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Abdominoplasty (Tummy tuck)

Abdominoplasty (tummy tuck) is indicated in patients with a large excess of skin and fat in the abdomen. It is usually accompanied by relaxation of the abdominal muscles and is combined with liposuction.

   

Abdominoplasty (tummy tuck)

Abdominoplasty (tummy tuck) is an operation that gives immediate results and offers great satisfaction to patients. The problem usually occurs after pregnancy or after losing many pounds. The skin over the years gradually loses its elasticity. Thus, it can not follow the reduction of the volume of the underlying tissues. Quite often it is accompanied by relaxation of the abdominal muscles. Relaxation of the rectus abdominis basically means the dimension, ie the increase of the gap, the midline of the abdomen between the two rectus muscles.

How Abdominoplasty is done

The patient is under general anesthesia. The abdominal incision is made from one pelvic spine to the other, low, to a point where it can be hidden by underwear or swimwear.

The length of the incision depends on the relaxation of the skin. Excess skin and subcutaneous fat are removed. When needed, the muscles are sutured to tighten them.

When the problem is large, the umbilicus is repositioned in its new position, since the extent of the dermal tissue that is removed is large.

Abdominoplasty and postoperative course

The duration of the operation is 2.5 – 3 hours and the patient usually stays in the hospital for one day. Postoperatively, an elastic bandage is applied to the abdomen, while after the first change, a special corset is applied, which the patient wears for about two months. The return to activities for the patient is estimated at 1-2 weeks, depending on the severity of the operation and always following the instructions of the doctor, regarding issues like weight lifting etc.

The results of the abdominoplasty are spectacular and visible almost immediately after the surgery. A belly smooth, flat, without relaxation, which can not be achieved in any other way.

It is recommended to perform the operation when all the extra pounds have been lost, so that the re-loss of weight after the operation will not cause further relaxation.

Abdominal sagging after pregnancy and abdominoplasty

Motherhood is undoubtedly a period of joy but also of great changes for a woman. The physical condition of the body changes dramatically and at the same time her personal time is limited. As a result of full time devotion to her child, not every mother can devote time to exercise.

For some mothers it is quite difficult to maintain their ideal weight. Thus, during the period of childbirth, while the excess 5 to 6 kilos of amniotic fluid and the baby have disappeared, some or even several extra kilos are difficult to be lost.

Even worse it seems that the body does not return to the previous state but shows a difficulty in losing weight. This is especially common when the skin is overstretched. This period often lasts for years and the woman enters a vicious cycle especially when she is not strict with her diet.

People who have lost weight suffer in the same way. Many, after a successful return to their normal weight, notice that the skin no longer has elasticity and does not shrink on the muscular system.

Abdominoplasty: Techniques and History

The first recorded abdominoplasty was performed in 1899 in Meryland. The techniques evolved a lot in comparison to the first technique which created several problems. It is characteristic that in these early techniques the surgeon removed the navel.

Now, with the right choice of patients, it is a safe operation that gives very satisfactory results to patients. The right Plastic Surgeon has been trained in the full range of techniques so that he can give the maximum in each case. By reading this article you will probably have a much better understanding of the operation.

Here is a complete guide to deciding what is the best technique to get the most out of your abdominoplasty. You will read that using abdominoplasty we transform the body with excess skin and sagging into a well-shaped body with firm skin.

Slightly outdated technique which involves the removal of a large amount of skin and fat, as well as the repositioning of the navel.

The incision is made supraperitoneally from one pelvic bone to the other. Then the skin and fat break down up to a few inches below the sternum. During the preparation of the flap and when we reach the navel, we make sure to cut it with a more circular incision so that it remains on the ground of the abdominal wall. Remove all the fat and skin from the height of the navel and below and re-coat the muscle wall with the skin and fat of the upper abdomen.

I avoid using this technique as it has higher serum rates. The serum is a collection of serous fluid that encapsulates and requires its postoperative puncture by the doctor until it subsides. In addition, conventional abdominoplasty requires the use of drainage precisely because of postoperative fluid collections. Nevertheless, the percentage of serums remains high.

It is a variation of the classic abdominoplasty with the difference that the navel is not cut perimetrically but at a depth from its stem. Thus, it remains in place on the skin of the abdomen and descends lower when the flap of the upper abdomen is sutured in the supraspinatus. It is a technique that I present but never use as the navel shifts lower. This new low position of the navel seems in my opinion inelegant and is the main reason I avoid it.

It is also a variation of the classic abdominoplasty with the difference that the incisions extend to the sides of the abdomen towards the so-called buns. Extensive abdominoplasty is indicated for people who have lost weight en masse and have dramatic skin sagging. It is the technique for people with many sags and “folds” as in these cases the excess skin can not be treated otherwise.

It is the appropriate operation for someone who needs to remove excess skin from the abdomen and at the same time straighten the buttocks and thighs. It is a great operation which when performed by a properly trained Plastic Surgeon gives impressive results. The surgeon has the ability to perform liposculpture of the whole body. It is indicated when we have too much saging also on the buttocks and thighsand a strong appearance of orange peel. The result is a now formed body, in exchange for the scars that often extend to the middle of the sanctuary.

It is an operation used almost exclusively in people who have lost weight after bariatric surgery. As the name of the operation suggests, it is an abdominoplasty that extends around the perimeter. It is essentially an extensive body lift that provides effective solutions to people with loose skin around the perimeter.

The incision is just like a belt and in this way any excess is removed which incidentally creates serious infection problems under the folds. Patients undergo buttock and thigh lifts along with abdominoplasty and admittedly everyone is satisfied with their new image. To apply this technique it is required that the patient has remained at a constant desired weight for at least one year. It is the most expensive operation of its kind as it requires a lot of surgery time. The cost is also determined by the fact that these patients should be hospitalized for 2 to 3 days for follow-up.

Reverse abdominoplasty is indicated for people who have excess skin and lipodystrophy above the navel. The incisions are inserted into the submandibular folds and joined. The incisions can thus be camouflaged satisfactorily. Patients who are indicated for reverse abdominoplasty remain satisfied as epigastric lipodystrophy is a difficult problem especially in people who have tried liposuction of the area without success.

It is another variant of the classic abdominoplasty which differs in the placement of the incisions. In addition to the horizontal “hidden” incision, a vertical super-umbilical incision is made which is impossible to camouflage. Despite this disadvantage there are patients who even benefit from this option. It is suitable for people with enough excess who do not want to extend the incision laterally but vertically in the center.

Another category is patients who have previously undergone laparotomy. I could also say that this group of patients benefit from the correction of the usually deformed scars of the laparotomy.

In selected patients, liposuction or VASER liposuction significantly facilitates abdominal surgery. The acronym VASER stands for Vibration Amplification of Sound Energy at Resonance. It is essentially ultrasound-assisted liposuction that makes the tedious task of manual classical liposuction easier for the surgeon. It is important to understand that technology cannot replace a surgeon’s competence in liposuction. In fact, in the hands of someone who does not adequately understand the art of liposculpture can be a disadvantage.

The most common failures are asymmetry and deepening of the skin in places. In any case, I must emphasize that there are patients who particularly benefit from the combination of liposuction with abdominoplasty.

A variant of abdominoplasty-liposuction is abdominoplasty-liposuction. In this case, some of the fat can be used in areas where we want to add volume. Usually the majority of patients request breast augmentation and buttock augmentation also known as Brazilian Butt-lift liposuction. Patients who choose these breast augmentation methods report that they feel that the result very natural.

The technique of this abdominoplasty was developed to reduce the chance of creating a serous postoperative collection, as more lymphatics are preserved while retaining the Scarpa fascia. In addition, the perspiration of the area is better resulting in faster recovery of patients. It is a technique that I always combine with others as I have found that all patients benefit.

The concomitant contraction of the rectus abdominis muscle in many cases is the only way to do it, as many patients have muscle dimension. The beautiful shape of the abdomen is not only related to the relaxation of the skin and the presence of fat. The muscular system is especially important. The muscles of the abdomen are its natural corset. When for some reason the corset “overflows” the Plastic Surgeon is called to correct it. Either a pregnancy or chronic obesity are factors that exert forces on the abdominal wall. Constant pressure from the inside transforms the trunk from pipe to barrel.

There are tendon sutures in the abdomen. These are one vertical line in the middle and three horizontal. These look like a “six-pack” on fit thin people. Thus, it is especially important when this middle tendon suture has been extended to be folded as needed so that the body acquires the hourglass shape. The narrow waist is in demand for a sturdy beautiful body. In combination with liposuction on the sides of the abdomen, this technique gives perfect results.

When some of the above techniques are combined with this technique, patients, in addition to enjoying an amazing aesthetic result, are safe and do not suffer any particular discomfort such as pain, delayed healing and other complications.

Indications Contraindications Complications of Abdominoplasty

Relevant contraindications are if:

  • You want to lose a significant weight
  • You are thinking of a pregnancy in the short term
  • You have a body mass index greater than 30
  • You are a smoker
  • You have had previous abdominal surgery that caused significant scar tissue

While the absolute contraindication is if:

  • You have a serious chronic illness, such as heart disease or diabetes 

An abdominoplasty can involve several risks, such as:

  • Collection of fluid under the skin (serous). Installing a drain hose can help reduce the risk of collection. In case of collection, puncture under local anesthesia with a syringe and a fine needle is required.
  • Poor wound healing. Sometimes the areas along the incision are difficult to heal or may split.
  • Deformed scar. The incision of a tummy tuck is permanent, but is placed along the bikini line. The length and visibility of the scar varies from person to person.
  • Changes in the aesthetics of the skin. During an abdominoplasty, the preparation of your tissues can affect the nerves in the abdominal area. You probably have reduced sensation or numbness. This is usually transient for a few months afterwards.

Like any other type of major surgery, a tummy tuck carries a risk of bleeding and infection. For any possible complication, countermeasures are taken such as taking antibiotics, meticulous hemostasis, prophylactic anticoagulant therapy.

First, talk to your plastic surgeon about having a tummy tuck. During your first visit, the plastic surgeon will ask:

  • the medical history for current or previous diseases. You will list any medications you are taking or have recently taken, as well as any surgeries you have had.
    Let me know if you are allergic to specific medicines. You will also be asked detailed questions about your weight gain and loss.

  • The following is a palpation examination to determine treatment options. Photos of your abdomen will also be taken for the medical record.

  • You will discuss your expectations. Explain why you want a tummy tuck and what you hope for the appearance after the procedure. you will understand the benefits and risks, including scarring.

Before abdominoplasty it is also reasonable to:

  • Quit smoking. Smoking reduces blood flow to the skin and can slow down the healing process. In addition, smoking increases the risk of tissue damage.
  • Avoid certain medications. You should avoid taking aspirin, anti-inflammatory drugs and herbal supplements, which can change your coagulation profile.
  • Maintain a constant weight. Ideally, you will maintain a steady weight for at least 12 months before having a tummy tuck.

    If you are particularly overweight, I would recommend losing weight before. Significant weight loss after surgery can alter a good result.

    You will take medication to prevent complications. Shortly before your tummy tuck, you will receive an anticoagulant during your admission to avoid a prophylactic dose. Seek help during recovery. Make sure someone takes you home after you leave the hospital and stays with you for at least the first night of your recovery at home.

A tummy tuck is always done in a hospital. During a tummy tuck, you will be under general anesthesia. Upon awakening you will be led to your room where you will rest for a few hours. On the night of the operation, with the help of the doctor, you will mobilize. This will help you to stop the anticoagulant earlier as mobilization is the best anticoagulant protection.

During abdominoplasty, the plastic surgeon makes incisions to remove most of the skin and fat between your abdomen and the pubic area in a horizontal oval or elliptical shape. The connective tissue (fascia) above the abdominal muscles is then tightened with permanent sutures.

The plastic surgeon will reposition the skin around your abdomen. Your navel will come out of a small incision in the correct position and will be sutured in its normal position. The incision from pelvis to pelvic bone and through the scalp to the supraorbital region is sutured and will leave a scar that falls along the natural fold in the bikini line.

During the procedure you may be given an antibiotic to prevent infection.

The process usually takes about two to three hours.

After the procedure

After a tummy tuck, the incision will be covered with a surgical bandage. Small tubes (drains) can be placed along the incision to drain any excess blood or fluid.

The members of the treatment team will help you to walk from the first day after a tummy tuck to prevent the formation of blood clots in the lower extremities of those who are predisposed.

You will probably feel moderate pain, which will be controlled with medication. This pain is referred to as weight and superficial sting. It is normal to have swelling in the surgical area.

The drains can remain in place for several days after surgery. The doctor or another member of the care team will show you how to empty and take care of your drains. You may need to continue taking an antibiotic while they remain.

Your surgeon may also prescribe a blood thinner shortly after your abdomen.

You will wear a supportive abdominal garment (abdominal corset) for about six weeks after your surgery. This helps prevent fluid retention and provides abdominal support while you are healing. Your doctor will explain how to take care of your scar.

For the first 2 weeks after a tummy tuck, you need to be careful when moving. You should also avoid positions that stretch your incision line to prevent the wound from opening.

You will need to schedule regular follow-up visits. Ask your doctor how often you should see.

By removing excess skin and fat and strengthening the abdominal wall, a tummy tuck can give your tummy a softer, slimmer and more beautiful appearance. The effects of a tummy tuck are permanent if you maintain a steady weight.

Related links

Surgery
Abdominoplasty
Duration
2,5 – 3 hours
Recovery time
1 – 2 weeks

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