ABDOMINOPLASTY - “TUMMY TUCK”
Following pregnancy and also after weight loss, excess skin and fat carried on the abdomen can be a source of dissatisfaction. The skin may 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 re-contour the abdominal wall. To remove the excess skin, incisions are necessary. Unlike liposuction, which only involves very small incisions to remove fatty tissue only, abdominoplasty involves tightening of the abdominal muscles and removal of the loose skin. The resultant scars are around the navel and along the lower abdomen from hip to hip, located below the bikini line. 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 a small number of patients, there is not enough 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 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.
: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 re-contouring 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 view. Some of these photos may also be seen on this website, in Dr. Creasman’s Photo Gallery.
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 our nurse practitioner for a second visit, during which any remaining questions regarding the operation are answered. 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.
On the day of your procedure you will be greeted by 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 means 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 removed in the recovery area prior to your discharge.
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.
The vertical abdominal muscles are then tightened with heavy sutures from your xiphoid (solar plexus) to your pubic bone. This provides a firmer abdominal wall and a narrower waistline. The skin apron is then pulled down to the pubic area and after a new opening is made for the navel, the skin is stitched. A drain tube is placed under the skin apron to evacuate any fluid that may accumulate after the operation. The drain is attached to a suction bulb and the output documented by your caretaker. The drain is typically removed 7-10 days after surgery. The closure of the skin is done with dissolving-type suture material, which does not require removal. Dr. Creasman administers a long-acting local anesthetic during the operation so that you will have little pain in the early post-operative period. A local anesthetic pain pump device is inserted during your procedure that helps control your pain along with oral narcotic pain medication. That device is removed after two days. You will be able to shower after that.
Figure 2- Repair of vertical muscles
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. Pain pumps are not necessary with mini-abdominoplasties.
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 embolism (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. You will be seen back in the office in 2 days, at which time the wound is checked, dressings changed, and the pain pump 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 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 10-12 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.