Abdominoplasty

Abdominoplasty or tummy tuck surgery is a cosmetic surgery that is done to achieve a lean and flat tummy. 

This procedure involves detaching the excess and loosely hanging skin from the abdomen and tightening the abdominal muscles. It improves the protruding belly and, ultimately, leads to a smooth and firm abdominal profile.

However, it is not advisable to consider an abdominoplasty as an alternative to exercise or a weight reduction program.

Abdominoplasty can provide you with a better-looking belly as it fixes loose or overhanging skin. Loose and overhanging skin may be caused by the following factors:

• Heredity or genetics 
• Ageing
• Pregnancy (abdominal skin is stretched and generally hangs loose after pregnancy)
• Variations in weight 
• People who have been obese in past and still have surplus deposits of fat or loose skin around the abdomen

Abdominoplasty can be explored as a reconstructive operation in the following cases:

• For repairing the structural defects of the abdomen, e.g., birth defects like gastroschisis and omphalocele
• For the correction of abdominal scars from a previous surgery or loose or hanging skin due to obesity
• For enhancing the outline of abdomen after a hernia repair

Abdominoplasty is not recommended if: 

• You are a woman planning to start a family as future pregnancy can split the muscles and cause a hernia. 
• You have plans to lose a lot of weight (in that case, it is advised to delay the surgery until you have accomplished a stable weight)
• You are concerned about a visible scar (this surgery is known to leave scars on the abdomen)

The following are some preparatory steps that may be needed before an abdominoplasty: 

• Your doctor will enquire about your complete medical history, any prescribed medicines (previous or current) and any allergies that you (might) have.
• He/she will ask you to maintain optimum weight and stay fit as it would speed up the recovery process after the surgery. 
• You would also be advised to quit smoking for at least two to four weeks before the surgery as smoking hinders the healing process. Most doctors also recommend quitting smoking for at least four weeks after surgery.
• A few tests such as blood tests, x-ray or electrocardiograms will be advised to you.
• You will be asked to stop the use of some medicines such as non-steroidal anti-inflammatory drugs, aspirin, and aspirin-containing medicines. 
• Your doctor may also ask you to avoid using herbal substances such as ginseng, garlic and St John’s Wort as these can affect clotting and anaesthesia.
• You may be given some antibiotics before the surgery to reduce the risk of infections.
• You will be advised to arrange a recovery area in your home, which should include pillows, ice pack, thermometer and a telephone/cell phone that can be easily accessed. 
• You may be asked to avoid eating or drinking after midnight the night before surgery.
• You will be asked to sign a consent form that gives permission for the procedure. 

Make sure to have a trusted friend/partner who can arrange your commute to and from the hospital and stay with you when you return home after the surgery.

This procedure can take around two to four hours. Once you are admitted to the hospital for abdominoplasty, the following steps will be followed: 

• An intravenous line will be started through a vein in your arm or hand to provide you with necessary fluids and medicines.
• You will be given anaesthesia to put you to sleep during the procedure and keep you free from pain.
• Your doctor will select the exact location of the incision before the surgery.

One of the following types of abdominoplasty will be performed based on your requirement:

• Complete abdominoplasty: Complete abdominoplasty is performed in individuals in need of maximum correction. For this surgery, the surgeon will make a cut in the lower region of your stomach around the same level as your pubic hair. The cut usually stretches from one hip bone to the other. Another cut will be made around your belly button to release the navel from the nearby tissues.
• Partial or mini abdominoplasty: Partial or mini abdominoplasty is performed in individuals with fat deposits under the navel region. In this surgery, the cuts are shorter and your belly button may not be removed.
• Circumferential abdominoplasty: This type of surgery is performed on individuals with excess fat on the back and abdomen. Either circumferential abdominoplasty (a more extensive cut that extends all around the waistline) or liposuction (cosmetic procedure to remove fat) of the back is performed as required.

The abdominoplasty procedure is as follows: 

• A cut will be made into your abdomen and near the belly button depending on the type of surgery being performed.
• The surgeon will expose your abdominal wall, which is made of fibrous tissues and muscles, lifting your skin and fat above it.
• Next, the surgeon will pull your abdominal muscles together and tighten them by holding them in position. He/she will stitch your abdomen down the middle. 
• Next, the surgeon will draw back the fat and skin over the abdominal wall, and remove the excess fat and skin. 
• In case your belly button is not visible after pulling the skin and fat down, the surgeon will make another incision on your abdomen such that the belly button is visible. He/she will then stitch the skin around your belly button.
• The excess fluid that collects as the wound heals will be removed by placing drains (small tubes) in this area for a week.

Surgical glue, stitches or sometimes both are used to close the cuts made during the surgery. Stitches may be dissolvable or may be removed later.

After the surgery, you will be moved to a recovery area/room and given medicines to manage the pain and prevent infection.

• You will be asked to wear compression garments to reduce swelling and assist in shaping your abdomen.
• You will likely have some bruising, swelling and pain. In that case, you should expect a slow recovery process. 
• You might be given anti-coagulants that will prevent blood clotting.
• On the first day after surgery, you may be asked to walk around to prevent the formation of blood clots.
• It will take six weeks for complete recovery from the surgery and witness the total outcome of abdominoplasty.

The benefits of a complete tummy tuck surgery are as follows:

• Flatter and smoother abdomen
• Stretch marks are reduced

The benefits of a mini tummy tuck surgery are as follows:

• Short and less invasive procedure
• Faster recovery
• Flat and slim lower abdomen that looks better in swimsuits and fitted clothing.

Once you are back home, you need to adhere to the following instructions: 

Wound care: 

• You should not put strain (by exercising or hard work) on the wounds for at least six weeks after abdominoplasty.
• Most importantly, you should take proper care of your wounds/cuts and the dressing as directed by your physician. 
• Avoid going out for a swim, using a hot tub, taking a bath or doing other activities involving soaking the wound in water until your doctor permits you to do so. 
• After washing the incisions gently, dry them by gently patting on them. 
• You should refrain from using oils, lotions or creams on the incisions until they are completely healed. 
• After the approval of your doctor, you may use a cold pack wrapped in a towel to reduce discomfort and swelling (the application of a cold pack for 20 minutes is known to reduce swelling) on the site. Do not use the cold pack for more than 20 minutes at a time.
• Your doctor will give you instructions for positioning yourself while sitting or lying down to ease the pain.

Activity: 

• Avoid sudden movements like bending suddenly at the waist as the incision may open. 
• You might have to take a month’s leave from work to recover properly.
• Try to take a walk a few times daily but do not overdo it. Also, limit heavy-duty exercise for four to six weeks. 
• Do not lift heavy items for at least 14 days. 
• You should not drive until you receive your doctor’s permission.

When to see the doctor?

You must consult your doctor immediately if you face any of the following symptoms after surgery:

• Fever of about 100.4^°F or 38^°C
• Severe chest pain or difficulty in breathing
• Non-uniform heartbeats
• If the medicines are not effective in easing pain
• If you have not passed urine in 24 hours
• Swelling, pain, warmness or redness in your thigh, calf muscles or legs 
• Wound infection – increased redness or swelling, extreme pain or bad-smelling drainage from the wound

Abdominoplasty/tummy tuck surgery may have the following risks and complications:

• Fat and blood clots
• Poor healing of wounds/injuries
• Irregularities in body shape
• Fat necrosis (death of fat cells deep inside the skin) due to trauma to the area due to the surgery 
• Too much scarring
• Displeasure with surgery outcomes
• Changes in sensation (e.g. numbness or pain)
• Abnormal build-up of fluid (seroma)
• Bleeding or infection
• Discolouration of skin
• Injury or damage to nearby nerves, blood vessels, muscles and organs
• Risks related to anaesthesia

Your healthcare practitioner will plan follow-up appointments a few weeks after surgery to check how well you are healing.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.