Abdominoplasty, or a “tummy tuck,” is designed to correct abdominal wall and skin problems. A protruding abdomen may result from weak abdominal muscles, weight gain then loss, or pregnancy – especially with c-sections or twins.
Aging, weight changes, and pregnancy may cause the skin to lose its elasticity. This results in a “prune belly” appearance or a hanging apron-like fold of skin called a pannus. These conditions may not respond well to diet or exercise or liposuction only.
With abdominoplasty, the abdominal wall muscles are tightened and excess fatty tissue and skin are removed to improve the body contour. The goal is a flatter abdomen without excess tissue. Realistic expectations are important.
Abdominoplasty is not a substitute for weight loss. Liposuction is often used quite effectively in combination with abdominoplasty to contour the waist and the hips.
Dr. Wigod considers age, weight and smoking habits when evaluating a candidate for this procedure. Ideally, the abdominoplasty patient has no significant health problems. Patients on a weight-loss plan should be close to their target weight before having the operation. Women planning future pregnancies should delay abdominoplasty, as pregnancy may promote further abdominal stretching. Abdominoplasty is considered a cosmetic surgery and insurance coverage will not be requested or accepted.
Abdominoplasty is performed using general anesthesia. The surgery may take 2-5 hours, depending on your overall condition. A full abdominoplasty addresses the upper and lower abdomen, while a mini abdominoplasty addresses the lower abdomen only.
The procedure is most commonly performed by making a low incision curving between the hips. A second incision is made around the belly button (umbilicus). The skin is then separated from the abdominal wall and lifted up to the ribs, exposing loose tissue covering the abdominal muscle. Loose, stretched out muscles are tightened together with sutures like an internal corset. Excess skin and fat are then removed. The skin is next lowered over the abdomen and the incisions are then sutured together. Finally, a new hole for the umbilicus is made and it is sutured into place. Drains are inserted to eliminate fluid buildup and an elastic binder is applied to the abdomen. A local anesthetic pain pump is used to ease your recovery.
Depending on your health, length of operation, and personal preference, you may have outpatient surgery or stay in the hospital overnight.
You will be discharged with an abdominal binder and your wounds will be dressed with gauze bandages. Dressings should be changed daily or when significantly soiled. You do not require dressings once you have no more drainage from your wound, but you should have a clean soft cotton garment in contact with the wound which is washed or changed daily. After your drains are removed, you will need to wear a close fitting compression garment until 6 weeks post op. The garment is similar to a girdle, put on like a leotard, and provides compression from the ribs to the pubis. Garments may be fitted and purchased at our office.
Your skin will be closed by a combination of absorbable and non-absorbable sutures. You may have some oozing which is not unusual. You may shower and wash your wound 24-48 hours after the operation. Your sutures will be clipped at 1-2 weeks post-op. While every effort is made to minimize it, scarring should be expected. It often takes 9-12 months before the scars begin to fade. Dr. Wigod recommends using silicone gel strips with your compression garment for the optimal result.
You will have a rubber tube, called a drain, exiting from each corner of your incision. They are there to allow controlled drainage from the wound and to decrease pain. Depending on many factors, these tubes may be removed from one to several weeks after the operation. The drains should be emptied every 8 hours and the drainage tracked in milliliters (cc’s). Your hospital nurse will instruct you. You may shower with the drains in place. If a drain is accidentally removed, notify Dr. Wigod during the next business day.
Your abdomen may feel tight for 1-2 weeks and feel numb and swollen for weeks to months post op. Recovery time depends on your physical condition prior to surgery, as well as your personal pain tolerance. Those with stronger abdominal muscles usually recover faster. Allow at least 1-2 weeks to recuperate before returning to work.
Recovery may be delayed by seroma (clear fluid collection between the skin and abdominal wall). Dr. Wigod leaves drains in place as long as necessary to avoid this problem. Patients may rarely have “dog-ears”- small amounts of extra tissue at the far ends of the abdominal closure. Dr. Wigod designs his closures to minimize this problem which may not be evident until weeks to months after the operation. If it occurs, however, the tissue may be easily removed in the office under local anesthetic. Other problems, such as delayed wound healing of the closure or umbilicus, bleeding, infection, or asymmetry, are unusual.
Though the recovery period is longer than that of other cosmetic procedures, abdominoplasty patients tend to be the most satisfied of any cosmetic surgery patients. Those who follow a proper exercise routine and healthy diet will benefit from abdominoplasty the most. Your body will continue to change gradually post op as the operation does not prevent aging or weight gain.