Introduction and indications
Abdominoplasty (tummy tuck, apronectomy) is a frequently requested body contour surgery. Both men and women are candidates. The procedure is frequently undertaken for women who have had abdominal skin expansion, and unsightly stretch marks, having had children. Other candidates include men and women who have undergone extensive weight loss, leaving excess skin that exercise and weight reduction plans will not remove. There are, of course, many refinements tailored to the individual, and relating to scar placement, the use of combination liposuction, and simultaneous thigh lift, or breast contour surgery. These combination procedures are becoming increasingly popular. Abdominoplasty and combination procedures can provide a flat, contoured and waisted abdomen, with a hidden scar within the underwear line. Personal confidence improves, and clients can return to wearing sympathetic clothing, and normal exercise patterns, with an improvement in general health and fitness.
The basic abdominoplasty involves redraping the abdominal skin, lifting it from the underlying muscles from an incision in the underwear line. The scar is placed within the bikini – area, often removing previous Caesarian section scars if necessary, and there is a small, usually imperceptible scar around the umbilicus – which is sited back in its original position in the centre – line. Frequently the abdominal rectus muscles are tightened up to correct laxity following pregnancy and to restore abdominal shape. Liposuction may be used to improve the eventual contour, particularly in the lower abdomen and ‘love handle’ area, above the hips. Surgical drains are placed prior to closure with dissolving sutures.
There is usually a two – night hospital stay during which time there is a programme for gentle mobilization, beginning with bed to chair movement on the first day, progressing to walking gently bent at the waist with support by the time of discharge. Drains are usually removed prior to discharge, but it is not uncommon to be sent home with drains in place if determined by the surgeon, to be subsequently removed as an outpatient. TED leg – support stockings are worn until walking normally reduce the risk of blood clots in the legs. Post – surgical discomfort rather than pain is the norm, until mobility recovers. Pain relief and anti – nausea medications are prescribed as necessary. The recovery to driving, housework, picking up small children and gradual return to sporting activity is 4-6 weeks, dependent upon the individual. A surgical support garment is worn for 2-3 weeks, supporting the surgery and dressings, and then a girdle-type underwear provides comfort until confident mobility is achieved. Dressings are changed as required and usually in place for 2-3 weeks. The abdominal skin begins relatively numb (beware hot drinks and hot water bottles!) and sensation recovers slowly. Showering as opposed to bathing is recommended, and surgical suture – lines will benefit from cleansing irrigation and gentle towel drying. Time off – work varies according to the individual and work environment, but a 2-3 week leave period is usually recommended.
Although the desired result leaves a contoured abdomen and hidden scar, the extent of surgery is greater than immediately obvious, and is reflected in the recovery time. Reasons for early unplanned return to surgery include collection of blood or fluid beneath the tightened skin, or removal of non – viable or infected tissue. Such risks are increased in smokers. Perioperative antibiotics and meticulous surgical technique help to reduce infection risk. Later revisional surgery may be undertaken to tidy up small areas of asymmetry in the scar line, or redraped abdominal skin. Adverse events are unlikely, but often disappointing if they occur. A comprehensive list of possible adverse events and their management will be discussed by your surgeon.
You will be seen each day in hospital by the surgeon or member of the team, who are on 24 hour call if the hospital ward staff require support. First outpatient review is at 1-2 weeks, when sutures will be trimmed and dressings changed as necessary. Pain relief is prescribed as necessary. Further outpatient review is undertaken at or around one and six months, variable according to circumstances.