About Abdominoplasty Surgery
Pregnancy is the usual culprit for expanding the abdomen for women, but anything that has expanded the abdomen, such as massive weight gain and loss will set someone up to be a candidate for abdominoplasty. Many patients, who consult with our board-certified Plastic and Reconstructive Surgeon, Dr. A Jay Burns, question whether they should have abdominoplasty or liposuction. The answer lies most often in the skin tone. If skin tone is good and the primary problem is excess abdominal fat, liposuction may be all that is required. However, if the muscle tone is lax and is coupled with poor skin tone, then these structures need to be tightened and excised, respectively.
Our Dallas, TX Plastic Surgeon, Dr. Burns, performs abdominoplasty that vary in scope based on how much loose skin and fat is present. It provides immediate results and allows patients to achieve the tighter, slimmer look they want.
Tummy tuck surgery can be performed on both men and women. If you have loose or hanging skin, isolated pockets of fat, and excessive skin wrinkling in the abdominal region, this surgery can help restore a tighter figure. It is important that you are at a healthy weight and have realistic expectations. Abdominoplasty is not a surgery to help you lose weight. It is a skin tightening, body contouring procedure that addresses loose skin. If your abdomen has good skin laxity, but you are still not satisfied with its appearance even after you have tried diet and exercise, you may be a better candidate for liposuction. If you are a woman considering this procedure, we recommend completing all pregnancies so that the surgical outcome is not comprised with a new pregnancy after surgery.
You are not a good candidate if you have the following conditions:
- If you are morbid obesity, or even a patient who is significantly overweight, is not a good candidate for a tummy tuck.
- If you are a smoker, keep in mind that smoking makes the operation prohibitive as the chance of skin loss is greatly enhanced.
- If you have already had an extensive abdominal surgery, this could be a contraindication, especially with high transverse incisions under the rib cage, as this would decrease blood supply and increase the risk of skin loss.
Plan Your Procedure
- Procedure Recovery Location
Abdominoplasty is performed under general anesthesia in an accredited surgical facility. There are several methods to consider when performing this surgery. Some candidates with extensive loose skin may require a full (or extended) tummy tuck, which places the incision from hipbone to hipbone just above the pubic region. Others, for example, who have minimal skin laxity, but enough that is bothersome, may be better suited for a mini tummy tuck. This produces a much smaller incision that is less invasive, but large enough to create the tightening necessary. The goal of this surgery is to remove most, if not all, of the skin located below the belly button extending to the top of the pubic hair. The incision extends essentially from side to side and it is necessary that it be this long so that the scar can lay flat with no bulging on either side. It is helpful to think about cutting a circle out of a piece of fabric. It would be impossible to just close that circle without having excess fabric bunch at both ends; therefore, the ends must be tapered. That is why the incision is tapered to the left and right hip ending near the love handles bilaterally. The more skin that is removed, the longer the scars extend laterally. This scar is unavoidable. The abdominal skin and fat are both elevated off the abdominal wall after the belly button has been incised circumferentially and left on the abdominal wall (on a stalk of tissue). The separation of the muscles in the midline with abdominal wall looseness and laxity is also noted. The muscles are then tightened and repositioned to the midline so that the abdomen is flat. The excess abdominal skin is removed and a new belly button is marked in the midline and the old belly button is pulled through the skin excision and sutured in place to create a more youthful, contoured belly button.
The incision is closed over drains, which are brought out through the mons/pubic hair area, and these are left in place from 3 – 10 days and in rare cases even longer. The drains are very important to keep any drainage fluid from collecting between the skin/fat flap and the abdominal wall, as we want this to reattach as quickly as possible to facilitate healing and to maximize contour. Although the drains are necessary, we utilize drains that are not only the most efficient and functional on the market, but are also the most comfortable to remove. Discomfort varies from patient to patient.
What to Expect
Abdominoplasty, in Dr. Burns experience, is one of the most difficult recoveries in plastic surgery for his patients. Although, it is a procedure among the highest, if not the highest, in patient satisfaction at our practice. When tightening the abdominal muscles one can get muscle spasms, which may cause discomfort that can be significant for approximately 3 days. Some patients choose the option of a pain pump catheter to be placed at the time of surgery, which lasts for approximately 3 days. This is a topical anesthetic agent dripped onto the abdominal wall and will come out through the drain. Most patients find this to be helpful and choose this option, although it is not mandatory. For approximately 1 week the patient stays flexed at the hips to alleviate any pressure on the wound. During the next 3 – 7 days begins to stand more upright so that at 10 days – 2 weeks post op the patient is able to stand unassisted and upright. We recommend not lifting any weights over 10 pounds for approximately 4 – 6 weeks. Patients with small children need to take this into account as they cannot lift their children for about a month and appropriate help needs to be arranged. Patients can drive when they feel that they are not a danger to others, i.e., they can look in their blind spots easily and react appropriately unencumbered. It takes several months for the incision to heal and for the surgical results to take on a normal look and feel. The good news is that you will see your results immediately and will love your slimmer, tighter figure.
Skin loss due to decreased blood supply may be seen rarely. It is more common in smokers, and in our office, we do not knowingly perform this operation on smokers.
Belly Button Loss
Belly button necrosis (or loss) is a variant of skin loss as the umbilicus can have poor blood supply and be compromised as well in this procedure. This will result in a less than satisfactory scar around the umbilicus and a prolonged healing.
Fluid (seroma) can collect between the abdominal flap and the abdominal wall requiring drainage in the office and possible return to the operating room to drain the seroma or excise the seroma pocket. This can be an early or late complication, but is most often noticed in the first month after surgery.
Infection ranges anywhere from 1 – 2% in our series.
Bleeding may also occur requiring a return to the operating room. Fortunately, this is a rare complication as well.
Deep vein thrombosis or pulmonary embolism
Deep vein thrombosis (DVT) or pulmonary embolism (PE) clots can form in the legs and in rare instances may "dislodge" and travel to the lungs (pulmonary embolism). DVT would require oral ingestion of blood thinners for a period of time as would, of course, PE may be life threatening and is the most serious consideration. It is fortunately extremely rare. Although a fatality has not occurred and a PE and DVT are extremely rare, we still take special precautions in every operation. All patients have compression garments in place during surgery, which are well proven to drastically reduce the incidence of either complication.
Attain a Tighter Tummy
Many factors can result in a stretched out abdomen, creating loose skin in the stomach area. It is a frustrating problem to have because the only way to correct this is generally through surgery. If you are embarrassed or bothered by the amount of loose skin in your abdominal region, whether it is a significant amount of laxity, or minimal, we have a tummy tuck procedure that will most likely work for you. We invite you to call our office and learn more about the options available for abdominoplasty, as well as the other body contouring procedures we offer.