The best candidates for tummy tucks or abdominoplasty are men or women who are in relatively good shape but are bothered by a large fat deposit or loose abdominal skin. A protruding abdomen can be a cause of distress for men and women alike. The surgery is particularly helpful to women who, through multiple pregnancies, weak abdominal muscles are annoyed by loose skin that has been over-stretched and no longer responds to diet and exercise. For those who have experienced a massive weight loss, their only alternative to loose overhanging skin is surgery.
Patients who intend to lose a lot of weight should postpone the surgery. Also, women who plan future pregnancies should wait, as vertical muscles in the abdomen that are tightened during surgery can separate again during pregnancy.
Patients that have stabilized in their weight loss program or who feel they are at their ideal weight are the best candidates for a tummy tuck. Many patients combine their tummy tuck with other cosmetic procedures such as liposuction, breast augmentation or breast reduction surgery.
What is the procedure?
There are three basic techniques used to flatten a protuberant abdomen. Liposuction, mini-tucks and full tummy tucks. The best technique for you will depend largely on your goals and your specific problem.
Liposuction alone can produce a thin abdominal wall for some. If your laxity and excess skin is below your navel, a mini tummy tuck may be right for you. For those with severe laxity of their abdominal muscle or excessive skin, a full tummy tuck may be their only solution.
A full tummy tuck is usually performed on an inpatient under general anesthesia with the patient asleep, or with spinal anesthesia. Surgery routinely starts by infiltrating fluids under the skin thereby creating a hydraulic dissection. This loosens up the skin. A long incision (red line) is made low down in the abdomen just above the pubis and all the tissues of the abdomen superficial to the muscles are elevated. The skin flap becomes very flexible due to the liposuction and slides down easily.
The flap is elevated up to the navel and after going around it, limited dissection is done in the upper abdomen so as to preserve most blood and lymphatic vessels and nerves. If needed the abdominal muscles are tightened at the midline. The excess skin can easily be removed, the belly button which has been buried inside is brought out through a circular incision at the correct location and the abdomen can be closed. This provides a firmer abdominal wall and narrows the waistline.
Using the tumescent liposuction technique with limited dissection allows for liposuction to be conducted safely at the same time of the tummy tuck operation, creating good contour, better waste line while minimizing the risks of seromas, bleeding and infections.
When the belly button sits to high in the abdomen or when there is minimal skin sagginess above it we recommend a small operation called a mini-tuck. The incision is kept lower than in the full tummy tuck albeit it is as long. There is no scar around the belly button. The patient may go home in the same day.
With full tummy tucks the patient stays in the hospital for one to two nights. Pain is also not a big problem due to liberal use of local anesthetics in the tissue planes during liposuction and the intravenous painkiller after surgery.
Regardless of which procedure you have, your incisions are closed with small sutures. Small drains may also be inserted to eliminate fluid buildup. Snug elastic bandages are then applied to the area. All tummy tucks in our centers are done under spinal anesthesia with mild sedation.
What are the possible complications?
When done by a qualified surgeon who is operating in a good surgical hospital the results are generally quite positive. Nevertheless, there are always some risks associated with surgery and specific complications associated with this operation.
Post-operative complications such as infection and blood clots are rare, but can occur. Infection can be treated with drainage and antibiotics, but will prolong your hospital stay. You can minimize the risk of blood clots by moving around as soon after the surgery as possible.
What about after your surgery?
Bed rest is recommended for the first day. For the first few days, your abdomen will probably be swollen and you are likely to feel some pain and discomfort which can be controlled by medication. Depending on the extent of the surgery, you may be released within a few hours or you may have to remain hospitalized for two to three days.
A special abdominal support garment is often necessary for several weeks. Exercise will help you heal better. Even people who have never exercised before should begin an exercise program to reduce swelling, lower the chance of blood clots, and tone muscles. Vigorous exercise, however, should be avoided until you can do it comfortably.
Most patients experience some numbness in the area of their abdomen, which may last as long as a year. Your scars may actually appear to worsen during the first three to six months as they heal, but this is normal. Expect it to take nine months to a year before your scars flatten out and lighten in color. While they’ll never disappear completely, abdominal scars will not show under most clothing, even under bathing suits.
What about your new tummy?
A tummy tuck, whether partial or complete, produces excellent results for patients with weakened abdominal muscles or excess skin. And in most cases, the results are long lasting, if you follow a balanced diet and exercise regularly.
Patients who intend to lose a lot of weight should postpone the surgery. Also, women who plan future pregnancies should wait, as vertical muscles in the abdomen that are tightened during surgery can separate again during pregnancy. If the patient has scarring from previous abdominal surgery, the doctor may recommend against abdominoplasty or may caution that scars could be unusually prominent.
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