Abdominoplasty, or more commonly known as a tummy tuck, is surgery performed to remove sagging skin and excess fat from the middle and lower abdomen. The unwanted protrusion of the abdomen is usually a result of pregnancy, increase in weight or weight loss.
There are three layers to the abdominal wall that need to be corrected in an abdominoplasty; the skin, the fatty tissue and the underlying muscle. All of these layers at some stage are stretched, weakened or increased in size resulting in an undesirable appearance. In many cases, the muscles and skin stretch so much that they do not return to normal regardless of the amount of diet and exercise. An abdominoplasty can make an enormous change to a persons body contour.
Tummy tucks are typically performed for changes to the belly that have occurred through pregnancy and/or weight loss. The usual problems are stretch marks (scars caused by skin that has been forced to stretch too much too quickly), excess skin, excess fatty tissue and weakened separated muscles. Other problems can include hernias involving the belly button and significant abdominal wall muscle separation that can affect posture and result in lower back pain. Finally, problems with the pubic area frequently exist with excess fullness and hanging. This typically causes difficulties with tight fitting clothing, social embarrassment and hygiene problems.
All these problems can be improved/corrected with a well planned tummy tuck. The excess skin can be removed including most, if not all, the stretch marks. Doing this means removing all the stretch mark scars that you can’t hide, and creating a single scar below your pants line that can be comfortably hidden. If required, the pubic area is thinned out and lifted.
Also, any muscle separation and herniation is also corrected, ultimately creating a much tighter waistline, appropriate for your body size. The final objective is to create a narrower waistline with a smooth tight line from pubic area to chest.
YOUR CONSULTATION WITH DR DONA
Your first visit to Dr Eddy Dona will allow you to discuss any issues you have in relation to your abdominoplasty procedure. Dr Dona will perform a physical examination to assess and advise you on your options taking into consideration your desires and expectations.
Dr Eddy Dona may advise you to delay the surgery if you are in the process of losing weight, intend on losing a large amount of weight or intend to fall pregnant.
THE POST-PREGNANCY BELLY
One of the major concerns with women post-pregnancy is that despite the discipline of healthy eating and exercise, often the abdominal wall looks worse despite weight loss. This is because skin with stretch marks has lost its ability to contract down, so therefore as volume is lost (fat loss) the skin wrinkles more and becomes “deflated” and unsightly. So at a time when the person should be happier due to being slimmer and fitter, they look at their abdominal wall and get upset due the excess skin and wrinkling. Only a tummy tuck can correct this problem.
WILL PRIVATE HEALTH INSURANCE COVER COSTS?
You may be entitled to a rebate from Medicare and your private health fund for an abdominoplasty.
Dr Eddy Dona will advise whether this applies to you and the expected rebates after your consultation.
PREPARATION FOR SURGERY
Your complete medical history should be provided to Dr Eddy Dona, fully disclosing all health problems. All relevant details should be disclosed when you fill out your “Patient Registration Form” and during your initial consultation.
Do not take any blood thinning medications such as; aspirin or any medicine containing aspirin, large amounts of vitamins or anti inflammatory drugs for at least 2 week prior to surgery.
You should cease smoking for at least 2 weeks prior to surgery, as it increases surgical and anaesthetic risks and can lead to serious complications.
PROCEDURE IN DETAIL
A traditional tummy tuck operation involves correction to all three abdominal wall layers – the skin, fat and muscle layers.
A horizontal incision is made in your lower abdomen, usually from hip to hip just above the pubic region. Dr Dona will make the main incision under the “bikini line” so that the scar is concealed within regular pants.
Another incision is made around the navel, freeing the navel from the skin and fatty layer.
The skin and fat is lifted from the underlying abdominal muscles to the level of the rib cage. The abdominal muscles are then surgically tightened from top to bottom by stitching them together. This helps restore a normal appearing “six-pack” muscle and corrects any central hernias. Additionally, tightening these muscles acts like an internal corset, strengthening the abdomen and helping create a smaller, more shapely and desirable waistline.
The skin and fat layer is then stretched down with the excess skin and fat from the lower abdomen removed. This helps create a tight and smooth abdominal wall, removing excess skin and fat.
At the same time, the pubic area is lifted if it is required.
Finally a new opening is made for the navel and it is stitched into position.
WHAT ABOUT LIPOSUCTION?
Liposuction may be performed in conjunction with a tummy tuck. It can improve the abdominal wall and flanks to help provide the final form and contour.
WHAT’S A MINI-TUMMY TUCK?
If the excess skin and fat are located mainly under the navel then a mini tummy tuck may be more appropriate. This means a much smaller incision below the bikini line.
Additionally, the navel does not have to be repositioned.
WHAT HAPPENS DURING YOUR RECOVERY?
Your hospital stay may vary from 2 – 4 days.
Before you leave, some discomfort and pain is normal. The abdomen will be swollen and tender. Pain will subside as the healing progresses. Routine post-operative prophylactic antibiotics are provided and pain relief is generally required for the first few days.
Drain tubes are often inserted at the end of the operation, and these are usually removed 1 – 2 days after surgery.
Typically all stitches used are internal and dissolving. However, stitches around your belly button will be visible and need to be removed after one week.
You will be given verbal and written instructions about showering, wound dressings and caring for yourself. It is helpful to have someone stay with you for the first few days after you go home as you may have difficulty with normal mobility.
Although walking will be uncomfortable it is important to stay active to reduce the risk of clots in the legs.
During the beginning of your recovery, you should get lots of rest, drink plenty of fluids and have frequent, small, healthy meals. All surgery results in some swelling and bruising but should start to settle after a couple of weeks.
For the first 2 weeks it is recommended that you sleep on your back with your legs raised on pillows to take some of the tension off the tight abdominal skin.
Smoking should be avoided for at least 2 weeks after surgery as it impairs wound healing.
Like any scar, the incision will be slightly red for a few months until it matures to what should be a faded fine white line.
You will be advised by Dr Eddy Dona when you can return to normal activities and work. However, most patients should plan on having about 2 weeks off work. You should avoid any heavy lifting or straining for 6 weeks.
You will be provided with a post-operative compression garment which you will need to wear for approximately 6 weeks.
WHEN CAN YOU EXPECT YOUR FINAL RESULTS?
Ultimately, a tummy tuck aims to achieve what weight loss and dieting alone can never achieve – a tight firm abdomen with a much more pleasing body contour. However, time needed for complete recovery varies from person to person, but typically takes over 6 months to be achieved.
Expect to experience varying amounts of swelling and bloating for possibly several months.
It is important that you have realistic expectations about the surgery and what surgery may be able to achieve.
Your genetics, wound healing and scarring are beyond the control of the surgeon.
WHAT ARE THE POSSIBLE COMPLICATIONS?
As with any surgery, there are always possible risks and potential complications. These include wound infection, bleeding, chest infection, haematoma, poor scarring, blood clots, bruising and swelling.
Other potential complications include:
Asymmetry – Differences between the right and left sides of the abdomen.
Navel –May have a slightly unusual shape because the skin around it has been removed and tightened with stitches.
Fatigue – Some patients report tiredness and discomfort persisting for months.
Scar – ideally the scar should fade to a fine white line by 12 months. However, some people can develop thicker and darker than usual scarring. Occasionally, scar revision surgery may be required.
Swelling – Of the lower abdomen may take several months to resolve.
Seromas – Occasionally fluid can accumulate deep in the abdominal skin which may require needle drainage.
Numbness – Around the scars and in the lower abdominal area is to be expected and never returns to normal. Numbness and minor discomfort can also extend down the front of the thigh – this issue typically subsides over a few months but not always.
Circulation –May be poor in some areas of the skin around the surgical area. This may lead to a loss of skin and a wound that needs to be dressed until healed or possibly require further surgery.
Residual skin excess – often due to the individual having excess skin extending to and beyond the flanks. Excess skin and fatty tissue that persists along the outer aspects of the wound/flank is often referred to as a “dog-ear”.
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