Abdominoplasty

ABDOMINOPLASTY (Tummy Tuck, Surgery of the Abdomen)

What is an Abdominoplasty or “Tummy Tuck”?

Abdominoplasty also commonly known by the term “Tummy Tuck” is a surgical procedure which corrects loose or sagging skin from the abdomen, usually the lower part. This procedure can also correct the skin redundancy from the middle of the abdomen and occasionally the one that goes all the way to the back. The redundant skin and the stretch marks can be the result of weight fluctuations as a result of previous pregnancies. It can also be the result of significant weight loss as a result of dieting, stomach stapling, banding or bypass surgeries.

Contouring of the abdomen can be achieved using various techniques. If the problem is just redundant fat and the tone of the skin is good, then liposuction may achieve the desired effect. If the problem is both redundant fat and skin then a “tummy tuck” is the superior approach. With this technique both the redundant fat and skin can be excised in one procedure. During the same operation, if the abdominal muscles are found to have weakened as a result of previous pregnancies, they can be repaired. The weakness of the abdominal muscles is recognized by the bulging of the lower abdomen. This problem cannot be improved by exercising alone. With “tummy tuck,” the weak muscles can be tightened to make the lower abdomen flatter.

Abdominoplasty is not a substitute for weight loss. Although the results from an abdominoplasty are expected to be permanent, if one fluctuates in weight the results may not be ideal because the skin can stretch again. We, therefore, recommend that candidates for this procedure are those whose weight has stabilized and those who are not planning any new pregnancies.

Good candidates for this type of surgery are those who are:

1. Healthy adults with no serious medical illnesses.
2. People who do not smoke or are willing to discontinue smoking (as smoking is recognized to affect healing).
3. Women who are left with loose skin and stretch marks in the lower abdomen from previous pregnancies.
4. Men and women who have lost excessive weight due to dieting, exercising or stomach stapling, banding or bypass and are medically healthy.
5. Individuals with realistic expectations.

Although some scars from previous surgeries can be excised with this procedure, such as appendectomy or cesarean scars, some others especially those in the upper abdomen from previous gallbladder surgery may limit the potential results.

 

Where do I start?

We recommend an initial consultation in our office. In this consultation the plastic surgeon will learn what really bothers you about your abdomen. You will be educated about the procedure. There will be: 1) a frank discussion about your goals and expectations, 2) an assessment of your abdomen, 3) the options will be discussed with you and the most appropriate technique will be emphasized, 4) the expectations will be discussed as well as the potential complications, and 5) the general course of the treatment plan.

The Evaluation Process

During your evaluation process, you will be asked about your past medical and surgical history. It is important that you honestly disclose to your surgeon the requested information as they may have an impact on your “tummy tuck” results as well as the safety of the procedure overall. It is imperative that you disclose truthfully to your plastic surgeon any illnesses and all the prescribed medications you are taking as well as the ones you are taking “off the shelf” ie. non-prescribed medications such as herbal supplements, vitamins, etc. They too have interactions with medications and anesthetics you will be given at the time of the surgery. You will need to disclose alcohol, smoking, and drug consumption as well.

Safety in Abdominoplasty

Abdominoplasty (“Tummy Tuck”) is generally a safe procedure. It can remain so by following the instructions of your plastic surgeon. Dr.Thoma is a certified plastic surgeon by the Royal College of Physicians and Surgeons of Canada. This certification designates surgeons who trained in plastic and cosmetic surgery.

My Abdominoplasty (“Tummy Tuck”)

Your particular problem will be identified during the consultation and examination. The usual problems fall into the following four categories:

• Excessive skin and fat in the lower abdomen
• Loose and wrinkled skin in the lower abdomen
• Loose skin and multiple stretch marks in the lower abdomen
• Weakened muscles that make the lower part of the abdomen protrude. This is usually the result of previous pregnancies or aging.
• Any of the above and fat redundancy at the hips

Any of the above can be present and the abdominoplasty will take care of them. Stretch marks can be excised if they fall in the area of the redundant skin that is planned for excision. Fortunately, most of the stretch marks are located low in the abdomen, below the belly button which is the area that is excised. The overall intention is to provide a better profile and a firmer abdomen.

Along with the excision of redundant skin and fat, sometimes liposuction is added to take care of particular areas where there is fat redundancy and adding extensive scars is not appropriate. The liposuction can improve the contour of specific areas such as the hips where longer scars are avoided.

The decision for the scar length and the addition of liposuction will be dependent on your particular needs and will be discussed with you before the surgery.

Preparation for Abdominoplasty

Dr.Thoma will explain to you the procedure in detail. You will be told of the expectations of the surgery and the possible risks. You will be given specific details about what you should do the day before and the morning of the surgery. You will be instructed how to apply an abdominal binder over your abdomen which will control some of the discomfort. Before surgery or on discharge from the clinic, you will be given prescription for necessary medications. You will have the opportunity to talk to the anesthetist before the surgery as well. You will need to sign a consent form in preparation for the surgery. This will be required well before the surgery.

This operation is usually done under general anesthesia. On occasions when a “mini-tuck” is performed where the excision of skin is limited to the lower abdomen, this can be done under local anesthesia with the anesthetist providing some sedation to control your anxiety.

After Surgery

After surgery you will have dressings over the abdomen and a compression binder. This binder will control the swelling and support your abdomen while it heals. Two small drains will be left under the skin and you will be instructed how to care of them. These will be removed on your first post-operative visit in Dr. Thoma’s clinic. Upon discharge, you will be instructed again how to care for the dressings and binder. You will be told when to take the medications and who to call in the unlikely event of a problem. You will be given an appointment to see Dr. Thoma usually within one week.

Recovery Period

Some swelling and discomfort at the incision site are expected. This should improve day by day. The abdominal binder should control both the swelling and pain. It is important that you be up walking the same day as the surgery to avoid developing clots in the legs which can cause serious problems.

During the first post-operative visit the dressings will be removed and you can start having showers. Until then sponge bathing will be recommended. You will be expected to be up walking the same day as the surgery. Return to usual activities improves gradually. Unrestricted activities usually take 4 -6 weeks.

Expected Result

Although you will notice immediate improvement of the contour of your abdomen, the final result will be appreciated gradually over the next few months as the scars mature.

These are photos of Dr. Thoma’s patients. Written consent has been obtained to use them.