Tummy Tuck - Abdominoplasty

Abdominoplasty or tummy tuck is used to remove excess skin and fat from the stomach area, improve abdominal contours and scars, and tighten the muscles.

Who is a candidate for a tummy tuck?

Anyone who has excess abdominal skin and fat may be a candidate. With women the problem is usually caused by pregnancy, but is also greatly aggravated by weight loss. The muscles of the abdominal way may be weakened by pregnancy and actually pulled apart in the middle.

Men are similarly affected by weight loss. Often this results in stretch marks which are left after extreme stretching of the skin. They are usually most apparent on the lower part of the abdominal wall. There is no specific treatment for the stretch marks, but many of them are excised in an abdominoplasty and those that are left are tightened making them look less obvious.

Patients that are unable to tighten the abdominal wall skin with exercise or wish to achieve a smoother flatter abdomen will also benefit. In short the benefits of a tummy tuck are:

The Standard Abdominoplasty

The excess skin and fat of the abdominal wall between the pubic area and the umbilicus (navel) is removed leaving the umbilicus in place. The skin of the abdominal wall at the level of the umbilicus is then drawn down to suture it at the pubic level.

With a tummy tuck a patient is left with a long, usually curved scar across the lower part of the abdominal wall at the level of the pubic hair. There is also a scar around the umbilicus. Any looseness of the muscles of the abdominal wall or hernia is repaired at the same time - See Fig. 1

Liposuction may be carried out during a tummy tuck to thin the abdominal wall, or as a separate procedure either before or after the abdominoplasty.

The Mini Tummy Tuck

In the mini-abdominoplasty surplus skin below the umbilicus is removed leaving a low abdominal scar at the level of the pubic hair. The umbilicus is not disturbed but liposuction is usually carried out at the same time as the procedure to reduce the thickness of fat in the abdominal wall. Any laxity or hernia of the abdominal wall is repaired at the same time - See Fig. 2

The apronectomy is a modification of the mini-abdominoplasty for patients who have a large excess of skin and fat hanging down over the pubic area. In this procedure only the surplus skin and fat is removed. The scar is long and transverse extending from one side of the apron to the other.

The Extended Tummy Tuck

In the extended abdominoplasty surplus skin and fat of the loins and back are removed so that the scar extends around the flanks onto the lower back- see Fig.3.

The endoscopic abdominoplasty is used to tighten the muscles of the abdominal wall to give a better contour and is carried out through a short transverse incision above the pubic hair. Skin is not removed but liposuction can be carried out at the same time.

Modifications to the abdominoplasty skin excision are made when the patient has particular problems associated with scars from previous operations.

An alternative procedure which should always be considered instead of abdominoplasty is liposuction on its own. This reduces fat and causes just a little retraction to the skin.

What to expect with Tummy Tuck Surgery

You will need to be in hospital for one to three days. When you wake up from an abdominoplasty operation it is likely that you will be having a transfusion of salt solution. This is quite normal and is provide you with fluid you need whilst you are not drinking.

You are likely to have drainage tubes coming out of each side of the lower abdomen, which are there to drain any collection of blood or serum. You can expect some moderately severe pain for which you will be given pain killing tablets or injections. You will be asked to keep your knees and hips bent to take the strain off your stitches.

Recuperating from a Tummy Tuck

Over activity in the early days reduces healing and increases fluid accumulation. Light activities can comfortably be performed in 10 to 20 days. Sports will not be possible for about 6 weeks post abdominoplasty, particularly when the muscles have been strengthened with sutures. A corset is usually helpful to reduce the swelling and improve comfort in the first month.

The Results of an Abdominoplasty

The patient is left with noticeable scars after a tummy tuck. The main scar runs transversely across the lower part of the abdomen (see illustrations) and in a standard abdominoplasty there will be a scar around the umbilicus. Other or different scars may be left where the patient has particular individual problems. Some patient's scars heal better than others but in any case all scars are red initially. It is essential that the patient understands where these scars will be and should discuss them with the surgeon. Although we try and hide them beneath underwear, certain low slung fashions may make scars visible.

There is numbness in the lower part of the abdominal wall after surgery this is usually temporary but could be permanent. Swelling above the scars is usually present due to collection of tissue fluid, which normally drains to the groin. This swelling or edema settles within a few months of the tummmy tuck operation.

What are the limitations?
The tissue of the abdominal wall is generally fatter than the groin and if liposuction is not carried out with the tummy tuck, a fatty bulge may remain above the scar.

The beneficial effects of a tummy tuck will last well; however, the effects will be maintained better if the patient keeps exercising the muscles and their weight steady. A further pregnancy will of course stretch the skin again, although probably not to the same degree.