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Tummy Tuck
Women and men who have loose skin and subcutaneous fat that is concentrated in the abdomen can benefit from abdominoplasty. Sometimes these conditions are inherited. In other instances, substantial weight loss may cause abdominal skin to become flaccid. Abdominoplasty also can tighten muscles that have been separated and weakened by pregnancy. The procedure may somewhat improve the appearance of stretch marks, especially those located below the navel.
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Am I a good candidate for a tummy tuck?
The best candidates are those women and men who have a localized problem in the abdominal area and are otherwise healthy. Physical evaluation is the key to what will really correct your specific problem(s).
How will my plastic surgeon evaluate me for tummy tuck or other tummy problems?
As with all of his surgeries, Dr. Robinson will want to know about the whole person, her expectations and her medical history for diabetes, heart, lung or bleeding abnormalities. Then he will examine the “inside” looking to see how much fat is wrapped around the intestines and such. Because tummy tuck surgery cannot correct that condition. Dr. Robinson will also determine if the abdominal muscles are spread apart, which frequently follows pregnancy, especially with large babies. Unfortunately, some people, both women and men, are not blessed with abs that come together in the midline; this can be corrected by sewing them together.
Next, he determines how much fat is between the muscles and the skin, and how it is distributed. Liposuction is sometimes the answer, or some of the fat below the belly button might be thinned out during a tummy tuck. Liposuction on the area above the belly button interferes with the circulation of the skin farther down the abdomen, so liposuction of this area cannot be done in conjunction with a full tummy tuck. The flanks and sides can be suctioned at the same time as a tuck.
Excess skin may be excised leaving a long scar that will be covered by undergarments. In certain cases, a mini tummy tuck can be performed.
What are some variations to the tummy tuck techniques?
Depending upon the whole picture, as evaluated above, the technique can be as simple as liposuction of a specific area or mini tummy tuck removing the skin below the belly button, leaving an 8-inch scar above the pubic hair. If not too much skin has to be removed, the belly button can be moved down about an inch and a half to avoid visible scarring.
Most commonly you have to do a full tummy tuck, using an incision above the pubic hair line, extending from hip to hip (coverable by undergarments). Then the belly skin is separated from the muscles all the way up to the ribs. While the muscles and fascia are exposed, they are sutured together to pull the tummy into a flatter shape. Next, the skin is pulled downward to determine the maximum that can be removed. After this skin excision, the belly button has to be brought out through the skin (leaving a scar around it), and then the bottom excision is sutured closed.
In the case of massive weight loss, skin elasticity and circulation decreases, so the results may not be as good. Patients with diabetes have poor circulation which increases the chance that a little piece of skin just above the pubic hair will not have sufficient circulation and die, causing a larger scar. This can be avoided by making the incision higher, up through the belly button. If you make the flap shorter, the chance of skin loss is lessened. The trade off is that the scarring is more visible. Smoking causes the same circulation problems.
How should I prepare for surgery?
A healthy diet, body and lifestyle lead to a stable weight pattern, and this improves results immensely. If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Diet pills can stop your heart during surgery. “Dr. Chili” will provide you with additional preoperative instructions.
Tummy tuck and liposuction are usually performed on an outpatient basis. You must arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.
What will the day of surgery be like?
Your tummy procedure may be performed in a hospital, out patient surgery facility, or the accredited office-based surgical suite. The night before surgery you can take your medications (except those cancelled as above) and eat until midnight. This will ensure an empty stomach in the morning. An hour before surgery you will take your pre-operative medications with a sip of water, but NO FOOD. Wear something warm, like jogging pants and a shirt or jacket that can be buttoned or zipped, so your arms do not have to be raised after surgery.
The medications are administered for your comfort during the procedure. Frequently, general anesthesia is used for patients undergoing abdominal surgery, although epidural anesthesia (similar to that used for child birth) and IV sedation may be desirable in some instances.
When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. Your tummy will be bandaged to reduce messiness. You will go home after a few hours; you will be drunk but able to walk. You will need a friend to take care of you for at least the first night, getting out of bed is hard.
How will I look initially?
A day or two after surgery, you should be up and about with assistance. Any dressings will be removed within several days, and if a drain was necessary, it comes out in about 3–5 days. “Dr. Chili” will probably permit you to shower the day following surgery. Stitches are dissolvable and will not be removed. Some discoloration and swelling will occur initially, but this will disappear over a few days. Since the swelling flows down with gravity, some people are surprised that their legs, labia or scrotum swell temporarily. Most minor residual swelling will resolve within a month.
How will I look and feel, initially?
For the first three days, you need to be in a recliner of up on pillows, to reduce the strain and stretch on the tummy skin to prevent loss of circulation. The day after surgery, you will be encouraged to get out of bed for short periods of time. After several days, you will be able to move about more comfortably. Straining, bending and lifting must be avoided, since these activities might cause the fascial stitches to tear out. Bathing may usually begin the day after surgery. Any surgical drains will be removed several days after surgery. Generally, the stitches are absorbable but the fascia sutures are permanent so neither will be removed.
It may take weeks, months or even more than a year before sensation returns to normal. Your tummy may also require some time to assume a more natural shape. Incisions will initially be red or pink in color. They will remain this way for many months following surgery.
When can I resume my normal activities?
After tummy surgery, it is often possible to return to work within just a couple days (with liposuction) or weeks (with a full tummy tuck) and depending on your job. In many instances, you can resume most of your normal activities, including some form of mild exercise, after several weeks. You may continue to experience some mild, periodic discomfort during this time, but that is normal. Severe pain should be reported to your doctor. Any sexual activity should be avoided for a minimum of one week. After that, care must be taken to be gentle with your tummy for at least the next six weeks.
Results of Tummy Procedures
Tummy tuck or liposuction surgery will make your abdomen smaller and firmer. You may again find greater enjoyment in playing sports and engaging in physical activity.
The incisions from your tummy surgery will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible when unclothed, more so in some individuals than others. Fortunately, the incisions are in locations easily concealed by clothing.
Tummy surgery often makes a dramatic change in your appearance. For this reason, it may take some time to adjust to your new body image. Most men and women, however, quickly become comfortable and feel very pleased with the results of surgery.
I understand that every surgical procedure has risks, but how can I learn more?
The subject of risks and potential complications of surgery is best discussed on a personal basis between you and “Dr. Chili” or one of his staff.
Some of the potential complications that may be discussed include bleeding, infection, reactions to anesthesia, loss of skin, or suboptimal scarring. Following tummy tuck, sometimes the belly or the belly button may not be perfectly symmetrical. In certain instances there is a pooch (called a dog ear) at the end of the incision. If desired, minor adjustments can be made at a later time. Permanent loss of sensation below the navel may occur. Revisionary surgery is sometimes helpful, to improve the results, where incisions may have healed poorly or in the unlikely event of skin loss. After massive weight loss there is a higher risk for all these problems.
You can help to lessen the risks by following the advice and instructions of Dr. Robinson, especially regarding smoking both before and after surgery.
How long will the results last?
Unless you gain or lose a significant amount of weight or become pregnant, your tummy size should remain fairly constant. However, gravity and the effects of aging will eventually alter the shape of virtually everyone’s abdomen.
Maintaining a Relationship with Your Plastic Surgeon.
Please remember that your relationship with us does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon.
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