ABDOMINOPLASTY

If you’re considering abdominoplasty…

Abdominoplasty, known more commonly as a “tummy tuck,” is a common surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall.  The removal of excess abdominal skin may also include stretch marks and scars below the navel.  The procedure can dramatically reduce the appearance of a protruding abdomen.  Removing excess skin and tightening abdominal muscles can improve your shape and figure.  You can more easily find proper fitting clothing and will be more comfortable engaging in physical activities.

Multiple pregnancies and marked fluctuations in weight are most frequently responsible, as they stretch the abdominal wall tissues.  Sometimes the deeper elastic structures of the skin are torn, resulting in stretch marks.  These may be more evident because of the laxity of the stretched skin.  Proper diet and exercise may help up to a point after weight loss or pregnancy, but no amount of exercise will take away skin laxity and folds. 

The best candidates for abdominoplasty...

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

The best candidates for abdominoplasty are women who are in relatively good shape but are bothered by a large fat deposit or loose abdominal skin that won’t respond to diet or exercise.  The surgery is particularly helpful to women who, through multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where they can return to normal.  Loss of skin elasticity in older patients, which frequently occurs with slight obesity, can also be improved. 

Abdominoplasty is not used as a substitute for weight reduction.  Women who intend to lose a lot of weight should postpone the surgery.  Also, women who plan future pregnancies should wait, as vertical muscles in the abdomen that are tightened during surgery can separate again during pregnancy.

Abdominoplasty can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently.  Before you decide to have surgery, think carefully about your expectations.

How abdominoplasty is performed:

Individual factors and personal preferences will determine the specific technique selected to smooth and flatten your abdomen.  Generally, a horizontal incision is placed just within or above the pubic area.  The length of the incision, which extends laterally toward the pelvic bones, depends largely on the amount of skin to be removed.  Also, the abdominal wall muscles are tightened by pulling them close together to provide a firmer abdominal wall and narrow the waistline.

If, for example, your fat deposits are limited to the area below the navel, you may require a less complex procedure called a modified abdominoplasty.  A short horizontal incision made in the hairline is all that is necessary.  The skin is separated from the abdominal wall only between the incision line and the navel.  This skin flap is stretched down and the excess is removed.    

Some women have loose skin or muscle separation above the navel.  In such cases, a complete abdominoplasty may be the preferred procedure with the initial incision extending from hipbone to hipbone.  The skin is separated from the abdominal wall all the way up to the ribs. A second incision is made around the navel so that the redundant skin above it can be pulled down.  The excess abdominal skin is then removed.  The position of the navel remains unchanged.  

Stretch marks on the skin of the lower abdomen 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.

Panniculectomy is a surgical procedure for removal of the large abdominal apron of fat in obese women.  This procedure usually requires an inpatient hospital stay due to the medical status of the woman and the extensive nature of the surgery.  Complete wound healing may take several weeks.

An incision just above the pubic area is used to remove excess skin and fat from the middle and lower abdomen.
Skin is separated from the abdominal wall all the way up to the ribs.	The surgeon draws underlying muscle and tissue together and stitches them, thereby narrowing the waistline and strengthening the abdominal wall.

Understanding risks

Fortunately, significant complications from abdominoplasty are infrequent.  Anyone considering surgery, however, should be aware of both the benefits and risks.  Some of the potential complications include bleeding, infection, and reactions to anesthesia.  Tissue loss along portions of the horizontal incision is a possibility when the abdominoplasty is very extensive.  This complication, which delays healing and prolongs recovery, is more common in patients who smoke or have medical conditions such as diabetes.

After your surgery

Depending on the extent of the surgery, you may be released within a few hours or you may have to remain hospitalized for two to three days.  The day after surgery, you will be encouraged to get out of bed for short walks to promote blood circulation.  It is better to stay in a semi-sitting position at first.  You should not stand perfectly straight for a few days to avoid tension to the lower abdomen.  This way the skin will slowly relax and you will feel more comfortable.  A girdle is important to wear for support for the first few weeks.  Straining, bending, and lifting must be avoided; since these activities might cause increased swelling or even bleeding.  Sleeping with a pillow under your knees is a good idea.

For the first few days, your abdomen will probably be swollen and bruised and you’re likely to feel some discomfort, which can be controlled by medication.  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.  Incisions will initially be red or pink in color.  They will remain this way for many months following surgery and may even appear to worsen before they finally begin to fade. 

Getting back to normal

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 three weeks after surgery.  Exercise will help you heal better.  Even women who have never exercised before should begin an exercise program to reduce swelling, lower the chance of blood clots, and tone muscles.  Vigorous exercise, however, should be avoided until you can do it comfortably.

Your new look

Abdominoplasty, whether modified or complete, will enhance your body contour by making your abdomen firmer and flatter.  You may find that you feel more comfortable in you clothing and are more confident about your appearance. 

The incisions from the procedure will heal and fade over time.  While they’ll never disappear completely, abdominal scars will not show under most clothing, even under swimsuits. 

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’re realistic in your expectations, abdominoplasty may be just the answer for you.   

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