Abdominoplasty, or "tummy tuck" is an operation to treat slack abdominal skin and weakness of associated muscles. Women who have had children are the usual candidates for this operation; however, women and men alike who have lost a lot of weight or who have had previous abdominal surgery, especially with scars below the navel, may also be candidates. The presence of a thick layer of abdominal fat on its own, without skin excess, may be helped by liposuction alone. Very often skin laxity and fat excess co-exist, and in these cases abdominoplasty is combined with liposuction to obtain the best result.
Abdominoplasty is major surgery and patients scheduled for this operation have to be fit and well. In particular they should not be anaemic and have no previous history of deep vein thrombosis or embolism.
The operation is carried out under general anaesthesia and takes approximately two hours. The surgeon injects quantities of fluid under the abdominal skin to reduce bleeding and, if required, will carry out liposuction to thin the layer of fat. An incision is then made in the lower abdominal skin crease, just above the pubic hair, extending from hip to hip. The skin is then lifted off the muscle as far as the rib cage, and the navel left attached to the abdominal muscles. Where abdominal muscles are weak, or if there is a true hernia, a repair is carried out to produce a stronger and flatter abdomen. The skin is pulled down and excess removed. The upper part of skin is then sutured to the bottom incision. Drains are usually left inside the wound to remove any excess blood and fluid and are removed 24 to 48 hours later. Bed rest is required for the first two days and then the patient is gradually mobilised.
Sutures are removed 7 to 10 days after surgery. Return to full activity will take between four to six weeks. Swelling will take between 12 weeks to a six months to settle. Scars take up to one year to mature and fade.
In some cases, if the navel is placed very high and only the skin below it is lax, it may be possible to use a less extensive procedure called mini abdominoplasty. Apart from being less extensive it has the advantage of producing a shorter scar. This may be more suitable in younger women.
Abdominoplasty, like any other surgery, can produce complications and your surgeon will discuss these with you:
1. Bleeding: this usually occurs shortly after surgery and is one of the reasons why patients are kept in hospital for a minimum of 24 hours. It may necessitate removal of blood which has collected under the.
2. Infection: although very uncommon, this complication may need treatment with antibiotics and drainage.
3. Fluid collection: in some cases fluid can accumulate under the abdominal skin and will need to be drained on one or several occasions until no further fluid forms. This problem is usually of a self-limiting nature.
4. Poor wound healing: blood supply to the skin may sometimes be compromised because of tightness of wound closure or because of persistent smoking. This may slow healing and result in an unfavourable scar that may, at a later stage, have to be revised.
5. Scar: some patients may have a tendency to form thick or even keloid scars and these will require treatment with steroid injections, and may have to be revised at a later stage.