What is an abdominoplasty?

An abdominoplasty, also called tummy tuck, refers to the removal of loose skin in the abdominal area. It may also include muscle tightening and liposuction of the love handles or flanks.  The idea of surgery is to improve the figure and slim the waist.  The results can be quite dramatic and improve self esteem.  Many men and women who have a tummy tuck will find their new bodies as an impetus to exercise and improve their diet. For some, it is a start to a new you.

Who are best candidates for abdominoplasty?

The best candidates for this procedure are those that are healthy and have loose skin in the abdomen or have loose muscles of the abdominal wall, have reasonable expectations, who can accept the trade off of a scar for a better figure, have the ability to refrain from strenuous activity or lifting heavy objects for a month, and are willing to accept the risks of the surgery which are explained below.

What are the risks of a tummy tuck?

Tummy tucks are very safe procedures in qualified individuals.  However, every surgery has risks that relate to anesthesia, the surgery itself, and post operatively. Anesthetic complications are exceptionally rare in the hands of qualified anesthesiologists. Before surgery, candidates will have blood work drawn and be cleared by a physician for surgery.  Any medications that can interfere with surgery or healing that can be safely withheld temporarily will be evaluated with a physician.

The surgery itself is remote from any major vessels or nerves leaving major bleeding complications or nerve injury exceptionally rare.  The most common complications include bleeding that may require a surgical intervention such as in the case of a hematoma, infection, healing problems, poor scars, and dissatisfaction with results. 

To combat these potential unfavorable results, antibiotics should given both before, during, and after surgery; proper patient selection must be obeyed as well as the avoidance of surgery with those who smoke, and proper tension must be placed on the incision; patients must be counseled on scar location and potentinal; candidates must understand some of the limitations of a tummy tuck including the possibility of loose skin on the hips and flanks if those areas are not addressed surgically, the location of scars, and the potential depending on skin elasticity of to some degree some laxity  to return months to years after surgery.

At what age are abdominoplasties performed?

Most patients that are good candidates for a tummy tuck are anywhere in their 30s and above.  Most of the changes of the body that cause excess skin or loose abdominal muscles are related to aging, massive weight loss, and pregnancy.

What are the different types of abdominoplasty?

To simplify this answer, “one”. Abdominoplasty refers to improving contour of the abdomen.  The “type” of surgery really relies on the “problem” and goals.  As a rule, the looser the skin, the longer the scar.  If the problem is just loose muscle, the incision (and scar) can be shorter.  One may read about high lateral tension abdominoplasty, fleur de lis abdominoplasty, and mini-tuck or min abdominoplasty.

A high lateral tension abdominoplasty (HLTA) places more tension over the outer or hip areas which may preferentially improve this area more than the center of the abdomen. In doing so, the scar may have to be longer.  Certain patients may benefit from this approach while others may not.

A fleur de lis abdominoplasty addresses both up and down vectors of skin laxity as well as side to side skin laxity. This method is best suited for those with very loose skin (as is the case with massive weight loss).  The downside of this surgical approach is the necessary vertical scar that runs down the middle of the abdomen.  This is a trade off that must be carefully considered.

A mini tuck refers to a smaller scar, usually in the range and size of a C-section scar.  This is best suited for those with little skin laxity.

One may read about an “umbilical float”. This type of approach will spare a scar around the belly button.  The ideal candidate for this will be someone who has rectus diastasis (loose abdominal wall muscles) with very little skin laxity.  With the umbilical float, skin resection will drop the belly button location a few centimeters.  Depending on the starting point of the belly button, this may or may not be a deal breaker for this type of surgery.

What is rectus diastasis?

Rectus diastasis refers to looseness of the abdominal wall musculature, the rectus abdominus.  This is the pair of muscles that create a six pack when the muscles are well developed beneath skin with little subcutaneous fat. With age, or more common pregnancy, these muscles will stretch and separate from the midline allowing the intra-abdominal contents to bulge.  Generally, exercise will not correct this. It is corrected with a diastasis repair with surgery, and important component of most abdominoplasties.

What happens to the belly button in an abdominoplasty?

For most patients with skin laxity, an incision will be made around the belly button.  The belly button will remain attached by its stalk to the abdominal wall.  The skin will be pulled over the belly button and excess skin will be cut. When the skin is sutured back together, a new hole will need to be created and the belly button will be pulled through this hole and secured.

In a small subset of patients, the belly button does not need to be cut out.  It is “floated” with the abdominal skin that is pulled down.  This spares the added incision and scar around the belly button, but it also lowers the belly button by a couple of centimeters. 

How much pain will I be in after an abdominoplasty?

Pain after surgery will be proportional to the extent of the surgery.  The most painful part of the procedure will be related to the muscle tightening.  Narcotics should be adequate in controlling post operative pain.  By three days, the pain should subside considerably.  At no point along recovery should pain be so great that it becomes debilitating.  In fact, one should be out of bed the next day ambulating.

How long will the results of a tummy tuck last?

Results will be permanent, meaning that the skin that is removed, fat that is sucked out, and muscles that are tightened should remain as such.  However, skin laxity can return to some degree.  This is somewhat predictable preoperatively. Those individuals who have lost massive weight and developed significant skin looseness possess different properties of their skin compared to those who have not seen such radical changes in weight.  The loss of the elastic properties in this group of people will contribute to the return – to some degree – of some looseness months to years down the road.  Fat cells that are removed with liposuction will not return.  However, significant weight gain will cause the remaining cells to enlarge.  Pregnancy will stretch out the muscle repair but not interfere with pregnancy itself. After pregnancy, the muscles may not return to their prior, tighter state.

How much downtime is associated with a tummy tuck?

For the most part, one should expect a week from work if no strenuous activity is involved. In the first week, one will have pain controlled with narcotics and may even walk a bit hunched over.  There will be surgical drains in place as well as a garmet  or binder.  One will be advised to sponge bathe only until the drains are out which is typically in a week.

If the muscles are tightened, one must be very cautious with exercise or strenuous activity for a minimum of four weeks.  Overdoing it before the muscles heal can cause the stitches to become undone.  This may be accompanied by a “pop” and pain and return of a bulge in the belly, which is an unwelcome event for both patient and doctor.

What men are good candidates for a tummy tuck?

Men generally don’t develop rectus diastasis to the same degree as women for the simple fact that men don’t get pregnant.  However, skin laxity and excess fat in the flanks are common enough. Healthy men who do not smoke, that have loose skin in the abdomen, can take some time off work,  and have reasonable expectations make ideal candidates for a tummy tuck.    

Will I have drains after an abdominoplasty and if so how long?

Yes. Generally two drains are placed and exit by the hips or in the pubic region. Drains are placed to collect the fluid that accumulates after surgery. Without drains, this fluid will likely not be reabsorbed into the body and accumulate under the skin.  A collection of fluid that won’t reabsorb is called a seroma.  Seromas can become infected or develop into firm scar tissue that can become visible.

A drain will likely be removed in the office if the output is less than 30 cc over 24 hours for two consecutive days.

Will I need to be asleep for the surgery?

Yes. Tummy tuck requires a general  anesthetic.  A tube will be placed down your throat to protect your airway while you sleep.  However, small revisions may not require a general anesthetic.

Is liposuction combined with a tummy tuck?

In most cases abdominoplasty will include liposuction of the love handles, flanks, and potentially lower back and other areas. Fat can then be injected into the buttock area in a procedure termed Brazilian Butt Lift or into the face or hands for rejuvenation, termed facial  fat grafting or fat transfer. Liposuction should not be performed in the upper central abdomen during the time of a tummy tuck because this could disrupt the necessary blood flow to the skin and compromise healing.  This is an important point to mention because if there is fat in the upper abdomen, this region will be moved to a lower position on the abdomen.  At a later date when one is healed, liposuction of this area can be performed.  Because in most cases the main problem area is the pudge below the belly button, upper abdominal liposuction would otherwise be inconsequential to the overall outcome anyhow.

Where are the scars located?

Tummy tuck scars run along the lower abdomen, as short as 10 cm or from hip to hip depending on the extent of the surgery.  The scars are placed low enough to be hidden with certain clothing.  There will likely also be a scar around the belly button.  In some cases, where the belly button is floated, this scar is absent.  However, most people are not candidates for an umbilical float, as it is called. In those people where not all of the skin is excised from the lower incision to the belly button, a small, 2 to 3 cm vertical scar will be left in the lower midline representing the closed hole that was cut out around the belly button.  This may be difficult to conceptualize, but your surgeon often has a good idea if you will be left with a  “belly button hole” scar.  It is a worthwhile discussion to have even though such scars heal very well and become virtually unnoticeable in many people.

Why is smoking bad for an abdominoplasty?

Smoking tobacco or even vaping, chewing nicotine gum, or wearing nicotine patches causes small blood vessels in the skin to shrink.  This can result in poor healing of incisions and skin loss.  There is no magic number of how many cigarettes, patches, or pieces of gum is too much. Nor is it clear how long one should avoid all nicotine products before surgery.  As a general rule, one should not ingest in any form any nicotine products for a minimum of 4 weeks before tummy tuck surgery.  The risks of wound dehiscence (incision separation) and belly button necrosis (death) is real.

It is not clear how much marijuana affects healing.  To be safe, it should be avoided as well.

When can I exercise after a tummy tuck?

One should refrain from exercise for at least 4 weeks after abdominoplasty.  Crunches, or sit-ups, should probably be avoided for at least 6 weeks if muscles were tightened (diastasis repair).  The risks of early exercise include bleeding, wound separation, and muscle repair disruption.  All three of these may prompt one to return to the operating room.

Why are there drains after a tummy tuck?

Suction drains are placed under the skin to prevent fluid from accumulating.  When fluid accumulates, it can become infected or cause internal scar tissue. Drains will reduce but not eliminate the possibility of fluid accumulation (seroma).  As a general rule, they will remain in place until their collection is less than 30 cc over 24 hours for 2 consecutive days each.  Output will slow to this amount usually by post operative day 7. When the drains are pulled, it is done so in the office and is usually painless.  After they are pulled, it is still possible fluid will accumulate.  Binders worn religiously help reduce this risk.  If fluid does accumulate after drains are pulled, your physician may decide to observe it with the hope that the body will reabsorb it, or drain it in the office.  Seromas are one of the most common complications after tummy tucks.

When will I see the results?

Results after tummy tuck may be seen immediately since in most cases large portions of tissue are removed.  However, one will be very swollen for weeks to months.  Garmets help reduce swelling.  Endermology  or cryotherapy may play roles in swelling reduction and should be discussed with your physician. The final results of a tummy tuck may not be evident for three months or more.

What is the difference between liposuction and tummy tuck?

Liposuction addresses fat and to a very minor amount, skin.  Abdominoplasty addresses fat, skin, and muscle.  Liposuction is best suited for those who have skin with good elasticity and very discrete areas of fat.  With liposuction, fat is literally sucked out.  The skin may tighten to a small degree but one should not expect that if one starts with loose skin and undergoes liposuction that one will heal with tighter skin.   For loose skin, the only good solution for tightening is excision. 

Abdominoplasty removes skin with its underlying fat and tightens the muscle.  In most cases, liposuction is included to narrow the waist or carve out the lower back to accentuate the buttock.  Fat that is removed from liposuction may be transferred into the buttock in what is often termed a Brazilian Butt Lift.

How do I know if I can have liposuction instead of a tummy tuck?

If you have skin that hangs, you will certainly at least need resection of the skin to flatten the abdomen.  In men and women with a pudge and tight skin, often liposuction alone will do the trick.  And of course there is that gray area where liposuction will improve the abdominal contour but perhaps not as much as a tummy tuck.  In cases like this, one has to weigh the trade off: scar and downtime versus shape.  Dr. Neavin will help you make the best decision.

Are tummy tucks safe?

Abdominoplasty is a very safe surgery in experienced hands.  Risk factors that may make the procedure less safe include smoking, obesity, other medications that may contribute to bleeding or clot formation, combination surgeries, recent travel, and other health problems such as diabetes.  All nicotine products should be suspended for at least 4 weeks prior to surgery.  This is because nicotine impairs healing.  Smoking, and for that matter nicotine patches and gum, are a contraindication for abdominoplasty surgery.

Can I get pregnant after a tummy tuck?

Yes. The ability to conceive and deliver a child is not complicated by a tummy tuck.

Are the results permanent?

The results are permanent in the sense that whatever skin was removed is gone forever.  And the muscles that were tightened should stay tight barring any rupture of stitches or pregnancy.  Future weight changes can impact results. Pregnancy will separate the muscles from the midline during gestation.

What if I have a hernia? Can I still have a tummy tuck?

There are many different types of hernias.  The two that are most related to abdominoplasty surgery are umbilical and ventral.  These hernias may be addressed during abdominoplasty.  If a ventral hernia is unusually large in which there is what is called “a loss of domain”, then it may be unwise to combine a tummy tuck with such a larger hernia.  Loss of domain refers to a situation where the intestines are not supported by the abdominal wall and tend to “spill” outside of it.  A cat scan can often determine how large a hernia may be.  Significant hernias may require mesh for support.

Is it possible to have an attractive belly button after surgery?

Yes. There are several methods to construct a belly button with abdominoplasty.  While healing and scarring are two determining factors that are somewhat unpredictable at times, belly buttons can be created to be hidden rather well for most people.  In addition, simple revisions to improve their appearance can be made esily in the office under local anesthesia.

What happens if I gain weight after abdominoplasty?

It isn’t terribly uncommon for men and women to gain weight as they age. With weight gain, fat will be distributed normally throughout the body.  Small changes in weight will have no impact on the abdominoplasty. Large gains in weight or weight loss will affect the tissues to an unpredictable degree depending on a number of factors.

What can I do to improve the scars after tummy tuck?

Scars from tummy tucks are not avoidable.  They fade over time.  In some people, they become virtually invisible.  For most people, however, the scars are visible to some degree.  Scars are a normal part of healing.  When tissues heal under tension, as in the case with a tummy tuck, the scars can widen.  To counteract this force, silicone sheeting in the post operative period may be helpful.  When scars become very thick or hypertrophic, Dr. Neavin generally injects them with a solution to shrink them.  After 6 months, scars can be revised in the office under local anesthesia.  However, most people are satisfied with the scar after surgery.

What is a mini tuck?

A mini-tuck often refers to the resection of skin only.  Mini-tucks generally do not include dissection all the way up to the sternum and plication of the muscles.

Will a tummy tuck remove stretch marks?

It is possible that an abdominoplasty will involve the resection of tissue that includes stretch marks.  If the stretch marks extend well above the belly button, it is unlikely that all of the stretch marks will be removed.  They may be stretched as they are pulled down to the waist.

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