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Although exercise can help to restore the integrity and strength of the tummy wall muscles, no amount of exercise after weight loss or pregnancy will deal with redundancy in the skin.
During examination of patients who are unhappy with their tummy, I look at the excess skin and examine the integrity of the muscles. This is where we would determine whether a mini-abdominoplasty, liposuction of the lower abdomen alone, or a full tummy tuck is needed. Sometimes, where there is not much excess skin, we need to consider a modification of the “standard” technique, in which a short vertical scar is left below the belly button at the end of the operation in addition to the typical transverse scarring from an abdominoplasty. Patients who have additional excess skin in the upper abdomen (as can be seen after significant weight loss) may need a Fleur de Lys abdominoplasty, where the vertical scar extends from the pubis to the ribs.
It is important that your expectations concerning the outcome of the procedure are realistic. If they are, you can expect to be happier with the result. Patients still planning pregnancies should wait until completion of their family. I don’t offer this to patients who would be smoking around the time of surgery – it is critical to be able to stop for six weeks before and after surgery.
Surgery is carried out under general anaesthesia with an overnight stay. The operation begins with an incision around the tummy button, which is retained. An ellipse of tissue is removed from the bottom of the tummy, and this includes any lower abdominal scars. The skin between the belly button and the ribcage is then lifted to access the muscles and create more mobility in the skin layer.
With the muscle exposed, it is possible to carry out a repair of any diastasis, which contributes significantly to the quality of the final outcome – it improves in particular the profile of the abdomen, and to a degree the waistline. Any liposuction contouring is carried out after the muscle repair, and before the wound closure.
The wound is closed by advancing the skin downwards over the old tummy button, which is brought out to the surface so that it is visible once more. At the end of the operation, all wounds will have been closed using dissolving stitches and light dressings are applied. A binder/surgical corset is applied to the wound to provide support, which is easily opened by nursing/medical staff to allow regular inspection of the abdomen in the post-operative period.
I don’t use surgical wound drains, which means you don’t have to go through the painful process of having these removed, and has the very important benefit of allowing early confident mobilisation and quicker discharge from hospital. I quilt all abdominoplasty wounds at closure which means I suture the skin layer back to the muscle layer to close the space that was created during surgery.
You will be expected to be mobile by the time they leave hospital. This means that you should be getting dressed and pottering around and getting involved in light activities. It does not mean that you should be going home and doing normal household work! The presence of the lower abdominal wound means that driving is typically unsafe for a couple of weeks, and you should commence with short easy drives before attempting a long journey.
Once the dressings are removed in the outpatient clinic at one week, most patients will not require additional dressings, and advice is given on wound management. I recommend for either E45 your own preferred body moisturiser. It is probably worthwhile continuing with supportive binder or garment for 4-6 weeks – patients make their own choices.
Abdominoplasty is one of the commonest procedures I perform, and I find that, for most patients, it is a rewarding procedure that leads to improvements in the shape of the tummy, and in self-confidence.
Abdominoplasty surgery leaves extensive scarring that is permanent and of uncertain quality. Scars typically heal to leave faint, narrow lines, which are cosmetically very acceptable. A small percentage of patients will have problems with over-healing scars, which may require additional treatment.
Haematoma (blood collection in the wound) occurs in a small number of cases and typically occurs within the first 24 hours. The treatment is to evacuate the blood collection and stop any bleeding under general anaesthetic. This does not normally have any long term consequences.
Infections do not normally develop until several days after surgery or even into the second post-op week. Typical signs include redness, swelling, pain, fever, feeling unwell, and discharge of pus from the wound. Superficial infections may be treated with antibiotics alone, but neglected infections or those which are severe, sometimes additional surgery is required and the outcome may be adversely affected.
General complications may occur, including deep vein thrombosis and pulmonary embolism, (blood clots in the veins and the legs which may dislodge to the heart/lungs and may be life threatening). This risk is higher on women taking oral contraceptive pills or HRT, but this risk can be normalised by discontinuing the pill for six weeks prior to surgery or changing to dermal patches. Some patients choose to continue taking the oral contraceptive or HRT – blood thinning injections are given to mitigate the risk.
Seroma formation used to be relatively common, but since the introduction of quilting techniques, I have found that the incidence of seroma formation is now a relatively rare occurrence. Seroma formation for most patients is a nuisance, which is managed by drawing fluid off with a needle and syringe in clinic.
The shape of the new umbilicus (tummy button) may be different from the old one, but usually is very good. If stretch marks are present in the upper abdominal area, these will remain after surgery because it is not possible to remove the entire abdominal skin. Stretch marks or scars in the area above the tummy button will move downwards.
The skin of the lower tummy is typically quite numb after abdominoplasty surgery. Most patients recover the ability to feel pain and temperature, but sensation never returns to normal.
Occasionally, patients undergoing abdominoplasty will have some kind of adjustment or revision in the future. Typically, this will involve a minor procedure under local anaesthesia and most commonly is to smooth out the ends of the main scar across the low tummy. Surgery is carried out with the patient lying flat on the operating table, and no matter how perfect things look in that position, appearances sometimes change when standing.
For more information about the procedure, as well as information regarding benefits & risks, how the procedure is performed and recovery, download the Patient Information form.
For more information about the procedure, as well as information regarding benefits & risks, how the procedure is performed and recovery, download the Patient Information form.
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