Abdominoplasty

An abdominoplasty can provide a functional and esthetic improvement of the abdomen. The abdomen becomes flatter and the waistline greatly improves.

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ABDOMINOPLASTY

Due to extreme weight loss, pregnancies, aging and surgery of the abdomen loose skin may develop into an apron. Excess skin can cause irritation and infections beneath the skinfolds. An abdominal apron can also impede on physical activity and sports. When the abdominal recti muscles have separated as a result of pregnancies the forces of the abdominal muscles can become less effective. This can influence your body posture and result in back pain. Also pressing will be less effective. Furthermore, scars and stretch marks can be unsightly. Loose abdominal skin can be corrected with an abdominoplasty, also referred to as a tummy tuck. It involves correction of skin, fat and if necessary, the diastasis of the recti muscles.

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DETAILS OF THE TREATMENT

THE FIRST CONSULTATION

During the first consultation the excess skin, subcutaneous and intra-abdominal fat is judged. Also, the presence and the extend of separation of the recti muscles is determined. Of great importance is that that your weight and general health is acceptable. If you are too heavy it is advisable to lose some weight prior to surgery. The result of your surgery will be better and the operative risks reduced. Smoking gives spasms of vessels which causes wound healing problems. It is advisable to stop smoking at least 4 weeks prior to and 4 weeks after surgery. An abdominoplasty does nothing for the flanks or “love handles”. Liposuction can be effective in improving the waistline further and can be performed at the same time (see Liposuction). An abdominoplasty will result in a lower abdominal scar from left to right that will be located under the bathing trunks, in the bikini line. There will also be a scar around the belly button that is pulled and stitched inward.

THE PROCEDURE

An abdominoplasty is normally performed under general anesthetic. The procedure takes about 2 hours. The abdominal skin is elevated from the lower abdomen up towards the ribs. The base of the belly button is mobilized from the skin and the stalk remains attached to the underlying abdominal wall. If the recti muscles are separated from each other, they are sutured back together in the midline. Subsequently the lower excess skin is removed, the upper abdominal skin is pulled downward and sutured. A small hole is made to suture the belly button back into the abdominal skin. Most of the time 2 drains will be placed through the pubis to evacuate any wound fluid. These drains will remain for a couple of days until there is minimal drainage.

AFTER THE PROCEDURE

If the recti muscles are sutured toward each other, you will feel discomfort. You will receive an abdominal binder for support when you start mobilizing the next day. You will be given injections to prevent thrombosis and will stay in hospital until you are fully mobilized. This binder needs to be worn as much as possible for the first 6 weeks and you are not allowed to do any heavy lifting or pressing. After drain removal, normally 2 to 3 days after surgery, you can go home. Sometimes the patient can go home with drains which are subsequently removed in the consulting rooms. If the recti muscles did not need to be sutured you can mobilize the same day and may be able to go home the same day with the drains. The stitches in the lower abdomen are dissolvable and the stitches in the belly button are removed after 2 weeks. Most people have recovered well after 4 to 6 weeks. Complete return to all physical activities and sports will be after 2 to 3 months.

RESULTS

An abdominoplasty can provide a functional and esthetic improvement of the abdomen. Irritations and infections due to the apron are resolved and the abdominal muscle strength is improved due to the plication of the recti muscles. The abdomen becomes flatter and the waistline greatly improves. Stretch marks and scars under the level of the belly button are removed, but the ones above it will be pulled down and are still visible. The pubis will be pulled upward, which will have a rejuvenating effect. There will however be a long scar in the lower abdomen, but this will be placed in the bikini line area. The scar of the belly button is small and is not very noticeable.

RISKS AND COMPLICATIONS

An abdominoplasty has similar risks as other surgical procedures. Thrombosis and pulmonary embolus are important complications in abdominoplasty that need to be prevented with injections until you are fully mobilized. Bleeding and infections can occur and will to be dealt with accordingly. A seroma is an accumulation of wound fluid under the skin that could develop after the drains are removed. This needs to be aspirated regularly at the consulting rooms. Wound healing problems can always occur, more often in smokers than non-smokers. The lower abdominal scar will always be visible and some people make better scars than others. Occasionally some excess skin remains on the sides. Normally this settles down, but sometimes needs to be excised. This can take place under local anesthetic as an outpatient. Another consequence of an abdominoplasty is that the skin below the belly button becomes temporary numb and in time the area of numbness becomes smaller.

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