Tummy Tuck (Abdominoplasty)
Abdominoplasty or tummy-tuck surgery is designed to firm and smooth the abdomen, eliminating accumulations of excess fat and loose, sagging skin. Abdominoplasty surgery falls into the category of “excisional” body contouring whereby excess skin and fat are actually removed and excised.
Unlike liposuction which only removes excess fat and relies on skin elasticity to reshape the skin, abdominoplasty surgery surgically removes excess skin and fat while also tightening the underlying abdominal muscles. This can dramatically reduce the appearance of a protruding abdomen, giving you a flatter, firmer, tighter stomach and a thinner, shapelier waistline.
If you have loose abdominal skin, stretch-marked skin after pregnancy, weakened abdominal muscles and/or excess abdominal fat that won’t respond to diet or exercise, a tummy-tuck may be right for you.
The typical approach for a full abdominoplasty involves an incision across the lower abdomen in a bikini-line pattern just above the pubic hairline. A separate small incision is also made within the circumference of the belly-button, which remains attached but is freed from the surrounding skin. The skin and underlying fat are then elevated up to the level of the rib cage. The underlying muscles are then tightened by using permanent sutures. The excess skin and fat are then excised and removed, the lower abdominal incision is closed and the belly-button is brought out through a new opening and sutured in place. Typically, two closed-suction drains are also placed which exit the skin just above the pubic hairline. For pain control, a specially designed pain pump is also used. This device provides direct flow of anesthetic solution to the tightened abdominal muscles, which tend to be the most direct source of pain. The 5-day device is easily removed in the office, but can also be removed by the patient at home.
Typically, skin and fat from the belly button down to the pubic hairline incision are completely removed. The resultant scars are designed to fall along the natural creases within the bikini line. An additional scar is also present within the belly button as well. The final visibility of scars varies significantly from person to person, and depends on your healing characteristics as well as how tightly the incision was closed. Your healing process will be followed closely and the scars will be treated to obtain the best possible results.
This procedure removes loose skin of the lower abdomen only and does not tighten the upper abdomen or reposition the belly button. Muscles can be tightened but usually only below the level of the belly button. This procedure is best suited for patients who are thinner, have good muscle tone in the upper abdomen and moderately loose skin confined to the lower abdomen. The resultant scars are much shorter with no scar inside the belly button.
This procedure is performed with an endoscope via a small incision above the pubic hairline. No skin is removed. The goal is simply to tighten loose muscles. Often, liposuction is also used to thin the fatty layer of the abdominal wall if skin tone is good. This procedure is suited only for patients with loose muscles but no loose skin. Usually, most patients with loose skin also have weak muscles and therefore this procedure is seldom indicated.
Abdominoplasty surgery can be performed in combination with other abdominal procedures such as tubaligation, hernia repair, hysterectomy, and bladder suspension to name a few. Complication rates and recovery times are typically unchanged with these combination type procedures.
Tummy tucks are performed under general anesthesia, so you will sleep through the entire procedure.
LENGTH OF PROCEDURE
Full abdominoplasty 2½-3½hrs; mini-abdominoplasty 1½-2hrs; endoscopic abdominoplasty 1-1½hrs.
RECUPERATION AND HEALING
Most abdominoplasty surgery is performed on an outpatient basis whether done at a hospital, outpatient surgery center, or office-based surgical suite. In some cases, an overnight stay will be recommended because of age, medical issues, post-operative nausea or pain control. Initial discomfort is well controlled with oral pain medications and muscle relaxants. The Stryker Pain Pump device has dramatically decreased the needs for such medications and has made recovery much easier. You are given intravenous antibiotics during the surgery and are given 10 days of oral antibiotics after the procedure.
The incisions heal within 7-10 days and all sutures are under the skin and absorbable. Paper steri-strips cover the abdominal incision while antibiotic ointment is applied twice daily to the belly-button incision. You will also be instructed on how to cleanse the belly button with peroxide and Q-tips to keep it clean. Once all incisions are well healed, you will be given detailed instructions about scar management so that the scars will thin and fade. Special scar gels or silicone gel sheets will be prescribed to ensure the best possible scar. Scarguard is recommended and may be purchased through our office.
In full abdominoplasty surgery, two closed suction drains are placed during surgery under the abdominal wall skin. These drains exit the skin in the upper pubic hairline and are attached to small reservoirs the size of tennis balls. The drains are intended to prevent postoperative fluid collections called “seromas”. You will be provided with detailed drain teaching prior to your surgery that will instruct you on how to care and empty the drains. A log will be given to you to record daily outputs from the drains. Typically the first drain is removed 5 days after surgery at the same time as the pain pump, and the second drain at 7-10 days after surgery. The drains are not painful, and you will be allowed to shower even with them in place.
We recommend 1-2 weeks off from work or once you no longer require prescription pain medication. If your job requires lifting or manual labor, job modification will be required for 6 weeks to allow for healing of the internal, muscle-tightening sutures.
- Stop taking aspirin and aspirin-containing products at least one week before surgery. A sheet of medications to avoid those that contain aspirin will be provided to you.
- If you develop a cold or illness prior to surgery, please notify us so that we may reschedule your procedure. Remenber, this is elective surgery so everything should be optimized to prevent potential complications.
- Vitamins are important in healing. Take a multivitamin with iron as well as
- All other vitamin supplements and herbal medications should be stopped, since many can actually worsen bruising.
- Smokers must stop smoking 6 weeks prior and 6 weeks after the surgery.
- Make certain arrangements have been made to have someone pick you up after surgery and to stay with you for the first 24 hours if possible. Transportation services are available through our office.
- Fill all your prescriptions before the day of surgery. Bring your pain pills with you the day of surgery. You may be asked to take them after your procedure before you go home.
- You may want to purchase a stool softener such as Colace, as pain medication may cause constipation. You will be carefully measured and fitted for a custom post-surgical compression garment.
- This garment will be an integral part of your recovery process and must be worn at all times for the first two weeks after surgery.
EVENING BEFORE SURGERY
- Eat lightly; avoid heavy, spicy, or gassy foods.
- Get a good night’s rest.
- Do not eat or drink anything after midnight prior to surgery. If your surgery is in the afternoon, do not eat or drink anything at least 8 hours prior to surgery. You may take any prescription medications with a sip of water only.
HOME AFTER SURGERY
- After any surgery, it is important to rest. While at rest, exercise your legs and feet to increase circulation to your legs. Sleeping for the first week is recommended in a recliner or propped up in bed to avoid tension on the incisions or muscle repair. Walking hunched over at the waist should also be expected the first week until the tissues stretch and the muscles relax.
- A small amount of bloody drainage through the bandage can occur.
- Do what’s comfortable, and avoid activities that cause pain.
- Begin taking liquids slowly after surgery and advance your diet as tolerated. It is best to take your medications with food rather than on an empty stomach. Call Dr. Hainer if you have any problems with nausea after surgery. He will call in a prescription for an anti-emetic.
- Any discomfort should be relieved by the pain medication.
- Mild to moderate amounts of blood–tinged drainage may occur from the incisions. This is normal and represents some of the fluid infused during the liposuction that is not reabsorbed by the body and drains out instead.
- You may wash you garment if it becomes wet or soiled. You may shower the day after surgery or once the post-operative bandages are removed, but no tub bathing until the drains are removed and the incisions are well healed.
DEDICATED TO YOUR CARE
The entire surgical process begins well before your actual surgery date. Detailed descriptions of the entire pre and post-surgical course will be explained. Surgical consents will be signed once any and all questions are addressed. Drain teaching, if necessary, is provided. All prescriptions are provided and explained. If specialized garments are needed, exact measurements are made and sample garments are fitted.
During this entire surgical experience, Dr. Hainer and the entire staff at North Oakland Plastic Surgery is committed toward availability. Dr. Hainer will provide each patient with his personal beeper number that is available 24hrs a day. Your well being and smooth recovery is of utmost importance to us all. We strive to meet all of your needs and make ourselves available at all times for any questions that may arise. Our goal through the entire process is to inform and educate you so that there are no surprises and that all your expectations are fulfilled. Care is individualized and personalized to make this entire experience a pleasant one.
THE RECOVERY PROCESS
If your surgery was performed on an outpatient basis then you will typically be seen in the office 2-3 days after your abdominoplasty surgery. If you stayed overnight at the hospital or surgery center then you will be seen prior to discharge home. It is crucial that you wear the specially designed garment to help in contouring the tissues and in supporting the abdominal wall muscles while they heal. The initial garment is to be worn 2 weeks, day and night. After the initial two week period, another garment can be transitioned into and worn during the daytime. This second stage garment is less supportive and should be worn an additional 4 weeks. The garments can be removed for showering and for them to be laundered.
Most postoperative swelling and bruising will resolve within 2-4 weeks. Some swelling may persist for as long as 3 months. As the swelling resolves, it will linger in your lower abdomen above the incision line and may temporarily make this area look unnaturally full and feel somewhat firm. Abdominal numbness is expected and may last as long as 6 months. Some residual numbness may persist but most patients get used to it and do not find it bothersome.
By 10-14 days, the incisions are well healed. At this point, Scarguard once daily is started on all the scars to help them soften and fade. Ocassionally, other scar modification techniques such as silicone gel sheeting or steroid-impregnated tapes or creams are used to help in scar maturation. Dr. Hainer will monitor your healing process closely to ensure the optimal scar results. If your scar is exposed while you are outdoors, you should protect it with sunscreen SPF 15 or higher for at least one year to prevent permanent discoloration.
Driving may be resumed in 7-10 days or when you have stopped taking prescription pain medication. Light activities such as walking can also be started once your drains are removed and no seroma fluid collections are present. More strenuous activities that would stress the abdominal muscles are avoided for six weeks to allow for complete healing. At six weeks, all activities may be resumed. Many patients continue to wear a supportive Lycra or Spandex garment during exercise. As time progresses, the tissues will continue to soften, the scar will fade and thin, and the muscles will become stronger.
Bruising and swelling are expected. This will disappear in time. Be patient. It takes 6 weeks for the skin and soft tissues to begin to regain their natural appearance, softness, and shape.
Small areas of numbness are not uncommon and may last 6-12 weeks. Permanent numbness is extremely rare.
Sensations of sharpness and burning can occur during the healing process.
You may drive as soon as you are comfortable enough to stop in an emergency.
It is not uncommon to begin your menstrual cycle early due to the stress of surgery.
In some patients, antibiotic use may lead to a vaginal yeast infection, which is easily treated with an over-the-counter anti-fungal preparation or Dr. Hainer will prescribe something for you.