Tummy Tuck/ Abdominoplasty

What Is Abdominoplasty?

Abdominoplasty, or "tummy tuck" is a surgical procedure involving the removal of excess skin and fat from the abdomen and tightening the abdominal muscle wall. The procedure can make a dramatic reduction in the appearance of the abdomen. The one trade off that must always be considered is that it does produce a permanent scar which is usually minimized but may extend from hip to hip depending on the amount of reduction required.

Who is a usual candidate for abdominoplasty?

Men or women who are in good physical health but have been unable to lose excess skin and fat from the abdominal area. despite diet and exercise, are usually excellent candidates for this procedure. There are particular groups of patients who do especially well with this procedure:

Post partum women: Due to pregnancy, abdominal muscles become stretched and laxity develops, causing lower abdominal bulging. Stretch marks from pregnancy and scars from C-sections or other gynecologic surgery can also play a role in disfiguring the lower abdomen.

Obesity and weight fluctuations: Frequent weight changes and reduction in weight from obesity to normal weight parameters may cause loss of skin elasticity in patients which can usually be significantly improved with abdominoplasty procedures.

As with all cosmetic surgery, abdominoplasty can improve your appearance and may improve your self confidence. One must be careful to realize that results may not match your expectations. Before deciding on surgery, think carefully and discuss your expectations with your surgeon and staff of Blue Water Surgical Centre.

No Surgery Is Without Risk

Hundreds of abdominoplasties are performed each year at the Blue Water Surgical Centre Ltd. The results of this surgery are usually quite positive. However, there is always a risk associated with any surgery. Fortunately most complications are rare and can be prevented by closely following your surgeon's instructions before and after the surgery. However, because much of the healing in surgery is dependent upon your body, there can never be a guarantee of a perfect outcome or a surgery with no risk.

Infection and blood clots are rare complications which can occur. Drainage and antibiotics can be used to treat infection but may prolong your recovery. The risk of blood clots can be minimized by ambulating as soon as possible after the surgery.

Smokers can decrease blood flow to the incision and the skin of the abdomen, resulting in poor healing and skin breakdown. Hence, smokers should be advised to stop.

Conspicuous scars from poor healing may necessitate a second operation and may be completely unpredictable. This is not a complete list of all complications and a consult should be made with your surgeon to further discuss risks prior to performing surgery.

Pre-Operative Planning

Planning your surgery is a complex process that involves many steps. In your initial consultation, your surgeon will evaluate your candidacy for the surgery, both physically and mentally. Physically, the extent of fat deposits in your abdominal region, any abdominal scars, and careful assessment of your skin tone are critical. Aside from the physical parameters, you will also be assessed mentally to determine if your expectations for such surgery are realistic. Be frank in discussing your expectations with your surgeon. He or she should be equally frank with you, describing your risks, benefits, and alternatives for each procedure.

There are a number of options for most people seeking tummy tuck surgery. Full tummy tucks, limited tummy tucks or liposuction in combination with any of the above or alone may be performed. A combination or any of these procedures alone should be discussed in detail to help determine the right surgery for you. Post operative care needs, post operative activity limitations and time required to return to normal activities are all important parts of planning your surgery to maximize your result.

Getting Ready For The Operating Room

You will be given specific instructions on how to prepare for surgery. This will include guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

If you smoke, plan to quit at least three 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.

You should always arrange for someone to drive you home after your surgery and to help you out for a day or two after you leave the clinic, if needed.

Where Your Surgery Will Be Performed

Most surgeons today who are dedicated to performing cosmetic plastic surgery perform their surgeries in fully accredited private surgical centres. Some surgeons still perform surgery in hospital settings.

There are some important differences to note for each. Private surgical centres add an unprecedented level of privacy and comfort to your surgical experience for a number of reasons. If designed well, the centre will usually have a private entrance, exit and waiting area to keep your privacy secured. Most of the nurses and staff in a private surgical centre will also be very accustomed to doing your procedure, unlike public hospital nurses who will rarely deal with cosmetic plastic surgery. Many of the nurses in the private centre will likely have had the procedure done on themselves and will be able to share their experiences with you. Private surgical facilities can also be as safe as any hospital as long as they are fully accredited surgical centres. In Canada, an accredited Surgical Centre should be accredited by the CAAASF. In the United States, the AAAASF is the similar accrediting body. Clinics with these accreditations should have sufficient safety equipment and trained personnel to safely perform any cosmetic procedure.

Anesthesia

One of the most critical parts of your surgery is your anesthesia. In most centres in North America, anesthesia is provided either by an M.D. who is specialized in anesthesia or a nurse certified in anesthesia. At the Blue Water Surgical Centre Ltd. your anesthesia is only provided by M.D. F.R.C.S.C. fully certified specialty anesthesiologists. We believe that this person is as critical to your safe outcome as is your surgeon.

There are four different types of anesthesia routinely used in plastic surgery.

1. General-Complete anesthesia, with intubation and respirations performed by an anesthetic machine.
2. I.V. Sedation-Sedation without airway intubation. You are generally very sleepy and unaware of your surroundings, but still conscious enough to maintain your airway.
3. Spinal-Paralysis and anesthesia of the lower body while completely awake.
4. Local Anesthetic.-Anesthesia “numbing”of a specific area while completely awake.
   Abdominoplasty can be performed with any of option 1 through 3. Most abdominoplasties at the Blue Water Surgical Center Ltd. are performed under option number 1 with wonderful results.

Details Of The Surgery

A full abdominoplasty usually takes two hours, depending on the extent of work required. An incision is first made from hip to hip, just above the pubic area. The skin and fat of the abdominal wall is then lifted just above the muscles all the way up to the rib cage. A small circular incision is also made around the belly button to release the belly button from the surrounding skin that is being lifted. Attention is then focused on the abdominal muscles which usually require significant tightening. Once tightened, the skin is then pulled down and the entire skin from just above the old belly button position to the lower incision is usually cut off.

This is usually where all the stretch marks, C-section scars and excess abdominal fat reside. The remaining skin is then stretched tight to close the incision. Once closed, a new hole is made to bring the belly button through. This is then sutured. Your surgeon will then likely place in a small rubber drain tube to collect extra fluid from the surgery.

There are a few notable modifications to the tummy tuck. A mini or partial tummy tuck may involve a less wide incision and undermining only to the belly button. The muscles in this lower region only can then be tightened if needed, and then this smaller area of skin is excised. This will lead to a much smaller scar and is useful for young patients with a focused problem only in the lower abdominal area.

Another alternative to the traditional tummy tuck is the Fleur De Lise tummy tuck. This is done using the belly button. This procedure creates an additional vertical incision in the midline but has the advantage of allowing a pull in a sideways direction to tighten the sides of the patient. It also allows revision of a previous vertical scar to improve its quality.

Another commonly added alternative to the traditional tummy tuck procedure is the addition of liposuction to the sides of the hips. Liposuction on the sides of the hips can help reduce the excess hip bulges which people commonly complain of, once their tummy is smooth and flat. The bulges in this area are generally never noticed when the tummy is large, but become more noticeable when the tummy is smaller and flatter.

Post Operative

Your abdomen will probably be swollen for the first few days and you're likely to feel some pain and discomfort which can be controlled by medication. You will be discharged the same day of your procedure but return for scheduled follow up appoinments.

You will be immediately dressed with an abdominal binder which will help decrease swelling and protect the abdominal muscle repair by supporting it.

Your doctor 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.

Most sutures will be dissolving and will not require removal. You may find ends of the sutures protruding through your skin; simply leave them in place until your post operative evaluation.

It may take you weeks or months to feel like your old self again. 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 your doctor advises you to do it.

As you heal, you will find an ever improving abdominal contour. Results will continue to improve for one year after your surgery.

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.

Summary

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're 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.