Abdominal reduction (tummy tuck)

Abdominal reduction (tummy tuck)

Some people may have excessive or sagging skin around their abdomen, even if they are not overweight.  The problem may be a result of dramatic weight loss, multiple pregnancies, or twin and triplet pregnancies. There may also be the added problem of lax abdominal muscles.  The sagging may not be corrected by further dieting and exercise.  In this case the only remedy is surgical removal of the  excess skin.

Treatment

The surgical procedure to remove the excess skin is known as abdominoplasty. Excess skin and fat is removed from the abdomen between the pubic area and the umbilicus (belly button). If lax muscles are a problem, these can be tightened at the same time.  Occasionally, liposuction may also be carried out, but this is not a routine part of the operation.

Procedure

An ellipse of skin is removed between the umbilicus and the pubic area, along with the underlying fat. The umbilicus is left in place. Once this skin has been removed, the skin above the umbilicus is pulled down firmly towards the pubic area where it is sutured into place.

Post Surgical Care

Two drainage tubes are usually used which are removed once the drainage has subsided — usually 24-48 hours.

Surgeons will request that a supportive garment is placed around the abdomen before you leave theatre.  A pillow will be placed under your calves to keep your legs slightly bent at the hips. This reduces tension on your abdomen in the initial post operative period.

You will be given fluids intravenously (a drip) on the first day of surgery. You will be able to eat and drink normally on the next day. Some patients experience nausea. The nursing staff will be able to give you medication to alleviate this.

A degree of pain is expected following surgery but this can be controlled by pain killers, either by injection or in tablet form.  Your abdomen will feel extremely tight when you first get up following surgery. This will ease and nursing staff will help and encourage you to mobilise. This helps to reduce the likelihood of post surgical complications.

Most patients will stay two nights in hospital following abdominoplasty.

Limitations

Abdominoplasty is NOT a substitute for weight loss. You should aim to be at or near your ideal weight before undergoing this procedure. Continued weight loss following surgery could result in further drooping of the abdomen. In addition, an abdominoplasty tightens your abdomen skin downwards - it does not tighten or slim the waist.

It is possible to have a slight bulge above the scar because there is naturally more fat in the abdominal wall than in the groin. This can be corrected with liposuction. Your surgeon will discuss whether you are likely to need liposuction.

The effects of an abdominoplasty generally last well. This can be maintained by keeping at a steady weight, exercising regularly and avoiding becoming pregnant.  

In some cases minor adjustments under local anaesthetic are required at a later date.

What to expect following surgery:

You will be encouraged to be mobile and return to normal activities as soon as possible following surgery. Pain and tightness will subside over the coming week.

You will be able to return to work within 2-4 weeks of surgery, depending upon how physical your job is. Strenuous activities such as sport and heavy lifting should be avoided until 6 weeks following surgery.

Your surgeon may advise wearing a garment such as supportive underwear or shorts during the initial weeks to avoid strain on the incisions.

Some surgeons prefer you to avoid getting the surgical wounds wet during washing until you have had your first follow up appointment.

Risks

There are potential risks inherent in undergoing any surgical procedure such as pain, bleeding, infection and thrombosis. 

The risk of thrombosis is reduced by using anti embolic stockings and administering a low dose of heparin by injection whilst in hospital. Early mobilisation is also important to prevent thrombosis and chest infection.

The risks of infection, poor wound healing and thrombosis are increased in smokers, diabetics and overweight patients.  Collections of blood (haematomas) or fluid (seromas) can occur.  These can resolve spontaneously but sometimes require drainage with a needle or, more rarely, return to the operating theatre.  Over-activity in the early days can contribute to delayed healing and fluid accumulation.  Numbness of the abdomen can occur after surgery and will sometimes be permanent. 

The information contained in this website is not exhaustive.  A full consultation with a suitably qualified surgeon is essential to ensure  that your individual risks are assessed and to ensure that this type of surgery is suitable for you.

Sources/Further Information:

· British Association of Aesthetic Plastic Surgeons (BAAPS)

· British Association of  Plastic Reconstructive & Aesthetic Surgeons (BAPRAS)

· Department of Health Cosmetic Surgery: Information for Patients (August 2006)

· NICE Venous Thromboembolism (April 2007)

· NICE Surgical Site Infection Prevention & Treatment of Surgical Site Infection (October 2008)

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