before they finally begin to fade. When can i resume my normal activities? You may be able to return to light work anywhere from one to three weeks after surgery. In many instances, you can resume most of your normal activities, including some form of mild exercise, after a few weeks. You may continue to experience some mild, periodic discomfort and swelling during this time, but such feelings are normal. Severe pain should be reported to your doctor. You should avoid sexual activity for a minimum of two weeks. Results of your surgery Since the healing process is gradual, you should expect to wait at least several weeks to get an accurate picture of the results of your surgery. Incisions will fade over a number of months. 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 ageing will eventually take their toll. If, after a period of years, you become dissatisfied with the appearance of your abdomen, you may choose to undergo a second procedure to restore a more youthful body contour. Risks and possible complications of surgery Fortunately, significant complications from abdominoplasty surgery are infrequent. Every year, many thousands of operations are performed with no major problems and good results. However, everyone considering surgery should be aware of both the benefits and risks. The subject of risks and potential complications of surgery is best discussed on a personal level between you and your plastic surgeon. • Bleeding may occur. At worst, this will require return to the operating theatre to evacuate the blood clot and to stop the bleeding. • There will be bruising after surgery. This usually settles after approximately 2 weeks. • Wound infection may complicate the operation in approximately 5% of operations. The infection is usually treated with antibiotics, oral or intravenous, depending on its severity. • Dehiscence or reopening of the wound may occur in about 1 – 5% of operations. This usually happens as a result of infection and is managed by treating the infection. • Collection of blood or fluid under the operated skin. Because abdominoplasty is usually an extensive operation, blood can collect under the repositioned abdominal skin. This usually happens within the first 24 hours after surgery. Rarely, it may require return to the operating theatre. More commonly, fluid collects under the skin without any obvious ill effects. Removal of this serum is a painless process but may require several visits to the plastic surgeon’s office. • Skin loss in the lowest extent of the repositioned abdominal skin occurs in approximately 2% of operations. This complication is more common in smokers and it is therefore very important that you stop smoking at least two weeks before surgery. Skin loss is also more common in medical conditions such as diabetes. • The skin loss may occur at the belly button. • Wide or irregular scars may occur due to the tension on the tissues after surgery. Reversionary surgery is sometimes helpful in certain instances where incisions may have healed poorly. • There may be numbness in the lower part of your abdominal skin after surgery. This usually recovers with time. • Because of tension on the pubic skin, the pubic hairline may be elevated after surgery. • Clots in the legs may form and resultant clots travelling to the lungs have also been reported although this complication is very uncommon. You can help to minimise certain risks by following the advice and instructions of your plastic surgeon both before and after your surgery. Maintaining a relationship with your plastic surgeon If you have any questions regarding abdominoplasty make sure they are answered in advance. Well meaning friends are not a good source of information. Find out everything before proceeding with the operation - a well informed patient is a happy one. After surgery, you will return to your plastic surgeon’s office for follow-up care at prescribed intervals, at which time your progress can be evaluated. Post-operative photographs will form a part of the evaluation of your result. Once the immediate postoperative follow-up is complete, many surgeons encourage their patients to come back for periodic checkups to observe and discuss the long-term results of surgery. Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon.