Tummy Tuck (Abdominoplasty)

Background

Not infrequently, following pregnancy in women, and after weight loss in men and women, excess skin and fat carried on the abdomen causes consternation and embarrassment. The skin may also show conspicuous stretch marks that can be unsightly. This excess skin and fat is often unresponsive to dieting and exercise, which can be very frustrating.

The procedure known as abdominoplasty is an operation to recontour the abdominal wall, when the problem is one not just of excess fat, but also one of excess skin and frequently also of a bulging muscle wall. Unlike liposuction, which only involves very small incisions to remove fatty tissue only, the abdominoplasty, by its very nature, necessitates scars to remove redundant skin. These scars are placed very low on the abdomen (below the customary underwear or bikini line), so that it is as inconspicuous as possible, and one around the existing navel. In this way, the looseness of the skin can be corrected, and one is again able to wear clothing that exposes the abdomen without fear of revealing the surgical scar.

In some patients, there is insufficient excess skin to remove everything from the top of the navel down to the pubic area, but too much looseness to perform liposuction alone. In these patients a variation of the abdominoplasty, known as the “mini-abdominoplasty” is done in which usually the fat is suctioned and any excess skin in the lower abdomen removed without cutting around the navel. The muscles are tightened in the lower abdomen only. There is a similar, though somewhat shorter, scar below the bikini line, but no scar around the navel. This operation has virtually no impact on the abdomen above the navel. It has a shorter recovery than the full abdominoplasty.

The Consultation

Prior to the consultation, you should visit the glossary in this website and review the information regarding Body Mass Index (BMI). Dr. Creasman recommends against body contouring surgery in patients who meet the criteria for obesity as defined by the Centers for Disease Control (CDC) and The World Health Organization (WHO). Your can calculate your BMI by linking to a BMI calculator. If you exceed a BMI of 27, there is really no point in seeking a consultation at this time. We would recommend weight loss before considering any body contouring surgery. This type of surgery is not for weight loss. Most patients lose very little, if any, weight with either liposuction or abdominoplasty. Dr. Creasman recommends the Zone Diet (www.zoneperfect.com) to lose any unwanted weight.

Patients seeking consultation for abdominal recontouring should plan to meet with Dr. Creasman for approximately 30 minutes for a comprehensive evaluation. First, the doctor takes a medical history. It is important to inform him of any medical conditions such as bleeding disorders, heart disease, hypertension, diabetes, asthma, hernias, or a history of smoking. One should know that this is not an operation for obesity. Thus, any patient more than 50% over their ideal body weight should consult with a weight loss specialist prior to considering body-contouring surgery. It is also important for women to know that they should only consider this procedure if they have no future plans for pregnancy. Pregnancy stretches the muscle wall of the abdomen, and often leads to weight gain. One would not want to go through with the procedure of abdominoplasty only to then stretch out the muscle and skin with pregnancy. Patients who have scars from previous surgery may not be candidates for this operation, because of the risk of surgical complications due to alterations in the blood supply to the skin. This can be determined at the time of the consultation with Dr. Creasman.

Following this, the doctor carries out an examination of your abdomen. Dr. Creasman will usually draw a diagram of what your operation will involve in terms of the scar placement. There are also photo albums of representative examples in the office for you to peruse. Some of these photos can also be viewed on this website, in Dr. Creasman’s PhotoGallery.

Risks of Abdominoplasty

Abdominoplasty is a common aesthetic procedure and thousands are performed successfully each year. When done by a qualified Plastic Surgeon who is trained in body contouring, such as Dr. Creasman, the results are generally very positive. Nevertheless, there are always risks associated with surgery and specific complications associated with this procedure.

Post-operative complications such as infection and blood clots are rare, but can occur. Infections can be treated with drainage and antibiotics, but will prolong your recovery. You can minimize the risk of blood clots by moving around as soon after surgery as possible.

Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers are advised to DISCONTINUE SMOKING AT LEAST SIX WEEKS PRIOR TO OPERATION, as smoking increases the risk of complications and delays healing, by altering the circulation to the skin. CIGARETTE SMOKING IS A VERY SIGNIFICANT RISK FACTOR FOR DELAYED WOUND HEALING AND WOUND BREAKDOWN IN THIS OPERATION.

You can reduce your risk of complications by closely following our instructions before and after the operation, especially with regard to when and how to resume physical activity. Complications that arise after such cosmetic operations may lead to costs to you other than the cost of your procedure.

Before Your Procedure

Two weeks prior to your operation, you will need to discontinue medications that can lead to surgical complications. You will meet with Dr. Creasman and his nurse for a second visit, during which any remaining questions regarding the operation are answered. You will watch a CD-ROM, which covers the anticipated risks of the procedure. You will then be asked to sign a surgical consent, which gives the doctor your permission to carry out the procedure of abdominoplasty or mini-abdominoplasty, and this also allows for an Anesthesiologist to administer a general anesthetic.

Photographs will be taken of your abdomen and any other areas upon which Dr. Creasman will be operating. You will be asked to sign a photographic consent prior to having any photographs taken.

A general physical examination will be done to ensure that no ongoing medical problems are present which might interfere with the success of the operation. IT IS IMPERATIVE THAT YOU REPORT ANY POSSIBILITY THAT YOU COULD BE PREGNANT.

What follows is a preoperative checklist for you to follow in preparation for your tummy tuck:

1. Please pick up liquid Ivory hand soap and cleanse the skin of your abdomen, chest, back and pubic area for the three days prior to your operation.
2. Report any signs or symptoms of infection, such as fever, inflamed body parts, burning with urination, cough, diarrhea, or flu symptoms.
3. Avoid shaving or waxing the abdomen or pubic area prior to surgery. We will shave the area in the preop area.
4. Wear a non-pullover shirt to your operation. We suggest a zipper front sweatshirt. Your clothes should be loose fitting, and may get soiled with blood, so wear nothing of any significant value. Wear slip on shoes with smooth soles for ease of ambulation. Wear cotton underwear and clean white socks.
5. Do not wear makeup. Please remove any artificial nail material from both of your index fingers. We monitor your oxygen levels through your nail beds, and artificial nail products interfere with this.
6. Do not wear jewelry or bring other valuables to the office on the day of your surgery. Pierced body parts, including navels, nipples, and tongues, need to be free of jewelry for your safety.
7. Take any prescribed medications as directed.
8. DO NOT EAT OR DRINK ANYTHING FOR SIX HOURS PRIOR TO YOUR ARRIVAL.
9. Avoid smoking for six weeks prior to surgery.
10. Avoid alcohol for 48 hours prior to surgery. It can lead to dehydration and can interfere with clearance of your anesthetic medications.
11. Stock up on Coke Classic, Gatorade, and water. You need to maintain your hydration and Coke will reduce any nausea you might have after anesthesia.
12. If you are having any liposuction, you may have a significant amount of drainage after your procedure, so be prepared to protect your car seats and furniture/bedding at home. Purchase a couple of rubber sheets or “chux” disposable barrier drapes for this purpose.
13. You need reliable transportation to and from the office for the day of surgery and on the first postoperative visit, which is typically 2-3 days after operation. You need to have someone with you for the first 48 hours. If you cannot find transportation from a friend or family member, we can arrange medical transportation, but you will still need someone in the home for 48 hours as a support system.

The balance of your surgical fee is due at this pre-operative visit. Please visit our Financial Center for our payment policies. You can find out the current fee for this procedure by contacting our office (408-369-9300).

Finally, Dr. Creasman will write prescriptions for a narcotic analgesic for post-operative pain relief. You may wish to also purchase homeopathic medications to reduce bruising and swelling. YOU NEED TO INFORM US OF ANY HISTORY OF ALLERGIC REACTIONS TO MEDICATIONS.

The Procedure

On the day of your procedure, you will meet with Dr. Creasman’s nurse and your vital signs checked. The doctor will place skin markings on your abdomen to direct him during the procedure. The anesthesiologist will review your medical history and he or she will then administer an anesthetic known as a general anesthetic. This implies that you will be completely unconscious during the operation, and will feel no pain whatsoever. You are given a dose of intravenous antibiotics to lower your risk of infection. A urinary catheter is sometimes placed by the nurse, depending on the length of surgery planned. This is almost always removed in the recovery area prior to your discharge, but in rare circumstances is left in place until the first post-operative visit.

Figure 1- Incisions and extent of skin elevation

A full abdominoplasty usually takes 2-3 hours, depending on the extent of the work involved. During the procedure, the lower abdominal skin and fat are excised or removed. This tissue is discarded and will not return. The abdominal skin above the level of the navel is then lifted off the underlying muscle up to your lower rib cage, like lifting an apron. A cut is made around the navel , which is left alone.

A variation of the full abdominoplasty is the “mini-abdominoplasty” in which liposuction is done on the entire abdomen, following which the loose lower abdominal skin is removed, without cutting around the navel. The muscles in the abdomen between the navel and the pubic area are tightened. The lower scar is slightly shorter in length and the scar around the navel is avoided. This procedure is done in patients in whom there is insufficient looseness of skin to perform the full abdominoplasty procedure, but enough looseness that liposuction alone is not possible. It has no effect on the upper abdomen, so is not applicable to everyone.

Figure 3 - Excess skin removal, navel repositioning, and closure

Tapes are placed on the skin, completing the operation. An elastic belt or binder is placed to support your abdomen and provide comfort during the post-operative period. Almost always, patients are ready to be discharged from the recovery room an hour or two after the conclusion of their procedure, but it is necessary to have an escort to drive you home. Patients cannot be discharged to the company of a minor or to a taxi service. If you have no one to provide you with assistance, our office can make arrangements for medical transport at an additional charge. Out-of-town patients should plan to stay locally for approximately 7-10 days.

The Post-Operative Period

In the first few hours after surgery, Dr. Creasman encourages you to try to drink first, then eat before initiating the narcotic pain medication that you will need for the first several days after your operation. You should plan to rest with your legs slightly flexed at the waist and at the knees to take tension off the skin closure. On the other hand, we require that you get out of bed and walk several times on the day of your surgery; this is to avoid complications such as blood clots in your legs known as deep venous thrombosis (DVT) and/or pulmonary emboli (PE).

For the first few days, your abdomen will be swollen and you are likely to feel discomfort, which can be controlled with medication. We will provide you with instructions for hygiene and activity. Rarely, patients will be sent home with a Foley (urinary) catheter in place for their convenience, and for close monitoring of their fluid balance. This is placed after you are under anesthesia, and is usually not uncomfortable in any way. If used, the catheter is removed in 1-2 days.

You will be seen back in the office in 1-3 days, at which time the wound is checked, dressings changed, and if necessary, the urinary catheter is removed. On the next visit, usually at 7 days, sutures around the navel and the drainage tubes are removed. Most people return to work shortly after this, but in some instances, work cannot be resumed for 3-4 weeks. This depends on the occupation of the patient, and their individual pain tolerance and healing characteristics.

The abdomen does not usually feel "normal" for several months after surgery. There may be some temporary numbness, particularly just above the incision in the middle, that may stay permanently numb. The abdomen feels very tight, and one feels occasional twinges of pain from time to time during this later healing phase. The tissues feel quite “hard”. It is useful to begin massaging the area beginning approximately one week after surgery. We can refer you to a physical therapist or massage therapist for this. Do not plan to engage in rigorous exercise for 6 –8 weeks after your procedure. The scars take at least a year to mature and fade, and may require additional treatment to optimize their appearance. While they will never disappear completely, the scars usually fade quite well and will not show under clothing, even bathing suits. Most patients are very satisfied with their results.