Frequently asked questions about abdominoplasty
What can be done by abdominoplasty?
How do I prepare for tummy tuck surgery?
What does abdominoplasty surgery involve?
How will I feel after tummy tuck surgery? Is there a long recovery period?
Is abdominoplasty surgery safe?
How do I arrange a consultation with Mr Hamilton in London, UK
What can be done by abdominoplasty?
Abdominoplasty (“Tummy-tuck”) is an operation intended to correct the skin excess, tighten any weakened muscles and potentially remove some or all of the stretch marks. Often it is combined with some liposuction to the flanks to improve the overall contour. In some patients with only a minor degree of skin excess a smaller procedure called “mini-abdominoplasty” can be performed, again usually with some liposuction.
This surgery is very successful in removing skin excess and tightening the tummy muscles. Only those stretch marks in the area of skin which is taken away will be removed, though the remainder will tend to be lower on the abdomen. In patients who are generally overweight, it is better to lose weight before surgery to improve the end result. However, some overweight patients with significant skin excess hanging over the groin region find removal of that tissue highly beneficial.
Will there be scars?
Yes. The scar will run from one hip to the other at the level of the pubic hair, usually in a position concealed by swimwear. There is a second scar running around the new position of the navel (except in mini-abdominoplasty) which tends to be very acceptable once it has settled. The exact details of any scars will be discussed with you at consultation.
Before abdominoplasty surgery
How do I prepare for abdominoplasty surgery?
Where possible, it is important to avoid aspirin or non-steroidal anti-inflammatory drugs such as ibuprofen (Brufen) and diclofenac (Voltarol) for two weeks pre-operatively. These drugs reduce the ability of the blood to clot and can make bleeding more of a problem during and after surgery.
Smoking can increase the likelihood of wound problems in this type of surgery and abstaining from smoking for at least 2 weeks preoperatively and postoperatively is a sensible precaution.
Patients taking the oral contraceptive pill should ideally use an alternative form of contraception for a full cycle prior to surgery since the pill can increase the risk of thrombosis (clot) forming in the veins of the leg.
What does abdominoplasty surgery involve?
What happens when I come into hospital?
You will be admitted to hospital on the day of surgery and Mr Hamilton will come to re-discuss the procedure and to plan and mark the exact areas of excision and of any liposuction. You will be seen by our consultant anaesthetist who will discuss the anaesthetic with you and answer any questions you may have.
What does the surgery entail?
With you asleep under general anaesthetic, local anaesthetic is placed in the area to be treated to reduce any postoperative discomfort. Mr Hamilton will then remove the excess skin in the lower portion of your tummy, leaving the navel attached to the deeper structures. The skin of the upper part of the tummy is then freed. If the underlying muscles need to be tightened, this is then done using strong stitches. The skin from the upper tummy is then drawn down like a curtain, tightening it and bringing it to the position of the lower incision where it is stitched very carefully in place using dissolving sutures. Usually a small drain connected to a suction bottle is placed in the wound to remove any fluid which might collect and reduce bruising. This will be removed the morning after surgery in the ward prior to discharge. The navel is then brought out to the surface in its correct position on the newly tightened tummy and sutured in place. If liposuction is to be carried out on the flanks, this is done now and then a firm dressing is placed across the tummy. Our anaesthetist will then gently wake you before you are returned to your room on the ward.
After tummy tuck surgery
What happens after the operation?
Usually, after a relaxed night in hospital, you will be able to go home the following day. Occasionally patients wish to stay another night but the majority prefer to go home the morning after surgery. We usually recommend that you use an abdominal support (binder) or a fitted girdle to give extra support to the tummy as the swelling settles. This is usually used for 4-6 weeks.
Mr. Hamilton will see you back in the consultation room 5-7 days after surgery to check that all is well and to reduce the dressing. Typically, you will be seen again a week thereafter at which stage dressings can usually be dispensed with. Occasionally, small amounts of tissue fluid can collect under the scar (a seroma) which is removed painlessly in the consultation room. A final follow up visit is planned 3 months after surgery.
Is it painful?
Abdominoplasty does produce a degree of abdominal discomfort in the period immediately after surgery, particularly if the muscles have been tightened. Our experienced anaesthetist will ensure that you have appropriate painkillers after surgery and when you go home. It is often more comfortable to keep your knees flexed up in bed on a pillow or two after in the days immediately after surgery and to bend over a little while walking initially. Gradually patients return to a normal walking position over the first week or so following surgery.
How quickly will I recover?
If everything goes to plan, the tightness felt in the tummy after surgery will settle in the first couple of weeks. Normal day to day activities can be resumed by about 2 weeks and patients are usually back at work by 2-3 weeks. By 6 weeks you should be able to resume activities such as aerobics and sport. Some minor swelling in the lower tummy and around the scar is normal and the area of the scar can become a little lumpy and firm in the short term. This usually settles with time. The area above the middle of the scar is numb after the operation and whilst this will improve greatly after the operation, a degree of numbness here is normal.
Safety and Potential Risks of Abdominoplasty (Tummy Tuck)
The great majority of patients undergoing abdominoplasty in the hands of an experienced surgeon achieve good results with a rapid recovery. However, in a small proportion some complications are a possibility:
- Unfavourable scars – In some patients, especially those of Afro-Caribbean origin, scars can be thicker than expected or become raised. In the vast majority of cases, these settle spontaneously but occasionally other measures to improve the scar may be necessary. Most patients find that the scars settle well though all individuals are different and in some cases, scars can take many months to settle. Mr Hamilton will advise you on massage techniques to help speed up the rate at which the scars mature. Scars, of course, never disappear and some form of scar will always be present.
- Infection – fortunately, infection is rare in this type of surgery and the risk is minimised by careful surgical technique and the use of a dose of antibiotic before surgery commences.
- Haematoma – Rarely, small blood vessels in the wound may bleed after the surgery leading to a collection of blood under the wound (a haematoma) which needs to be released and washed out before resuturing the wound. If this problem arises, it is typically on the day of surgery and does not affect the final result.
- Occasionally, a small area of skin in the lower, central part of the abdomen just above the scar can become sloughy and form a scab. Usually this will separate and heal of its own accord but on very rare occasions it can be necessary to resuture or revise this portion of the scar. This problem is fortunately unusual and more commonly seen in smokers.
- Significant surgery such as this carried out under general anaesthetic carries a small risk of postoperative chest infection (particularly in smokers) and of thrombosis of the veins of the legs (DVT or deep veinous thrombosis) and the concomitant risk of clot moving to the lung (embolism). Patients wear protective stockings during and after surgery to help minimise the risk of DVT and embolism which is stated to be less than 1 in 3500. Early mobilisation after surgery is an excellent way of reducing the risk we also use a compressive massaging device on the calf muscles in theatre to further reduce the small risk of this complication.
Summary
Abdominoplasty and mini-abdominoplasty are highly successful operations in appropriate patients. The procedure needs to be tailored to your individual needs. Mr Hamilton will be happy to give you a friendly and honest opinion on your suitability for surgery at your consultation.