Abdominoplasty
(Tummy-tuck)
Indications
Abdominoplasty removes excess lower abdominal skin and fat
and may also help improve contours, muscle weaknesses and
some abdominal scarring. There are various types of abdominoplasty,
which in some instances, can be combined with liposuction
to achieve a better cosmetic result.
Anaesthetic
- General anaesthetic
Technique
In a standard abdominoplasty skin and fat between the umbilicus
and pubic hair is removed. An incision is made above the
pubic hair extending out towards the hips; another, incision
is made around the umbilicus. The abdominal wall skin and
fat are freed off the underlying muscles and excess skin
& fat from below the umbilicus is then pulled down and
cut off. Weaknesses of abdominal wall muscles are repaired
at the same time. Tubes are placed to remove excess fluid
and the incision is stitched with dissolving stitches.
Other types of abdominoplasty use different skin incisions
(usually in the same place but longer or shorter; occasionally
a vertical midline incision may be used).
Abdominoplasty may be combined with liposuction to thin
certain parts of the abdominal wall, particularly the hips
and flanks. Liposuction may be done at the same time or
as a separate procedure.
Length
of operation - 2 - 3 hours
Time
in hospital - 3 - 5 days
Postoperative
discomfort/limitations
Abdominoplasty is a major procedure; significant postoperative
discomfort is common - this is controlled with pain-relieving
drugs. In the first few days after the operation the knees
and hips should be kept bent to take the strain off the
stitches. Swelling and numbness of the abdominal wall for
several weeks are common. Mobility is limited for 2 - 4
weeks; lifting and sports should be avoided for 6 - 8 weeks.
Abdominoplasty
will not improve the appearance of the waist - if this is
needed an additional vertical midline scar can be considered;
this will be conspicuous - but if a scar is already present
then it can be a used. Abdominoplasty will not remove stretch
marks above the umbilicus. The scar of an abdominoplasty
is noticeable and long; the main scar runs horizontally
across the lower abdomen - the surgeon tries to place the
scar where it will be hidden by underwear - the placement
of the scar should be discussed with the surgeon; it is
not always possible to completely hide the scar. There will
be a scar around the umbilicus.
Secondary procedures are sometimes necessary to improve
the results; this commonly involves tidying up scars and
liposuction.
Time
off work - 4 - 6 weeks
Risks
and complications
General anaesthesia is safe; but in a tiny proportion caries
a very small risk.
General
complications: bruising, swelling and bleeding which may
be heavy and need a blood transfusion and a return to the
operating theatre to stop; chest and wound infections, unsatisfactory
scarring.
Leg vein thrombosis (clot) - this is a particularly important
complication and has been associated with death following
abdominoplasty - part of the clot breaks of and gets lodged
in the lung (pulmonary embolism), fortunately this complication
is rare (0.04%).
Specific
complications
Delayed wound healing, especially in midline where the stitching
is tightest; umbilical loss; dog-ears (prominent folds of
skin may be formed at the ends of any scar); bulging of
skin and fat above the scar -because the tissue of the abdominal
wall is generally fatter than that of the groin; seroma
- a collection of fluid which forms when the skin and fat
do not stick back down onto the muscles of the abdominal
wall; malposition of the umbilicus; injury to the lateral
cutaneous nerve of the thigh - produces tingling or numbness
down the outside of the thigh - usually resolves, may be
permanent.
Wound healing complications are increased in smokers and
in people who are overweight. Infections, leg thrombosis
and pulmonary embolism are also more common in people who
are overweight. The surgeon may insist you stop smoking
and lose weight before surgery.
