Abdominoplasty

You may be suitable for an abdominoplasty if you are close to your ideal weight but you still have excessive abdominal skin or bulging which you can’t get rid of. This commonly results from having had multiple pregnancies or as a result of significant, often rapid weight loss. A decision to undergo an abdominoplasty procedure will ultimately have to made after careful consultation with your plastic surgeon.

Yes and no. If the stretch marks are in the lower abdomen (below the belly button), then a tummy tuck will get rid of them. However any stretch marks above the belly button will be pulled down onto the lower abdomen and may be stretched further. They can, however, end up looking smoother and flatter

Broadly speaking there are three types of tummy tuck procedure:

Standard

Mini

Extended

They all involve removing variable amounts of skin and fat (resulting in variable length scars) and all of them may or may not involve tightening of the abdominal muscles.

A standard or full abdominoplasty involves removing the excess skin and fat of the abdominal wall between the pubic area (bikini line in women) and the belly button. The belly button is left in its place but a cut is made around it to free the surrounding skin. The remaining skin of the abdominal wall at the level of the belly button is then pulled down and stitched at the pubic level. The belly button is brought out through a new cut made in the skin that has been pulled down over it. The patient is left with a long, usually curved scar across the lower part of the tummy at the level of the pubic hair. There is also a scar around the belly button. Any weakness of the abdominal muscles or hernias are repaired before the skin is closed.

A mini abdominoplasty is performed when there is a small amount of loose skin and/or fat affecting the lower part of the tummy. Some of the loose skin and fat from below the belly button is removed, leaving a long curved scar on your tummy just above the pubic area. The belly button remains undisturbed but may be pulled down slightly. The scar from a mini abdominoplasty is usually shorter (but not always) than that of a standard abdominoplasty.

An apronectomy is a modification of the mini abdominoplasty for patients who have a large overhang of skin and fat over the lower tummy area. In this procedure only the surplus skin and fat is removed. The scar is long and extends from one side of the apron to the other.

Extended abdominoplasty is usually required after massive weight loss. It involves removal of excess skin and fat from the abdomen and lower back. It will leave a scar around the umbilicus and a long curved scar on the abdomen above the pubic area, and around towards the flank/ lower back. Sometimes the scar extends the whole way around the body – circumferential abdominoplasty and this is a very major and involved procedure.

Liposuction is commonly combined with any of the different abdominoplasty procedures. Some surgeons prefer to perform liposuction at a later date.

Sometimes liposuction alone can achieve a good result on the tummy. A very important factor is the quality of the patient’s skin. Dramatic improvements can be achieved when the skin is of good quality and has not been overly stretched in the past. Skin quality often determines whether liposuction alone will suffice or whether a combined surgical procedure will be needed.

Getting pregnant after a tummy tuck will not harm you or your baby, however it will undo (to some extent) the effects of your tummy tuck. If you are planning on getting pregnant it is best to wait until you have completed your family before undergoing a tummy tuck.

As with all surgical procedures, there are risks associated with abdominoplasty surgery. Some patients are at higher risk of complications than others (for example smokers and patients who are over weight). You surgeon will be able to point out particular risks that you may be more susceptible to depending on your personal history and circumstances.

All patients will experience:

A variable degree of pain and bruising for at least a few days. Pain is usually worse if there has been a requirement to tighten your abdominal muscles (rectus plication)

A variable degree of swelling – this can take several months to completely subside.

Permanent scarring – the quality of scarring cannot be guaranteed and usually depends on the way your body heals. Some patients can form thick, red, itchy scars but most scars usually fade over time (but won’t completely disappear).

A variable degree of numbness of the skin over your abdomen – the skin below your new belly button may be numb for several months (if you have had a standard or extended abdominoplasty), but this numbness will gradually disappear as the nerves regrow.

Complications can occur during or after the operation.

Possible general complications include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT). A DVT can be a serious condition and if the clot spreads to the lungs (pulmonary embolus) then the outcome can be fatal. Fortunately the incidence of pulmonary embolism after abdominoplasty is very rare (2 out of every 10,000 patients).

Complications specific to tummy tuck include:

Infection

This might require treatment with antibiotics.

Bleeding (haematoma)

This might require a return to theatre to stop the bleeding and drain the area.

Delayed wound healing

Particularly in the tighter central part of the wound. Sometimes dressings are needed for a few weeks. This is more common in patients who are overweight and who smoke.

Seroma

Is a persistent collection of serous fluid under your skin. The fluid can be drained with a needle during your post-operative visits. Such drainage generally stops eventually (but may last for more than a month) and usually does not affect the final results. The incidence of seroma has been reported as affecting between 2-8 out of every 100 patients.

Poor scarring

Scars can sometimes be red, thickened and itchy (hypertrophic scars). These can take several months to settle and fade

Numbness

This is usually temporary, but can be permanent

Asymmetry

Perfect symmetry does not exist before or after abdominoplasty surgery. Scars will never be identical from side to side and the umbilicus will not be exactly in the midline

Revisional surgery

Secondary procedures are occasionally required to revise scars or to excise more skin (particularly on the sides).

It usually takes about six weeks to make a full recovery from a tummy tuck, but this varies between individuals and the technique used. Over the counter pain killers such as paracetamol and ibuprofen are usually sufficient in the few days after your surgery. Patients can usually return to work about three to four weeks after their operation.

You will usually be able to do light activities at around 10 days after your surgery. Any vigorous activity should be avoided for at least six weeks. Your surgeon will give you specific instructions depending on the type of operation you have had.