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Abdominoplasty

IF YOU ARE CONSIDERING AN ABDOMINOPLASTY

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 operation can dramatically reduce the appearance of a prune belly or pot-belly abdomen. A permanent scar is produced which, depending on the extent of the original problem and the surgery required to correct it, can extend from hip to hip.

THE BEST CNADIDATES FOR ABDOMINOPLASTY

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 surgery is particularly helpful to women who, through multiple pregnancies, or weight loss have stretched their abdominal muscles and skin-resulting in a MUMMY TUMMY.

  • Patients in whom less invasive techniques are not helpful in reducing the skin excess on their abdomen.

  • Loss of skin elasticity can also be improved in older patients with slight obesity.

ALL OPERATIONS CARRY SOME RISKS

To minimize risk of complications some restrictions may apply. Patients with a BMI>35 should postpone the surgery until further weight loss. Also, women who plan future pregnancies should wait, as abdominal muscles that are tightened during surgery can separate again during pregnancy.

If you have scarring from previous abdominal surgery, Dr Dolynchuk may recommend against abdominoplasty or may caution you that scars could become stretched appearing.

Abdominoplasty can enhance your appearance and your self-confidence, but think carefully about your expectations and discuss these with him.

Dr Dolynchuk performs about a dozen regular abdominoplasties each year. When done by a qualified plastic surgeon that is trained in body contouring, the results are generally quite positive. Nevertheless, there are always risks associated with surgery and specific complications associated with this procedure.

Postoperative complications that will prolong your course such as infection and blood clots are rare, but can occur. Infection can be treated with drainage and antibiotics. Walking around as soon after the surgery as possible can reduce the risk of blood clots.

After surgery, the patient has a flatter, trimmer abdomen. Scars are permanent but fade with time. Conspicuous scars, in spite of preventative actions may necessitate a second operation. Smokers are advised to stop, since smoking will increase the risk of complications and delay healing.

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

PLANNING FOR YOUR ABDOMINOPLASTY

In your initial consultation, Dr Dolynchuk will evaluate your health, determine the extent of fat deposits in your abdominal region, and carefully assess your skin tone. Be sure to tell us if you smoke, and if you’re taking any medications, vitamins, or other drugs.

Be frank in discussing your expectations with us. If, for example, your fat deposits are limited to the area below the navel, you may require a less complex procedure called a partial abdominoplasty, also known as a mini-tummy tuck, which can often be performed on an outpatient basis.

You may, on the other hand, benefit more from a full or complete abdominoplasty done in conjunction with liposuction to remove fat deposits from the hips, for a better body contour. Or maybe liposuction alone would create the best result. In any case, we should work with you to recommend the surgical procedure that is right for you and will come closest to producing the desired body contour.

During the consultation, Dr Dolynchuk will also explain the anesthesia the anaesthetist will use, the type of facility where the abdominoplasty surgery will be performed, and the costs involved. In most cases, health insurance and Medicare does not cover the cost of abdominoplasty surgery, but you should check your policy to be sure.

Dr Dolynchuk and his staff will give you specific instructions on how to prepare for abdominoplasty surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. The date and time of your procedure as well as the location will be written down for you. If you smoke, plan to quit at least one to two weeks before your surgery and not to resume for at least two weeks after your surgery.

Avoid overexposure to the sun before surgery, especially to your abdomen, and do not go on a stringent diet, as both can inhibit your ability to heal. If you develop a cold or infection of any kind, your surgery will probably be postponed.

WHERE ABDOMINAL SURGERY WILL BE PERFORMED

This surgeon performs both partial and complete abdominoplasty in an outpatient day surgical center or the hospital, where his patients can stay for several days. Whether your abdominoplasty 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, if needed.

TYPE OF ANAESTHESIA

We may select general anesthesia, so you’ll sleep through the operation, or he will use local anesthesia, combined with a sedative to make you drowsy. You’ll be awake but relaxed, and your abdominal region will be insensitive to pain. (However, you may feel some tugging or occasional discomfort.)

THE OPERATION

An incision just above the pubic area is used to remove excess skin and fat from the middle and lower abdomen.

Skin is separated from the abdominal wall all the way up to the ribs. The surgeon draws underlying muscle and tissue together and stitches them, thereby narrowing the waistline and strengthening the abdominal wall. Abdominal skin is drawn down and excess is removed. With complete abdominoplasty, a new opening is cut for the navel. Both incisions are stitched closed.

Complete abdominoplasty usually takes two to five hours, depending on the extent of work required. Partial abdominoplasty may take an hour or two.

Most commonly, we 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 partial abdominoplasty, the incision is much shorter and the navel may not be moved, although it may be pulled into an unnatural shape as the skin is tightened and stitched.

Next, we separate the skin from the abdominal wall all the way up to your ribs and lifts a large skin flap to enable us to tighten muscles in your abdomen, providing a firmer abdominal wall and narrow waistline.

The skin flap is then advanced and the extra skin is removed. Over time the skin will accommodate being tightened in this way. A new hole is cut for your navel, and the incisions will be stitched, dressings will be applied, and a temporary tube may be inserted to drain blood and fluid from the surgical site.

In partial abdominoplasty, the skin is removed only between the incision line and partway to the navel. This skin flap is stretched down, the excess is removed, and the flap is stitched back into place.

AFTER YOUR SURGERY

For the first few days, your abdomen will probably be swollen and you’re likely to feel some pain and discomfort that can be controlled by medication.

Abdominoplasty may be combined with Breast Surgery and /or liposuction.

Depending on the extent of the abdominoplasty surgery, you may be released within a few hours or you may have to remain hospitalized for two to three days. We 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.

Surface stitches will be removed in five to seven days, and deeper suture will dissolve in three to six weeks. Sometimes the knots can come out in two to three weeks through the skin. The use of paper tape, such as Micropore® for five weeks on your wound is necessary after the first dressing change. A support garment will maintain the dressing on your incision. If liposuction was performed you may require the garment for 6 weeks.

GETTING BACK TO NORMAL

It may take you weeks or months to feel like your self again. If you start out in top physical condition with strong abdominal muscles, recovery from abdominoplasty will be much easier. Some people return to work after two weeks, while others take three or four weeks to recuperate.

Exercise is recommended, even for people who have never exercised before, since an exercise program to reduce swelling, lower the chance of blood clots, and tone muscles will reduce problems. Vigorous exercise, however, should be avoided until you can do it comfortably at about six weeks.

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.

THE ULTIMATE OUTCOME

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.

If you are realistic in your expectations and prepared for the consequences of a permanent scar and a lengthy recovery period, abdominoplasty may be just the answer for you.

ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. Dr Dolynchuk is an ASPS physician member and is certified by the American Board of Plastic Surgery (ABPS) and the Royal College of Physicians and Surgeons of Canada.