Tummy Tuck (Abdominoplasty)
An abdominoplasty (or tummy tuck) is an operation to remove loose skin and fat on your abdomen and tighten up the muscles. This excess tissue is often a result of pregnancy or weight loss. The aim of the operation is to produce a tighter, flatter tummy, but is not designed as a way of losing weight.
I perform four types of abdominoplasty – lipo abdominoplasty, corset abdominoplasty, reverse abdominoplasty and mini-abdominoplasty. All of these can be combined with liposuction as necessary.
What does the surgery involve?
A traditional full abdominoplasty elevates large areas of skin from your lower abdomen to your ribs and pulls this skin tight to remove the excess. Not only does this leave a large potential space to collect fluid/blood, but it can compromise the blood supply to the skin. Large drains have to be used to ensure that fluid does not collect and these need to be removed on the ward when the drainage has slowed down.
I use a lipo-abdominoplasty technique that uses liposuction to remove fat deposits and establish a plane. As the liposuction cannula passes into the tissue, it preserves the perforating blood vessels so that the skin is not completely undermined. By keeping these attachments, the abdominals or ‘six pack shape’ and definition of the waist is maintained. There is no large empty space so that drains are not required. Lipo-abdominoplasty involves an incision from hip to hip, near the pubic hairline. If you already have a scar (such as a caesarean section scar) then I will remove this, thereby avoiding new scars. A separate incision is then made around the navel (belly button). If your muscles have stretched apart, they will be pulled together and stitched in the correct place, to tighten your abdomen. Once the underlying tissues have been tightened, the skin is pulled down thus allowing the excess skin to be removed. A small hole is made so that your navel can be stitched in its new position.
The mini-abdominoplasty is similar to a lipo-abdominoplasty, but it requires a much smaller incision and leaves the navel intact. It is suitable for those who only have excess skin and fat below the navel.
A Fleur de Lys abdominoplasty is used for patients who have laxity in all directions and have lost a considerable amount of weight. Skin is excised through a horizontal incision from hip to hip just above the pubic hairline. A longitudinal incision is added vertically down the midline of the abdomen and a new opening is made for the umbilicus. The scarring is more extensive than with a standard abdominoplasty technique but it allows excellent tightening of the skin. If you require any procedures to enhance or tighten the breasts, then this can be done through an additional incision underneath the breasts which also allows the upper abdomen to be tightened further and this is called a corset abdominoplasty.
A reverse abdominoplasty allows for tightening of laxity in the upper abdomen via an incision underneath the breasts. It is used in patients who have laxity confined to the upper abdomen, or for massive weight loss patients who have already had a lower abdominoplasty.
Abdominoplasty procedures are usually carried out under general anaesthetic (you will be fully unconscious) and take between two to three hours to perform. You are likely to stay in the hospital for one to two nights.
The incisions are closed with absorbable sutures that do not need to be removed. They are covered with a waterproof glue and tape dressing. You can wash as soon as you like and you do not need to have any dressings removed. I recommend that you wear a compression garment for 4 weeks following your surgery.
What are the risks and side effects of surgery?
Having cosmetic surgery should be a very positive experience. Complications are infrequent and usually minor. However, no surgery is without risk and it is important that you are aware of these potential problems.
Scar – scars tend to settle remarkably well, however some people heal with thick scars and this can make them more noticeable.
Bruising and swelling – bruising and swelling is very common and may take several weeks to settle.
Haematoma – this can happen if a bleed occurs under the skin, allowing a large blood clot to form. If this does occur, it is likely to happen within four to six hours of surgery. Any increase in swelling or pain should be reported immediately so that treatment can be given. Sometimes patients need to have this blood removed with another short operation.
Infection – this is rare but you may require antibiotics if there are any concerns.
Seroma – this is a collection of clear fluid under the skin, which sits in a pocket. This spontaneously reabsorbs over the course of a couple of weeks, although it can be drained with a needle if it feels tight. Vary rarely a surgical procedure may be required if it does not reabsorb.
Wound healing problems – these healing difficulties can range from minor problems, such as small areas of wound separation, to major issues, such as skin loss. Although very rare, this situation may require a skin graft to close the wound, meaning more surgery. People who have diabetes, smoke, are obese or elderly are at an increased risk of delayed healing.
Dog-ears – these are prominences of soft tissue found where the scar stops. In most cases these settle over the course of 3 months. However a small local anaesthetic procedure may be required to remove any excess that remains.
Numbness, reduced sensation or oversensitivity – this can occur around the abdomen and possibly upper thigh. This is usually temporary, but occasionally these changes can remain to some degree.
DVT/PE – following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and move to your lungs. If the blood clot is large enough it could prove fatal. In order to reduce any risks of this we give you special stockings to wear in bed and a blood thinning injection if you are not mobile.
All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to ask. Decisions about cosmetic surgery should never be rushed.
What happens after the operation?
When you wake up from the anaesthetic, you will have pillows under your knees to take the tension off your abdomen. This will relax over the course of a week and it will feel less tight. You will have dissolvable sutures with a glue dressing.
A firm, supportive compression corset will be in place around your tummy. This should stay in place for the first four weeks, but can be removed for washing. It should help to reduce any swelling and generally make you feel more comfortable.
Your abdomen will feel tight and fairly sore for the first few days. You will be given pain relieving medicines to make you feel more comfortable. You should expect to be in hospital 1-2 nights.
Before you leave the hospital, you will be given a follow up appointment to see the nurses at a week to check your wounds. I would normally see you at 4 weeks or sooner should you have any problems.
What is the estimated time for recovery, absence from work and return to usual activities?
How much does the surgery cost?
Abdominoplasty Compression Garments (PDF)
Pre and Post-Operation Instructions (PDF)
I hope you find this information useful. If you have any questions or require a little more information then please do not hesitate to contact me.