Abdominoplasty( Tummy Tuck )

The abdomen is universally the most common part to go out of shape with weight gain or pregnancy. This happens due to the accumulation of fat under the skin, excess loose skin and or loss of tone of the abdominal muscles. Abdominoplasty surgery (or a tummy tuck surgery) involves removal of excess fat and hanging skin as well as the tightening of loose muscles in a single Tummy Tuck Surgery or an Abdominoplasty surgery to result in a flat abdomen.

You may be a good candidate for an Abdominoplasty surgery if you have one or more of the following conditions:

If you are a male or a female with bulging abdomen and hanging fold of skin:

1. Post-pregnancy abdomen with stretch marks and hanging skin fold.
2. Post-caesarian section bulging abdomen with or without a hernia or a vertical scar on lower abdomen.
3. If you have lost a lot of weight after Bariatric surgery.

Anaesthesia: General
Duration of Surgery: 3-4 hour
Stitches: Self-absorbable/ Staples – removable in 1 week
Hospital Stay: 1-2 days
Recovery: Walking and light meal same day

Self Care:
Getting dressed, combing hair, eating: Next day
Preparing tea, heating food: Next day

Work:
Cooking, dusting, light household work: 1-2 weeks
Driving, desk job: 2 weeks

Activities:
Morning walk: 1-2 weeks
Treadmill/Yoga/Swimming: 1 month
Weight lifting: 3 months

STEP ONE: CONSULTATION

You can see the typical clinical pictures of patients to satisfy yourself about the procedure and ask any questions regarding the results, and possible risks of the surgery.

You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries and medications you are taking. It is important for you to provide complete and accurate information. You should tell the doctor if you plan to lose a significant amount of weight or planning future pregnancies. It is recommended that you stabilize your weight before having Tummy Tuck Surgery. You may consider combining a Tummy Tuck Surgery with liposuction of the thighs for a very favorable result. Routine diagnostic tests will be ordered.

STEP TWO: PREOPERATIVE EVALUATION

Once you have decided to undergo surgery, you will be evaluated for your fitness for anaesthesia and the Abdominoplasty surgery. Your diagnostic test reports will be studied. Dr Priti will examine your abdomen, taking measurements and clinical photographs for your medical record. The quality of your skin, amount of fat, the tone of muscles and presence of any a hernia or scar will be noted. If a hernia is suspected a US scan or CT scan may be ordered. You will be given consent forms to sign and detailed preoperative instructions in writing.

STEP THREE: SURGERY

Report to the hospital on the morning of surgery. Before being taken into the operating theater, your abdomen will be marked with a marking pen while you are in a standing position to shape it to the desired size. The location of the scar will be marked. The operation is under general anaesthesia and is pain-free.

STEP FOUR: AFTER SURGERY

You will wake up soon after surgery with compression garment on your abdomen. You can drink water after 5 hours and have some snacks afterwards. You can walk and have dinner on the same evening. Drains (tubes) are usually removed the next morning, and you will be ready to go home with the bandages. If the drainage from the tube is excessive, you can be sent home with the drains and can come back in 2-3 days for drain removal when drainage has lessened or stopped completely.

STEP FIVE: RECOVERY

The bandage will be worn for ten days, and the binder for six weeks. You will need some assistance initially. Many women and men start light work within 2 weeks. Usually, by the end of one and a half months, you will be feeling quite normal and ready to resume all normal activities. As the surgical swelling goes down, results are visible in a month’s time.

How is abdominoplasty performed? Where will the scar be?

A long cut is made very low horizontally on the abdomen, within the panty line, in the same place where caesarian section scar is. The skin is lifted up from the abdomen, pulled down, and excess skin and fat are cut away. The belly button is not detached from muscles. The scar is within the panty line and also around the belly button. Liposuction of the abdomen is usually done along with abdominoplasty surgery.

What are the risks involved with Tummy Tuck ( Abdominoplasty )surgery?

Fortunately, significant complications from a tummy tuck surgery are infrequent. Anyone considering surgery, however, should be aware of both the benefits and the risks. Some of the potential complications include bleeding and collection of a blood clot- which may require another surgery to remove the clot. Infection and reactions to anaesthesia can occur. At times there is a collection of watery (serous) fluid called seroma, and the drain may need to be kept for a week or longer for that. Rarely, a patient may require a blood transfusion during or after the operation especially in obese people who are also having liposuction of thighs, etc. Depending on the individual’s healing capacity, the incision may take longer than the usual one week to heal. Rarely, loss of part of the skin may occur which may take 2 to 3 months to heal. The scar can be prominent at times, or there can be bulges at the corners of the scar (dog ears) that may require a minor surgery for correction. Umbilicus may also have a healing problem. In a case of an umbilical hernia, umbilicus may need to be removed, and new umbilicus can be made.

Apart from these, the problem common to all the  surgeries like a mild or severe reaction to anaesthesia and clotting of blood in leg veins leading to potential life-threatening pulmonary thromboembolism can occur.

Like in any surgical procedure risk depends on your general health. If you are healthy and nearly average in weight, the risks are minimal. On the other hand, risks are higher in the case of patients who have diabetes, hypertension and obesity. You can help to lessen certain risks by following the advice and instructions of your plastic surgeon, both before and after a tummy tuck surgery.

How will I look and feel after a Tummy tuck surgery/ Abdominoplasty surgery?

The day after the Abdominoplasty surgery, you will be encouraged to get out of bed for short periods of time. After several days, you will be able to move about more comfortably. Straining, bending and lifting must be avoided, however, since these activities might cause increased swelling or even bleed.

Any surgical drains will be removed a day or two after the tummy tuck surgery, at which time your dressings may also be changed or removed. You will be instructed to wear a support abdominal binder for a few weeks. Stitches are self-absorbable. If staples are used, they are taken out in a week.

You may notice that you feel less sensation all over the abdomen. This usually is temporary. It may, however, be months or even more than a year before sensation returns to normal. Incisions will initially be red or pink in colour. They will remain this way for many months following surgery.

The abdomen will not look very flat initially because of the swelling, but in 6 to 8 weeks the results will appear.

Recovery time is shorter if muscle tightening is not done and it is often possible to return to light work after a week or two, depending on your job. In many instances, you can resume most of your normal activities, including some form of mild exercise, after several weeks. You may continue to experience some mild, periodic discomfort during this time, but such feelings are normal. Severe pain should be reported to your doctor.

When muscle tightening is done, the pain and stiffness may be there for two weeks which will need pain killer tablets. You will be able to join light work in 2 weeks.

Any sexual activity should be avoided for a minimum of one week, and your plastic surgeon may advise you to wait longer. After that, care must be taken to be extremely gentle with your tummy for at least the next six weeks.

What is a drain? Why is it used in an abdominoplasty surgery?

Drains are soft slender plastic tubes one end of which is placed underneath the skin of the abdomen and another end comes out of the skin. Two such tubes are connected to a small plastic container which continuously sucks out any blood or fluid accumulating in the operated part. Usually, the drainage is bloody on the first day and watery afterwards. Drainage reduces day by day. Most times drain removed after 24 hours. If drainage is more, then it can be kept longer. In that case, the patient is sent home with drains and drainage is measured every day till it comes down. Drains are painless.

Why is the compression garment necessary?

Compression garment gives firm and an elastic support, so the skin sticks to muscle and fluid collection are avoided. Also, most patients feel more comfortable with garment during an early post-surgical period.

Is the result permanent after an Abdominoplasty surgery?

Unless you gain or lose a significant amount of weight or become pregnant, results stay. You can even improve upon the results by toning the muscles with abdominal exercises.

What results can I expect after Tummy tuck surgery?

You can expect a significantly flatter abdomen, reduced waist size and tighter skin. The scar will be hidden even in a bikini, except the scar around the belly button.

How long do I need to see the doctor after Abdominoplasty surgery?

You will return to the clinic for follow-up care at prescribed intervals, usually two days, two weeks, one month and three months later. At these visits, your progress will be evaluated and  any minor problems are taken care of. Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. If you have questions or concerns during your recovery or need additional information at a later time, you should contact Dr Priti Shukla.

Will I be able to have a normal pregnancy after Tummy tuck surgery?

If you are planning pregnancy in future muscle tightening part will be avoided, and only skin and fat removal will be done. Then there will not be any problem.

Are there methods available to reduce the scarring?

Scars can be improved by creams, gels and taping for 3 to 6 months. Excessively prominent scars can be revised surgically after six months.

Is there a way to do reduce abdomen without scars?

Liposuction surgery can remove fat but not the loose skin. Waist size can be reduced to some by liposuction through small holes, but skin and muscle tightening are not possible by this method.

I have had bariatric surgery done for morbid obesity and have lost 50 kgs. My tummy is sagging up to my thighs, and I am having skin infection under the skin fold. Can I have a tummy tuck?

A tummy tuck surgery is commonly required after massive weight loss. In your case, the loose skin will be there on the back side also so that circumferential abdominoplasty surgery may be needed.