Abdominoplasty – Tummy Tuck Surgery

Over the past few decades, abdominoplasty, one of the most common procedures in the field of plastic surgery, has undergone significant changes. Over the years, the scar lines have been adapted to suit the fashion trend of the time, so that when the low bikini line (St. Tropez) was in fashion, the scar line was very low, but when the bikini line was raised (the Brazilian bikini), the scar line had to be suited to the new fashion trend.

Together with the fashion-based changes in the surgical techniques, the professional literature began to publish studies that discussed the pros and cons of the new methods, and primarily focused on the need to reduce the surgical complications. A better understanding of the anatomy and the development of surgical techniques that do not require extensive incisions, have led to a dramatic reduction in the prevalence of complications and to the desired aesthetic outcomes that we see today.

The purpose of Abdominoplasty

The purpose of tummy tuck surgery is to remove excess skin and fat in the area of the abdomen, to strengthen the abdominal wall muscles and to design the hip outline to better suit the other areas of the body.

Who is suitable for abdominoplasty?

Tummy tuck surgery is suitable for men and women who have a weakened stomach wall, excess skin, stretch marks or weak stomach muscles. The ideal patient is someone of normal height and weight (BMI), those who have lost weight (sometimes in a drastic manner) and the resulting excess skin looks like an apron around their stomach, or women after having given birth who do not plan to have any more children.

The most common reason for a weak abdomen (abdominal laxity) is multiple pregnancies. During pregnancy, the skin and stomach muscles are stretched beyond their biomechanical limit. Consequently, the elasticity that is necessary for the muscles to return to their previous state is damaged. In fact, the stomach’s straight muscles become weak and its structure becomes thinner. As seen following pregnancy, significant weight loss, through dieting or surgical procedure (gastric bands), is likely to contribute to large amounts of excess skin and weakening of the stomach wall.

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Who isn’t suitable for a tummy tuck?

Counter-indications (relative) to the surgery are scarring in the various abdominal areas, various medical conditions (cardiac patients, diabetes, obesity and heavy smoking), plans for additional pregnancies, earlier incidences of pulmonary embolism, extreme obesity [BMI over 40. The BMI is defined based on the ratio of weight (in kg.) divided by height (square meters)] and patients with unrealistic expectations.

Prevalence of the surgery

According to U.S. statistics, between 1997-2008, there was an increase of 333% in the number of tummy tuck surgeries.

Preparation for Surgery

Preparation for tummy tuck surgery is very important. There will be a need to focus primarily on the patient’s weight stability and lifestyle. The pre-operative evaluation will include taking a complete history of cardiac disease, diabetes, pulmonary embolisms, and previous surgeries (including laparoscopic procedures). Moreover, in the case of female patients, there is a need to determine whether other pregnancies are planned. In patients that have lost weight drastically, it is recommended to wait until their weight stabilizes before proceeding with the surgery. The medical examination will include an assessment of the abdominal structure, the amount and quality of the excess skin and the presence of stretch marks, assessment of the fatty component and its distribution in the abdomen and hips, ruling out lumps and/or hernias and the assessment of the abdominal muscles wall. Finally, there will be an assessment of the presence and location of previous scars. After all of this is examined, there will be a need to discuss the surgical methods with the patient and to suit the method to his/her expectations.

Additional preparations include routine blood tests (including coagulation functions), chest X-ray, EKG, and pulmonary functions if necessary. In the event that there is a suspected hernia, a general surgeon should be involved during the surgery in order to repair the hernia at the same time as the tummy tuck.

The surgical procedure

Prior to entering the operating room, surgical markings will be made on the patient’s body, while he/she is in a standing position. The tummy tuck surgery is performed under general anesthesia and lasts two-three hours. During the surgery, an incision is made along the bottom groin line (that stretches from one hip line to the other). This incision is made based on the location of the bikini line of the bathing suit usually worn by the patient. Through the incision, the skin and fat will be separated from the stomach muscle shell, up to the rib cage. When the navel is preserved, the shell of straight abdominal muscles will be sutured and brought closer, thereby strengthening the abdominal wall. Now the excess skin and fat (generally found between the navel and the scar line) are removed and the abdominal scar will be closed using layers of dissolvable sutures. At the end of the surgery, drains will be left and the stomach will be bandaged using a tight abdominal belt.

Hospitalization Days

In recent years, there have been many changes with regard to the hospitalization of patients following tummy tuck surgery. While in the past, it was customary for patients to stay in hospital for two days following surgery, currently, many medical centers around the world discharge the patient on the same day as the surgery. Studies recently published indicate the efficacy and safety of tummy tuck surgeries performed on an outpatient basis. These studies indicate that there is no correlation between the percentage of complications and the duration of hospitalization following surgery. Tummy tuck surgery has become an outpatient procedure in light of the changes in anesthetic safety and the post-surgical efficacy, as well as pain control (pain pumps and electromagnetic treatments).

The post-surgical procedure, recovery time and the final result

A few days following the discharge from the hospital, the drains will be removed. It is recommended not to lay in bed or to avoid moving around, rather to gradually return to your normal routine. A stomach belt is worn for a period of 2-3 months during the day. The belt is designed to reduce swelling and to accelerate the absorption of bodily fluids that accumulate in the surgical areas. Lifting heavy weights is not recommended, but the patient can return to work within two weeks from the date of surgery. It is generally recommended to return to gradual physical activity about 6 weeks following the surgery. The final result is usually apparent within 3 months after the surgery, when most of the fluids have been absorbed in the surgical area.

Side Effects and Complications

Although the prevalence of complications is generally low, complications may occur, such as the rupture of the surgical wounds, accumulation of fluids (seroma), bleeding, infections, hypertrophic scars (which protrude at the sides of the incision), sensory changes primarily in the lower abdomen. Rare complications include pulmonary embolisms, loss of umbilical tissue or skin necrosis, oversensitivity in specific spots (neuromas). Note that there are risk factors that may contribute to these conditions, including: diabetes, hypertension, high BMI, heavy smoking, or asthma and multiple surgeries at the same time that lengthen the duration of the surgical procedure). These conditions are not frequent during or following the course of the tummy tuck surgery.