Tummy Tuck: Abdominoplasty procedure

Abdominoplasty, which is also known as a tummy tuck, is one of the most popular major surgical procedures when it comes to removing excess skin and fat from the middle and lower abdomen and tightening the muscles of the abdominal wall.

The abdominal skin and fatty tissue in humans are elevated to the level of the rib cage and the underlying abdominal muscles are tightened. This underlying structure helps to flatten the abdominal surface. The truth is that the tummy tuck procedure can dramatically reduce the appearance of a protruding (bloated, fat) abdomen, although a tummy tuck does lead to a permanent scar, which can sometimes extend as far as from hip to hip. While a person's choices about their diet and exercise can help keep their abdominal area in shape, only a tummy tuck is able to remove the skin folds and stubborn subcutaneous fat deposits which many fat people hate so much. An abdominoplasty procedure can enhance a person’s appearance and their self-confidence, but it won't necessarily change the looks to match a person’s ideal — in other words you won't look like a photo model, just a tighter, slimmer version of yourself. A tummy tuck can also be very expensive, because the treatment can cost around $3,600.00 and $5,500.00 or sometimes even more (this includes the Operating Room and also the Anesthesiologist).

Ideal Candidates for Abdominoplasty: Who usually has a tummy tuck?

There are several reasons due to which someone might want to consider having an abdominoplasty procedure.
Some of the the reasons why someone may choose to have a tummy tuck include:

• having excess skin
• stretch marks or
• loose abdominal muscles

which may happen after:
 

• losing a lot of weight through dieting and exercise
• pregnancy
• successful surgery to treat obesity

It is important to remember that a tummy tuck is not a treatment for weight control and is not a substitute for regular physical activity and a healthy balanced diet. It should also not be confused with liposuction although surgeon may elect to perform liposuction as part of a tummy tuck. A tummy tuck is a commonly performed and generally safe surgical procedure. For most people, the benefits in terms of improved appearance are greater than any disadvantages, but it carries many possible complications.

How should  the surgery be planned?

Before an operation, everything should be checked and planned with a specialist. Abdominal surgeon should:

• evaluate the patient’s health
• determine the extent of fat deposits in the abdominal region
• carefully assess skin tone

They will also probably be asking about some habits such as smoking, as well as if the patient is taking any medications, vitamins, or other drugs.

During the consultation, the surgeon should also explain about the anesthesia he will use. General anesthesia could be used so that the patient will sleep through the operation. Some surgeons use local anesthesia, combined with a sedative to make the patient drowsy.
 

What happens before an abdominoplasty?

The most important thing that every patient should discuss with the surgeon is what he or she is hoping to gain from the operation and what are the realistic expectations. Surgeon should ask every patient some of these following questions and give some useful advice:

• lose weight if you are overweight – an abdominoplasty gives the best results in people who are at the correct weight for their height
• stop taking the contraceptive pill six weeks before surgery and use an alternative method of contraception as this reduces the risk of blood clotting (thrombosis) after the operation
• give up or cut down on smoking - smoking increases the risk of chest infection and slows the wound healing

The incision localization

Patient must understand that this is not a scar-free surgery. Quite the opposite, the scars may be quite severe depending upon:

• the amount of skin that needed to be removed
• your body's ability to heal
• the skill of the surgeon
• the technique used

Most surgeons choose techniques that leave a well-hidden horizontal scar which can be covered by a standard bikini. In most patients with moderate to severe redundant skin, there will be a need for the creation of a new navel.
 

Types of abdominoplasty

Endoscopic abdominoplasty

Endoscopic surgery has become very popular in the last couple of years because it is much less invasive then standard abdominoplasty. The only tourble is that in patients with loose belly skin, this procedure will not suffice. Endoscopic abdominoplasty is performed with the help of small camera, called an endoscope, which is attached to the surgical instruments. The procedure is performed through a small incision, usually suprapubic incision or in the umbilicus. This procedure also includes another operation called liposuction which also removes the fat. After a drain is placed, the incision is closed.

Mini-Tummy Tuck (Partial or Modified Abdominoplasty)

It is a very effective procedure especially for the patients who need skin and fat removal only and no new umbilicus placement. The good thing about this type of abdominoplasty is that it usually results in a shorter scar. Complete abdominoplasty usually takes two to five hours, depending on the extent of the work required. Partial abdominoplasty may take an hour or two.

Dermolipectomy

Dermolipectomy is the removal of redundant skin and excess fat and it is very similar to the previous type of operation but requires repositioning of a new belly button. The important thing is  that there is no muscle tightening. 

Full Abdominoplasty

This is definitely the most invasive technique. It is generally reserved for patients who have very lax muscles and excess amounts of skin. In the full abdominoplasty a new navel will be made instead of the original one. Patients should be aware that there is more pain and swelling, as well as bruising during and after this procedure due to the amount of work to be performed for proper correction. 

Reverse Abdominoplasty

This is a very uncommon procedure, because, in most cases, it is being done in conjunction with breast reduction or mastopexy. The incision is made along the breasts field in a shape of the inverted letter V. The patient should know that there are pros and cons to each technique so check with your surgeon what is best for you. 

Vertical Scar Abdominoplasty

This is also a very popular technique which combines lower abdominal transverse incision with a midline vertical incision up the abdomen. This technique is usually reserved for those who need a substantial skin excision and waist tightening.

After the operation

In the first few days, the patient’s abdomen will probably be swollen and some pain and discomfort could occur, but in most cases it can be controlled by medications. 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. Surface stitches will be removed in 5 to 7 days, and deeper sutures, with ends that protrude through the skin, will come out in two to three weeks. The dressing on your incision may be replaced by a support garment. Most people are able to return to work between two to four weeks after the operation, but vigorous exercise is not recommended for at least six.

 

Risks from operation

Although there are thousands of abdominoplasties performed successfully each year, a patient should be aware there are some risk associated with it.. The good thing is that post-operative complications such as infection and blood clots are rare, although they can occur. Infection can be treated with drainage and antibiotics, but it will prolong your hospital stay. The problem is that poor healing, which results in conspicuous scars, may necessitate a second operation. 

Specific complications of a tummy tuck are uncommon but can include:

• Numbness in the lower part of the tummy which often reduces over the next 6 to 12 months following the operation but can be permanent
• Poor healing, which results in noticeable scars, may mean you need more surgery
• Final position of the tummy button may be off-centre
• Bleeding can occur under the skin, causing the area to swell and become painful.This is called a haematoma. Sometimes it is necessary to return to theatre to stop the bleeding, remove the blood and help avoid infection

Other serious complications of tummy tuck operations are rare. They include the formation of fat or blood clots in the blood vessels, which can break off and move to the lungs. This is called a pulmonary embolism and can be life-threatening.

Getting back to normal

Although, most patients aren’t aware of this fact, the truth is that it may take you weeks or months to start feeling like your old self again. If you start out in top physical condition with strong abdominal muscles, recovery from abdominoplasty will be much faster. Some people return to work after two weeks, while others take three or four weeks to rest and recuperate.

The important thing to know is that exercise will help you heal better. Even people who have never exercised before should begin an exercise program to reduce the swelling, lower the chance of blood clots, and tone the muscles. It may take nine months to a year before your scars flatten out and lighten in color, although the fact is that they'll never disappear completely. Abdominal scars will not show under most clothing, even under bathing suits.

What are the alternatives?

For some people, an alternative is liposuction, where fat is sucked out through small holes in the skin. Liposuction involves the use of an instrument known as a cannula for removing unwanted fat from a specific area. Liposuction can be performed on

• the abdomen area
• the flanks
• the hip area
• the buttocks
• the inner and outer thighs
• above the knees
• in the upper arms
• under the chin and neck area