Abdominoplasty (Tummy Tuck)

Abdominoplasty, known more commonly as a "tummy tuck", is a major surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The procedure can dramatically reduce the appearance of a protruding abdomen. But bear in mind, it does produce a permanent scar, which, depending on the extent of the original problem and the surgery required to correct it, can extend from hip to hip.

The best candidates for abdominoplasty are men or women who are in relatively good shape but are bothered by a large fat deposit or loose abdominal skin that won't respond to diet or exercise. The tummy tuck surgery is particularly helpful to women who, through multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where they can return to normal. Loss of skin elasticity in older patients, which frequently occurs with slight obesity, can also be improved.

Patients who intend to lose a lot of weight should postpone the abdominoplasty. 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 you have scarring from previous abdominal surgery, particularly gallbladder removal using a long incision, Dr. Bolitho may recommend against tummy tuck surgery or may caution you that other options may be more appropriate.

Tummy tuck surgery can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Bolitho.

Full vs. Mini Abdominoplasty vs. Liposuction

In your initial consultation, Dr. Bolitho will evaluate your health, determine the extent of fat deposits in your abdominal region, and carefully assess your skin tone. A full medical history is important at this time, particularly focusing on prior surgery, whether or not you smoke, and if you are taking any medications or other drugs.

Improvement of the esthetic appearance of your abdomen is generally achieved by one of three techniques: full abdominoplasty (tummy tuck), mini-abdominoplasty or liposuction alone.  Liposuction is usually used in conjunction with  a full or mini-abdominoplasty.

If your fat deposits are limited to the area below the navel, you may require a less complex procedure called a mini abdominoplasty, also known as a mini-tummy tuck, which can often be performed on an outpatient basis. If the skin and underlying tissue above the navel require improvement, then a full abdominoplasty will better serve your needs. If you are young and have excellent skin tone, and minimal or no stretch marks, liposuction alone may give the best result. Occasionally the appearance of the thighs can be dramatically improved by the extension of the usual full abdominoplasty incision.

In some patients, especially those who have lost large amounts of weight, a circumferential lower body lift can produce the most dramatic results.

In any case, Dr. Bolitho will work with you to recommend the abdominoplasty or liposuction procedure that is right for you and will come closest to producing the desired body contour.

Abdominoplasty Surgery

For a full abdominoplasty, Dr. Bolitho will make a long incision from hipbone to hipbone, just above the pubic area. A second incision is made to free the navel from surrounding tissue. With mini-abdominoplasty, the incision is much shorter and the navel may not be moved. Next, he separates the skin from the abdominal wall all the way up to your ribs and lifts a large skin flap to reveal the vertical muscles in your abdomen. These muscles are tightened by pulling them close together and stitching them into their new position. This provides a firmer abdominal wall and narrows the waistline.

The skin flap is then stretched down and the extra skin is removed. A new hole is cut for your navel, which is then stitched in place. Finally, the incisions will be stitched, dressings will be applied, and a temporary tube may be inserted to drain excess fluid from the surgical site.

In mini-abdominoplasty, the skin is separated only between the incision line and the navel. This skin flap is stretched down, the excess is removed, and the flap is stitched back into place.

The time to perform full abdominoplasty is about three hours. Mini-abdominoplasty will usually take approximately two hours. Time to perform liposuction varies according to the area and anticipated volume.

In most cases, health insurance policies do not cover the cost of abdominoplasty.

Potential Risks and Side-Effects

Thousands of abdominoplasties are performed successfully each year. When done by a qualified plastic surgeon who is trained in body contouring, the results are generally excellent. Nevertheless, there are always risks associated with surgery and specific complications associated with this procedure.

Postoperative 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.

Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers should be advised to stop, as smoking may increase the risk of complications and delay healing.

You can reduce your risk of complications by closely following Dr. Bolitho's instructions before and after the tummy tuck surgery, especially with regard to when and how you should resume physical activity.

Abdominoplasty Recovery

For the first few days, your abdomen will probably be swollen and you're likely to feel some pain and discomfort which can be controlled by medication. Expect to find two drainage tubes, which will drain excess fluid for the first few days after surgery. The dressings will be changed frequently in the first week. You will give you instructions for showering and changing your dressings. And though you may not be able to stand straight at first, you should start walking as soon as possible. All sutures will be beneath the skin and will dissolve on their own. If you are having liposuction a support garment will be provided, to be worn for four weeks after the surgery.

An abdominoplasty is not a minor procedure. If you start out in top physical condition with strong abdominal muscles, recovery from abdominoplasty will be much faster. Some people return to work after two weeks, while others take three or four weeks to rest and recuperate.

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.

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.

Dr. Bolitho prefers to admit his patients to hospital the evening after full abdominoplasty. Mini-abdominoplasty and liposuction alone are done on an outpatient basis. Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two after you leave the hospital.

Abdominoplasty, 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.