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.
Understanding what a tummy tuck is, including some of the different types, and what happens during your first consultation with Dr Dona.
If you’ve booked a consultation to visit me and discuss Tummy Tuck surgery, then there’s a few things to know about what happens on that day.
Firstly, upon arriving at our clinic you will be met by our friendly staff and they will walk you through the initial patient registration process. Once this is done, you will be ready to be taken through for your initial consultation with myself.
During this consultation, I will ask you a number of questions, including about your relevant medical background, history of surgery, especially abdominal surgery, and your general tummy concerns.
I will then carry out a physical assessment where I assess your belly and all concerns you have with it, including skin, fat and muscle issues.
Once you are assessed, and if you are considered suitable for surgery, then a surgical plan is created to provide you with the desired outcome. Of course, an important part of this is ensuring you have a realistic expectation about the results achievable.
I will then discuss the details of the surgery, your expected recovery period and inform you about the potential risks and complications that allow you to make an informed decision.
At this time, you can ask any questions you might still have if I haven’t already answered them for you.
Photos are then taken for our medical records.
Finally, you will then discuss with one of our staff costs and any logistics about possible surgery dates.
Tummy tuck – easy to understand explanation
Abdominoplasty, commonly referred to as a tummy tuck, is one of the most common plastic surgical procedures.
The tummy tuck procedure is designed to correct abdominal wall problems typically experienced after massive weight changes.
One of the most common reasons why someone would want an abdominoplasty is often due to the changes that have occurred during pregnancy. Some of these changes include loose or excess skin, excess fatty tissue and to a lesser degree, weakened or separated abdominal wall muscles.
During pregnancy, the abdominal wall is forced to stretch quicker than the skin can naturally expand, often causing the skin to tear, and leading to the development of stretch marks. Stretch marks are basically scars, and like all scars they initially appear red and as they mature, fade to a lighter, paler colour.
Many women develop these stretch marks during the first pregnancy, as this is often when their body undergoes the most significant changes
With that said, many women will put on a small amount of weight and still get stretch marks, whilst others put on an enormous amount of weight and do not get stretch marks. Many factors contribute to this, one important factor is our genetic makeup which often determines the likelihood of who will and won’t get stretch marks.
After pregnancy and or massive weight loss, your body shrinks down. You’ve lost weight, you’re healthy, you’re fit, but you look in the mirror you don’t like what you see. The skin, especially skin with stretch marks, has lost its elasticity and is not going to contract to tighten up around your smaller body.
So now you find that your skin, which represents your former self, or rather the “clothing” that used to fit you, is way too big for your body!
This is the most simplistic way of viewing things. Your skin represents your older self or an older dress or outfit that you used to wear. Now your body is much smaller and healthier but you’re still wearing that old dress.
So basically you need a tailor, that being the surgeon, to tailor your skin to suit your new body.
With any tailoring you need to have seams, and the seams in surgery are the scars. The scar for a tummy tuck are typically hidden low down on your belly and concealed within normal underwear.
Some people are concerned about the appearance of a scar and say they don’t want a scar. However my response to this is simple. Stretch marks are scars, and you have multiple stretch marks and associated excess skin along your entire lower abdomen in an area that you can’t hide. We are going to remove all (or most of) those with one very controlled linear scar that will be comfortably hidden by regular underwear. What wold you rather?
Now with pregnancy, these changes are mostly confined to the front of you belly. However, for those who have undergone massive weight loss, then the skin excess often involves the entire body – front, sides and back – and often other areas such as chest, arms and thighs. So in this case the surgery is a little more involved in these situations and basically customised for each individual to address their specific concerns.
Fleur de Lis Tummy Tuck
Most tummy tucks result in a single scar along the lower abdomen, which is nicely concealed within normal underwear line, and an additional scar around, or within, your belly button. However, sometimes an additional scar is also required along the entire midline of your abdomen up to you lower chest. This type of tummy tuck is referred to as a fleur de lis.
The reasons for this is best explained by thinking about how you would tailor a pair of trousers.
So, consider the skin around your entire body like the material on a trouser pants.
If you have a pair of trousers that are too long, then simply shortening them by trimming down the bottom end is all you need to do. This is just like a standard tummy tuck where you are removing the excess along the lower abdomen and the scar sits low down on your belly which is equivalent to the seam on the bottom of your trousers.
However, if you have trousers that are too long and baggy and you only shorten them, then whilst they will fit you better length ways, they will still be baggy! So, to make the trousers fit you better you also need to run a seam along the length of it to remove the bagginess and tailor it nicely to fit your leg size.
This very same principal applies to a tummy that has a lot of excess skin hanging, and also has excess skin side to side. This is typically seen when someone has lost a massive amount of weight.
So, in this scenario to make your skin fit your body better and tighter, not only do you have to remove the excess hanging down, you also have to remove the excess skin along the midline to tighten the “bagginess” -which means a scar along the midline.
In doing so, you maximise the improvement in your body contour. Of course, the cost for that is accepting a scar vertically along the length of your belly. In the end, only you can say what you are prepared to accept.- great contour, more scars, or less scars, and less contour improvement.
Some of the commonest questions about tummy tucks including what it can do for you and the potential results.
Will you fix my muscle separation?
One of the common problems associated with pregnancy is separation of the abdominal six pack muscles, officially known as diastases recti.
Now this can vary from mild to extreme.
This causes a few issues.
- Firstly, it results in a greater abdominal girth than is necessary, which basically means your belly is bigger than it needs to be.
- In extreme cases it can act very much like a hernia, so when you strain a large ridge like fullness protrudes along your abdominal wall midline.
- And with significant separation, it can potentially result in a disturbed biomechanical performance of your entire lower back and midsection. So basically your core strength is not as great as it should be, you get increased arching of your lower back and the resultant back pain.
Ultimately, a routine part of most tummy tucks is tightening of these separated muscles to help re-align the muscles, tighten your waistline and improve your biomechanics.
Occasionally, in some women who have great skin quality and tone but significant muscle separation, you could have a minimal access surgery designed to just tighten your muscles. This is done via a small belly button incision and a lower abdominal incision similar to a caesarean scar.
Will it help my Back pain & Urinary Incontinence?
Some people that have seriously separated rectus muscles and effectively have a large midline hernia often experience lower back pain due to the significant biomechanical disturbance to the core and back. These patients often claim an improvement in back pain after this is corrected. So this can be considered an added bonus to having the surgery.
In addition to this, some women claim that urinary incontinence is improved after a tummy tuck with muscle tightening. However, I would never encourage a patient to undergo surgery if incontinence is the primary concern as it may well make no difference, and really there is only anecdotal evidence to support the fact that tummy tuck surgery improves incontinence.
Can you fix my hernia during the tummy tuck?
Abdominal wall hernias are relatively common, and many people wanting a tummy tuck that also have hernias ask if the hernia can be fixed at the same time.
Now the first thing to appreciate is that the muscle separation is very common especially after pregnancy and is in many ways a type of hernia. It is an area of weakness along the midline and in some people, it can protrude ridgelike down the midline when they strain.
Repairing this involves tightening up and re-aligning the muscles to close this weakness.
Now abdominal wall hernias are common along this midline, they are typically found at or near the bellybutton, and can be a problem and ideally should be repaired due to the potential complications they can cause. When performed by a general surgeon the repair of these can involve an incision within or near the belly button, and often the placement of a mesh to patch the hernia hole. This often means that the belly button has been completely detached from the underlying muscles. This has potential consequences as it can result in problems with the belly button if that patient was to later have a tummy tuck. In simple terms, if you’ve had a previous repair of an umbilical hernia, and you then go on to have a tummy tuck, depending on how that previous surgeon fixed your hernia, you could end up with serious wound healing problems with your belly button. This basically means after the tummy tuck the belly button could ulcerate and die off, becoming a wound that takes many weeks to heal. This is because without knowing exactly what the previous surgeon has done, it is very easy to potentially cut off all the blood supply to the belly button.
So usually if someone wants a tummy tuck and has a small hernia, I’ll happily go ahead and fix it at the same time, and this would not require the use of any mesh. Of course, once the muscle tightening has been done, you’ve effectively completely removed any hernia anyway.
Will I have a “six-pack” after surgery?
One common myth with tummy tuck surgeries is that you’re going to achieve a six pack after surgery.
This is typically not the case. The operation is designed to remove excess skin and the associated fatty tissue. It is a contouring procedure, tailoring the skin to better fit your underlying body.
A six pack requires two things:
- A well-formed and defined six pack muscles. If you don’t have those before surgery, then surgery is not going to create them.
- A very thin fatty layer, or minimal fatty tissue. The thickness of the fatty layer will be proportionate to the other areas in your body. In other words, if your body fat percentage is not down to a “shredded” state before surgery, then it won’t be like that after surgery.
Of course, some of the greatest results after a tummy tuck are achieved not by me, but by the patient, who uses that massive change achieved by surgery as the inspiration and motivation to continue their personal journey of self-improvement and further transform their body by changing their lifestyle – that is, a better diet and exercise.
How much weight will I lose with the surgery?
An important thing to understand is that for the majority of patient’s a tummy tuck should never be considered a weight loss procedure. A tummy tuck is usually performed to remove excess skin that diet and exercise will not remove. As such, the total weight removal with these procedures is often disappointingly low!
Of course, there exists a group of patients who have large fatty aprons. Obviously, these patients do lose quite a significant amount of weight from the surgery, but these patients represent a very small minority. Furthermore, they are generally not doing the surgery for weight loss, but to reshape the abdomen and create a flatter abdominal contour and remove the functional and lifestyle problems associated with an overhanging fatty apron.
Will I lose my big belly after a Tummy Tuck?
One thing to understand about abdominal fat is that fatty tissue exists deep to the skin, and this is the fat which you can pinch between your fingers.
Then of course there is the fatty tissue that lies deep to your muscle and surrounds your abdominal organs. This fatty tissue you cannot feel but can see. This is the person you see with a very full and prominent belly – most of that is the internal fat.
Now a tummy tuck only removes the skin and the fatty tissue in front of the muscle. The surgeon does not go deep to the muscle so the fatty tissue around the organs is never reduced surgically. Therefore, whilst the muscles are typically tightened to help tighten the waistline, the intra-abdominal fat will remain.
This fatty content can only be reduced through an overall reduction achieved through weight loss via diet and exercise. This is often why many people still notice that their abdomen remains “full” after surgery.
Yet a simple fatty pinch test will reveal that most of the problem lies deep to the muscles. That is, the fatty tissue deep to your muscles is the main contributing factor to a persistently fuller girth which is bigger than you might desire.
In fact, in certain individuals the upper abdomen can appear larger after surgery. The typical person who experiences this is someone that has a large lower abdomen with a fatty apron. With the removal of the apron the person undergoes a massive improvement and reduction to the lower abdomen. Now whilst the upper abdomen also becomes smaller, the degree of change is less than that of the lower belly, and therefore it becomes more noticeable.
Can I get pregnant after a tummy tuck?
Most people tend to undergo a tummy tuck after they’ve completed their family, in other words, not planning on having any more children.
A common question I get asked is “can you get pregnant after a tummy tuck?” The answer to this is YES you can. Surgery of course will not stop you getting pregnant and most importantly it will not prevent your tummy from growing during pregnancy. So, it’s not going to complicate future pregnancies.
The other question is, will pregnancy ruin the tummy tuck results?
The answer to this is “it depends”.
If you put on 20+ kgs during pregnancy, then you will have to expect some “damage” to the results.
So, if you are going to get pregnant, sensible healthy weight gain, see a nutritionist and personal trainer experienced with pregnant women. This way, you are giving yourself the best chance of a healthy safe pregnancy, and less likely to undo any of the results achieved with a tummy tuck.
What are the costs of a Tummy Tuck?
Not all tummy tucks are the same. Some tummy tuck procedures are straight forward, while others may be complex and can take much longer to perform. In other words, it can take me anywhere from 2 hours to 5 hrs to do a tummy tuck based on the complexity. Therefore, the pricing can vary significantly.
Other issues such as your private health insurance status and whether you fit the criteria to be able to claim a rebate also has a massive difference on the potential out-of-pocket costs. These factors relating to your tummy tuck procedure will be discussed with you at the time of your initial consultation.
Whilst many of the smaller tummy tucks procedures may be deemed a “cosmetic” procedure, many of the larger tummy tucks are far more of a functional procedure. This is because for these people the belly in the pre-surgery state is often a significant functional concern to that individual. Loose skin, sweat rash and ulceration within the belly button and abdominal folds, a fatty apron, a low hanging pubic area, hygiene issues, relationship issues, clothing issues etc.
These are all concerns that affect the day to day functioning of that individual, and the surgery is designed to first and foremost improve function, with the secondary benefit being an improved appearance.
What happens on the day surgery?
The day before surgery the hospital will call and advise you when you need to arrive at the hospital and the pre-surgical requirements such as when to begin fasting prior to your surgery. Upon arrival at the allocated hospital, you will be required to check in with the reception staff. You will then be seen by a hospital staff member who will direct you to the pre-surgical waiting area where you are officially “checked in” for your surgery. At this point you will be made comfortable while you wait to be taken into the operating room. We do our best to ensure that you are advised to come to the hospital as close to the scheduled surgery time, however sometimes you may have to wait a little longer than planned before we can start your surgery.
Prior to your surgery, you will be taken into the theatre anaesthetic bay. This is where I will see you, have a final chat about the surgery, remind you about what to expect when you wake up. I will also make my tentative surgical markings on you. In other words, I’ll draw on you and explain what I’m going to be doing.
The anaesthetist will also talk to you about the anaesthetic and the medications they’ll be giving you after surgery to keep you as comfortable as possible. Finally, you get taken into the actual operating room, go to sleep, and get transformed.
What follow up appointments do I need?
As a routine we see all our patients after surgery back at our clinic for follow-up appointments at 1 week, 3 weeks, 6 weeks, 3 months, etc from the day of your surgery. Of course, we see you any time in between if necessary. You don’t need to pay for any of your follow-up appointments for the first 12 months after surgery.
These appointments are important to ensure things are progressing the way they should, and you are hitting the right recovery and healing milestones.
Many of our patients commute from interstate to have their surgery. In this case we make provisions and arrangements to stay in touch with you especially at the key time points to make sure nothing is missed. And those patients are welcome to see us any time they are traveling to Sydney just by letting our office know in advance and we’ll fit you in.
Can a mini-tummy tuck fix my problems?
Many people often enquire about a mini-tummy tuck.
The first thing to realise is that only a small group of women would benefit from a mini tummy tuck.
The mini-tummy tuck is only suitable for those few women who have a little bit of loose skin in the lower abdominal area – just above the pubic level. It also means that your happy with and don’t need to change the skin around the belly button and upper abdominal region.
The mini-tummy tuck basically removes this excess and loose skin at the very lower abdomen, just above the pubic area.
The scar is often not much larger that a caesarean scar, the belly button is not “moved”, it’s typically a day surgery procedure and usually not associated with any muscle tightening.
In order to better prepare for your surgery and to help with getting back to normal, it’s important to appreciate what you’re going to experience, all the things that are normal, and how to deal with them.
What to expect for the first 24 hours:
Most of my patients having a full tummy tuck will spend at least two days in hospital. Most patients are medically fine to go home at this stage, although some may benefit from another day or two in hospital.
Now what happens after surgery?
- You will wake from surgery in a hospital bed with the head of the bed elevated and one or two pillows under your knees all designed to keep your hips in a flexed position. This is to ensure you have minimal tension on your surgical wounds.
- All your wounds are stitched up using several layers of internal dissolving sutures….although often some stitches around your belly button are visible and will need to be removed after one week.
- All your wounds are covered using waterproof dressings.
- You have a body suit or compressive garment on. Edited too early?
- One or two plastic tubes, or drains, are usually placed and come out from, or just below your wounds on you left and/or right sides.
- You also have a catheter in place, which is basically a tube going into your bladder, so you don’t have to worry about getting up and trying to go to the toilet.
- You have at least one drip in place to give you intravenous fluids and pain control medication and antibiotics.
- You will also have special massage devices on both legs designed to minimise the chance of any clots in your leg veins.
- You will also have a nasal prongs or oxygen mask designed to give you supplemental oxygen.
All these tubes and drains etc are all in place to keep you as comfortable as possible and so that we can monitor you.
Many women claim they find the experience and discomfort like that after a caesarean, with the first 24 hours being the least pleasant. You’re attached to all these tubes, largely confined to bed, sometimes feeling a little nauseous, and not the most comfortable in the world. This is when most patients question their sanity and wonder why they’ve done this to themselves and paid for it as well.
However, before you leave the hospital, all your drips, drains and catheters have been removed and you’re up walking around, albeit a little slowly and slightly hunched over.
Rest assured, this is normal, fortunately very short lived, and settles down. And before too long, once you start to appreciate the results, you’ll probably be wondering why you didn’t do it sooner!
Most patients having a full tummy tuck stay in hospital for a minimum of two days…….this is how long it takes before most people are medically ok to be discharged. When you do go home after surgery you will be provided with the appropriate pain medication to keep you as comfortable as possible.
The main reason people are in hospital is to keep them comfortable and manage pain.
The first 24 hours is generally the worst and this is when you’re lying in your hospital bed wondering why on earth you did this to yourself and start to question your sanity! This is normal, and fortunately goes away pretty quickly….and before too long you start to appreciate your results!
Now what does it compare too?
Well, it’s a significant tightness across the abdomen. Many women who’ve had a caesarean would say a caesarean is worse than a tummy tuck, others say it’s worse than a caesarean. Either way, it’s similar.
In the beginning when you get up you’ll feel tight and will need to walk a little hunched over and shuffle along.
All drains, catheters, drips etc will be removed prior to discharge from hospital.
As a very general guide, you will feel like you can’t straighten up for about two weeks. So don’t force yourself to straighten up it will happen when it wants to happen.
Also, with any chest or abdominal surgery, any straining will cause significant pain. So anything that causes you to strain your abdomen such as coughing, sneezing etc will be uncomfortable. Therefore avoid these as much as possible and firmly hold your belly when doing this.
Also, it is painful taking deep breaths so naturally you will be taking short shallow breaths. Because of this it’s important that every hour on the hour you take two or three nice slow deep breaths to expand your lungs and minimise the chance of any chest infections.
When you first get up to walk, which we encourage with assistance on the first post-operative day, then you will be hunched over and slowly shuffle along. Don’t try to straighten up because you are feeling tight for a very good reason, your skin has been tightened and usually so have your muscles. Of course, those who have not required any muscle tightening, are generally far more comfortable but will still feel tight.
As a very rough guide, it takes approximately two weeks before you feel like you can straighten up. Don’t force the issue, it will happen when it wants to happen.
Whilst in hospital, your bed is positioned with the head of the bed up and a pillow under your knees, designed to ensure your hips are flexed and therefore you have minimal tension on your wound.
So when you go home, you will need to maintain a sleeping position largely on your back with a pillow under your knees to help with the hip flexed position. Of course, you could also potentially sleep on your sides as long as your hips remain flexed. However, I wouldn’t consider this for the first two weeks.
Now I do advise everyone that it takes about two weeks before you feel like you can stand up straight. So it would be at least two weeks before it would be even possible to roll onto your tummy. Given this, I would recommend that you avoid deliberately sleeping on your stomach for at least the first 3 weeks. After this let your body guide you.
After surgery developing bowel troubles such as bloating and constipation is common.
This is because:
- you’ve just had abdominal surgery
- you’re less mobile,
- you’re taking narcotic painkillers which cause a slowing of the bowels with association constipation.
This can be a very unpleasant experience given that you can’t really strain with the muscle tightening surgery that you’ve had.
So we provide a number of medications whilst in hospital to minimise any bowel problems. And when you go home we encourage lots of fluid and fibre, and taking supplements such as Metamucil to help making going to the toilet more frequently and therefore less traumatic on your wounds/muscle repair.
The potential bloating, along with general surgical swelling, will make you appear a lot fuller in the beginning, but don’t worry, it’s all temporary and will settle.
Returning to driving
As a general rule it takes about two weeks before you can straighten up due to the significant abdominal tightness. Therefore, you shouldn’t even consider driving for the first two weeks.
After two weeks, common sense should be used. If you feel like you are safe to get behind a wheel based on how your body is feeling and how mobile you are, then by all means you can drive.
Returning to work
After tummy tuck surgery, how quickly you can get back to work obviously is going to depend on the type of work you do.
However, I do offer some general guides to follow:
Firstly, you shouldn’t consider driving for two weeks. You could possibly consider returning to an office based environment doing light work at two weeks. However, to be safe I would plan on not returning to an office based/light work environment for at least three weeks. Light hospitality work at 4 weeks is possible. I tell all my patients that they are free to attempt normal strenuous activities at 6 weeks. You will definitely still feel sore and will be far from 100%, but you can try and just use common sense and let your body guide you. Given this, then any form of employment that involves heavy lifting or straining must be avoided for at least the first 6 weeks, after that use your common sense and as stated, let your body guide you. You will definitely still feel a little sore, but common sense prevails.
Returning to exercising
Returning to normal physical activity including exercising is important after a tummy tuck. Of course, you will need to understand that a full abdominoplasty is a big operation with a sizeable external wound, usually with muscle tightening and a significant internal surgical wounds that need to heal.
So these wounds need to be given the appropriate respect and time to heal properly so you get the best possible outcome.
With this in mind there are some general guidelines:
- We try to get you up and walking the day after surgery, although it’s more like a slow shuffle in the beginning.
- As you continue to become more comfortable and when you get home continue to get up and walk around gently.
- After about two weeks once you feel like you can actually stand up straight, feel free to increase the walking distance, but no power walking or running.
- Avoid any physical activities that cause you to strain or activate your core muscles for the first 6 weeks.
- At six weeks, you can then slowly return to doing normal training and physical activities. I say slowly because you are definitely not going to be able to do what you want to do and you will still have a reasonable amount of pain and discomfort when you start straining.
So at 6 weeks:
- You can certainly ride a stationary bike at the gym to burn some calories.
- You can also try some light jogging and gradually build yourself up until you feel normal.
- You can start some light weights and gradually build yourself up week by week until your back to your pre-op levels.
Abdominal workouts such as crunches etc are something you probably want to avoid for the first 2 months at least, although most people will struggle before the 3 month mark.
Ultimately, there is absolutely no reason why you can’t eventually get back to normal, it just takes time.
The question about returning to sexual activity after surgery is very common.
Now basically you can’t do anything that causes you to strain or activate your core muscles for the first 6 weeks.
Also, because of the size of the wounds and the healing required you don’t want to be doing anything that gets your heart rate or blood pressure up too much.
And of course the level of physical activity one undertakes during sex varies for each individual and often each time you’re having sex.
So with all this in mind some generalisations can be made.
Realistically you’re probably not going to be even thinking about for the first week at least.
However officially, you should avoid any sexual activity for the first two weeks. Anything that gets your heart rate and blood pressure up is not ideal and any potential pressure etc on your abdominal wall and pubic area will potentially compromise your wound healing.
When you do return to having sex, as previously stated, don’t undergo any sexual activity for the first 6 weeks that involves you being too active or activating your core muscles. So basically, up until the 6 weeks post op period, you are taking on a very passive role during sex!
After 6 weeks, you can do what you like without any fear that you’re going to compromise your results. Obviously you will still be a little sore here and there but just let your body guide you. Ultimately common sense will tell you what’s right and wrong at this stage.
A very important aspect after tummy tuck surgery is the potential for weight gain. Many of my patients are training quite a lot before surgery and are very strict with their diet. In fact, that’s one of the reasons why they’re getting surgery, because diet and exercise can’t get rid of the excess skin.
However, after surgery when you’re unable to do any significant exercise for the first 6 weeks, and sitting around a lot more potentially eating more, you are at a high risk of putting on weight.
So the best way to avoid this is to make some serious conscious efforts to control your diet and start walking as soon as you are able. The last thing you want is to get through the first 6 weeks and realise that you’ve put on 5-10kgs.
Whilst its very reversible, it can put a downer to what should otherwise be a very happy time for you.
Just like every operation, you need to be patient before you can appreciate the “final” results.
Of course, those who have significant problems prior to surgery, will almost immediately be able to see a massive change after surgery. This is despite all the swelling and discomfort.
However, certainly by 6 weeks once you slowly start to get back to doing your normal activities you’ll be appreciating things much more. But you still have a long way to go.
Most of the swelling and pains and tightness should have resolved by 6 months. This is when you could say life has pretty much gotten back to normal and you’ve basically forgotten you’ve had it done, except for the fact that you’re looking and feeling much better.
But the scar hasn’t matured and ideally faded until at least 12 months, although you can continue to experience some scar improvements for up to 2 years. Of course, the scar, like all scars, never goes away.
The list of potential complications is not all-inclusive; however, it does include all the general and specific key issues that should be considered and understood.
General Potential Complications
Whenever someone is having an anaesthetic, no matter what it’s for, then things can potentially go wrong. That is why no surgery should be considered “minor”. Of course, whilst the chances of the following potential problems occurring are extremely small, you still need to know about then:
- Anaesthetic Heart, Lung, Stroke
- Allergic This can be very mild to life threatening.
- Superficial vein clots, which is a complication of the canula or drip that’s placed in your vein
- Deep vein clots – these can potentially spread to the lung and be life threatening. We do several things during surgery and after surgery whilst you’re in hospital to minimise the risk of you developing these.
- Wound problems and bleeding
- Death – whilst the chances of this is exceeding rare, any of the previous issues can result in this devastating complication.
All these potential problems are standard for any operation, although some operations and some patients have an increased risk of developing them.
Now every operation has the potential for wound healing problems. This includes wound bleeding, infection, wound breakdown or even skin and tissue necrosis or loss. These can result wound ulceration and wound breakdown. These issues can be minor or major and warrant further surgery and hospital treatment.
With a tummy tuck the wounds are obviously very large so these risks are much greater compared to surgery with smaller wounds. Those patients at greatest risk of these potential complications are:
- Immunosuppressed including those taking certain immunosuppressive medications
But for the majority of people without these risk factors, the chances of any significant wound healing problems is quite small.
Wounds and Scar treatment
After surgery you will have two wounds, a lower abdominal wound and a wound around your belly button.
The lower abdominal wound is closed using several layers of internal dissolving sutures, so usually no sutures need to be removed. However, sometimes during the first few months post-op some of the stitches come to the surface and come out. These can cause a minor pin-hole sized wound irritation which settles very quickly.
Your belly button wound will often have a number of sutures that will need to be removed one week after surgery.
At the time of surgery dressings are applied involving surgical tape across the wounds and large waterproof dressings. These dressings remain intact until you return to our clinic one week after surgery. You can shower with these on.
At your one week post op clinic appointment, all your dressings are removed and any sutures are removed. Dressings are then reapplied and these remain intact for another two weeks until you return to our clinic for your 3 week post-op appointment. So at your three week post-op visit to our clinic all your dressings are removed and they stay off.
This is when we will talk to you about scar care and what to do to end up with the best possible scar, keeping in mind that it takes 12 months for the scar to fully mature. What we would want to see at this stage is a fine white line.
However, sometimes the scars can thicken and widen and end up darker then we would like. So, on the rare occasion we would consider a scar revision surgery after the 12 month mark.
Also, in some rare cases for reasons not terribly clear some people develop patches of skin discoloration or pigmentation in the lower tummy region but above the scar but not associated with the scar. Whilst these often fade away, they don’t always do so and can be quite frustrating.
An important thing to understand is that sometimes in the very beginning the scar line can appear very “pleated” with skin folds. This is largely because the upper length of skin (the skin flap that is dragged down to stitch into the lower end), is often longer than the lower length of skin. This is especially the case if the person has multiple wide stretch marks that extend above the line of excision.
So this longer length of upper skin has to be pleated to match the shorter length of the lower skin.
So basically don’t worry about how the wound might look at that one week post-op appointment when we first take down the dressings. Any irregularity along the scar line generally irons itself out by 6 weeks post op.
Also, we do ask you to start massaging the scar at the three week stage. Initially the scar typically has a deep lumpy feeling along its length. This eventually usually completely settles, but it can take a few months.
Seroma is a well-known potential complication of tummy tucks. I generally quote an incidence of 5%…in other words, about one in 20 patients can develop it. So what is it? Basically, it’s the build-up of fluid under the abdominal wall skin. This typically manifests during one of your regular early follow up appointments where your belly essentially feels like a water bottle with a slushy feel. However in some cases when the fluid is under tension it feels tight and firm.
Now this is not considered a major complication but more of a hassle to you. If it occurs, we will organise for you to undergo an ultrasound and the doctor doing it will insert a needle and drain the fluid.
The need to undergo an ultrasound and have the fluid drained often requires repeating, sometimes multiple times, until it eventually dries up.
It does not compromise long term results…but it is a personal inconvenience.
Swelling – long term
Like any surgery site you will develop swelling after a tummy tuck. Now remember that the area of surgery for a tummy tuck is extensive…..from the surgical scar all the way up the rib cage internally. So you have to expect an extensive area and degree of swelling involving the entire abdominal wall…including the pubic region and down into the groin.
This swelling is often quite dramatic between the scar line and belly button. Also, the pubic area can initially be very swollen, especially if liposuction was also performed here.
One of the reasons you are recommended to wear a pressure garment for the first 6 weeks is to control the swelling. This swelling gradually subsides but typically takes several months to fully settle.
Also, it can fluctuate with some days where you can look quite bloated whilst other days you’re looking trim.
Many people continue to wear the garment beyond 6 weeks as it tends to provide some control of this swelling. We also recommend you perform gentle daily massage to these areas starting a few weeks after surgery to help control the swelling and facilitate the settling process.
Purpose of Abdominal Binder
At the end of your tummy tuck operation we place you in a compression garment….so basically you’re waking up with this corset type garment on.
This is designed to apply gentle but controlled pressure to your abdomen.
It serves several functions:
- It controls swelling.
- Minimise any early potential bleeding issues
- Provides external support for the internal tightening…so the muscle tightening that is often done is further supported by external compression.
I recommend all my patients wear this continuously for 6 weeks…only coming off for brief periods such as when you’re showering or bathing.
After 6 weeks, I’m happy for my patients to no longer wear it. However, many of my patients like to continue wearing it as they find it provides a degree of physical and psychological comfort at a stage when they are slowly returning to normal physical activities.
Also, it is normal for the post-operative swelling to vary from day to day….and this can take many months to fully resolve.
So after you stop wearing your garment at 6 weeks, some patients experience an increase, albeit temporary, in this degree of swelling. So for this reason many people continue to wear garment beyond 6 weeks to control this longer term fluctuating swelling.
And some people simply find these garments quite comfortable and wear them for a very long time…and that’s not a problem.
Abdominal wall numbness will happen after a tummy tuck.
Now all women that have had a caesarean will notice that the belly above the scar, typically has a dull or numb feeling. Now the scar from a tummy tuck is much larger than that of a caesarean, so the numbness covers a much greater area – the full length of the scar and often extending above the level of the belly button. This odd feeling is quite noticeable initially, but over time it does improve, but never completely. So expect permanently reduced sensation in this area.
This is not a clinically significant area. However, with the reduced sensation it is possible that you could injure that skin without knowing about it – such as burning your skin with a hot water bottle.
The reason why loss of sensation occurs is that the surgery involves lifting the skin and fatty tissue from the muscles to allow it to be moved down for the excess to be removed. So the small nerves that run from the muscle to the skin are by necessity divided to allow this to happen.
In addition to this, some people may experience some numbness or even pain down the front and outer aspect of their thighs. This will occur in small percentage of people as the nerve that supplies this area runs immediately deep to the outer aspect of the wounds on each side. SO any possible irritation or disturbance to this nerve (often due to the sutures used to close the wound), can cause this sensory disturbance. This typically resolves after a few months, but on the rare occasion can be permanent.
People often think that with a tummy tuck the surgeon create a new belly button. This is not the case, you keep your original belly button! However, you do end up with a scar around your belly button.
Surgically, an incision is made around the belly button, but the belly button does not physically move….it remains attached to the underlying muscle.
The skin above the belly button is lifted off the muscle, the skin is then pulled down over the top of the belly button and stitched to the pubic skin.
Then towards the end of the operation an incision is made in the skin at the level where the belly button lies underneath and the belly button is brought back to the outside world and stitched into position.
Surgeons use all manner of techniques or incisions to deliver the belly button. Ultimately you want a near normal appearing belly button and the least visible scar possible.
The technique I’ve developed over the years I believe provides the best possible and least noticeable scar in the vast majority of my patients. Typically I’m converting what is prior to surgery a very unhappy looking belly button, to a cute little belly button.
Looseness on the sides
After a tummy tuck, one of the common complaints is residual looseness or excess on the sides.
This occurs for a number of reasons.
If it occurs, it typically happens in those who have experienced massive weight loss. In this situation the excess skin and residual fatty tissue extends all the way around to the back.
Pre-surgery the most noticeable problem is of course only on the front and this is what the tummy tuck fixes.
Of course, during a tummy tuck, the segment of skin that needs to be removed, in other words the surgical scar, has to end somewhere, and that’s basically along the sides towards the back region. Therefore, at and beyond the region where the scar ends the looseness in this area will remain.
Furthermore, once the front is improved, naturally your eyes are drawn to the next problem area, which will be the sides.
In some people they will need further surgery, which will involve surgery to remove the flank and even back excess, which largely amounts to a two-stage total body lift.
Finally, when a surgeon has removed a wedge shaped segment of skin which is typically what occurs in a tummy tuck, at the end of the scar on either side, the skin and fatty tissues can sometimes bulge out – this is often referred to as a dog ear. This can be quite dramatic and to some degree unavoidable, but not always. If it’s a significant problem, that does not settle, then further contouring surgery may be required.
“Dog Ears” and irregular folds
A potential complication of any surgery where skin has been removed is an abnormality at the end of the scar which are referred to as Dog ears. These are not uncommon in tummy tuck surgery.
As stated, they occur at the end of a scar and it’s where the skin and fatty tissue abnormally bulge out and create an unusual contour. These often do settle after several months, however they sometimes don’t.
If it’s very small and minor, it can often be removed with a minor surgical procedure under local anaesthetic.
However, a large dog ear is a real problem. Of course, this is not to be confused with the natural looseness almost everyone has along the sides and flanks, with of course some people having more than others. This common excess tissue along the sides is what’s often referred to as a muffin top.
Due to this not uncommon natural looseness along the sides, for some people apparent “dog ears” seen after surgery are almost unavoidable and can’t be changed.
However, for others the development of dog ears after surgery is a problem that can be fixed. In these cases, a dog ear typically occurs when the surgeon has not made the scar long enough, and therefore the angle of the segment of tissue that’s been excised is too great. In other words, the surgeon has tried to make the scar too short! So when he/she stitches things up, the apex of the scar area bulges forward! This is the classical dog ear.
As a plastic surgeon, I always state that you should never sacrifice contours and aesthetics for the simple sake of trying to make a scar a little bit shorter. Not only does this potentially result in dog ears, it may also result in significant creases along the lower abdominal wall. This is because the upper length of skin is often ends up much longer than the lower length of skin and needs to be pleated to fit. Now small creases seen immediately after surgery almost always resolve…..or as I often say “iron out”. However, large creases along the lower abdomen often don’t completely resolve.
So basically, contour irregularities associated with the tummy tuck scars can occur. And if they haven’t resolved after 6 months, and are significant, then you may need further surgery to improve them.
Further surgery – fine tuning
It’s not uncommon for a tummy tuck patient to require further surgery to “fine tune” the results.
I always state that a tummy tuck, like many procedures, is like dress making – the surgeon is the tailor and they need to tailor your skin to fit your smaller body.
And like dress-making, often once its “done” you need to have a second fitting to have some fine adjustments made to make it just right!
Well tummy tuck surgery is just the same but many times more complex. The skin and tissues are not static and rigid objects. They swell, they stretch, they shrink, they sag etc. In addition to this, the underlying body is also changing.
So as a surgeon I’m crafting, sculpting, reshaping everything that’s 3D and not static, whilst at the same time making sure that I don’t push things too far and make it too tight…..Because that increases the risk of wounds not healing and breaking down.
So, with all this in mind, after everything settles and swelling starts to settle and things “relax” into position, it’s normal for things to be nowhere near as tight as they initially were. Therefore, it’s not uncommon for patients to require further surgery to “fine tune” the results, just like you would for a second fitting of a tailor-made dress. This is especially the case in quite large transformations.
So you should not undertake any surgery, especially these larger transformations, if you’re not prepared or willing to have further surgery, and the potential time off and costs involved.