Abdominoplasty, commonly known as a “tummy tuck” is a major surgical procedure which flattens your abdomen by removing extra fat and skin and tightening abdomen muscles. Abdominoplasty can dramatically reduce the appearance of a dropping or protruding abdomen.
Significant weight reduction
Diastasis of rectus abdominis muscle and weakening of abdominal wall
The reason of a drooping or protruding abdomen is mostly a big change of abdomen’s weight or volume. In women it is mostly after pregnancy or weight reduction, when the skin is often damaged by striae, it does not adjust and remains in excess. It can also be a functional disorder of abdominal wall when the rectus abdominis muscle weakens and the abdominal wall is loose. There creates a gap (diastasis) between this muscle, which causes the already mentioned drooping or protruding abdomen. The plastic surgery reduces the gap between rectus muscles, removes excess skin and moves the navel.
Male Tummy Tuck
Tummy tuck is also an alternative for men that were obese at one point in their lives and they still have excess skin in abdominal area after weight reduction. In men the fat is often deposited in the abdominal cavity and not in the dermis. It is important to have in mind that abdominoplasty does not solve this problem.
When is liposuction sufficient and when do I need a tummy tuck?
Liposuction is sufficient when the skin is in good shape with no scars (striae). When there is not much excess skin and muscle diastasis. The procedure is far less invasive compared to abdominoplasty. Today there is a great number of clients that undergo liposuction so we know a lot about the healing process of the dermis after this surgery. Liposuction is more often recommended, mainly to younger people with more elastic and adjustable skin.
What does abdominoplasty (Tummy Tuck) include?
Skin and fat reduction in the lower part of abdomen
Skin and fat reduction in the entire area of abdomen
Skin and fat reduction including plastic surgery of rectus abdominis muscle
Abdominoplasty is a surgery under general anesthesia with muscle relaxation. It is forbidden to eat at least 12 hours before the surgery. It is an abdominal surgery with higher risk of embolism, that is why an adequate intake of fluids is necessary, together with bandage of legs to prevent thromboembolism. The patients have to stay in hospital at least for two days after the surgery, they have drains inserted for this time. The pain is reduced by opiates and the drains are removed on the second or third day. The client is invited for the first rebind after a week, other visits are planned individually according to the wound healing by a surgeon.
Complete abdominoplasty usually takes two or more hours, depending on the extent of the procedure.
Identification of the to-be-operated area
Nowadays abdominoplasty is often associated with suction-assisted liposuction (SLA). A suction pump is inserted before the actual incision into the area of future scar and the subcutaneous fat is sucked out. If a greater skin resection is planned we have to count with moving the navel scar back to its natural position. At first we ensure free move of navel scar in the surrounding tissue by round incision. After that the surgeon most often makes a long incision from one hip bone to the other, just above the pubic area. Next, the surgeon separates the skin from the abdominal wall all the way up to the ribs and lifts it. That reveals the vertical abdominal muscles. These muscles are tightened by pulling them closer together and they are sutured into their new position. This provides a firmer abdominal wall and narrows the waist.
The skin excess is then pulled down and removed. A new hole is cut for the navel, which is then stitched in place.
The wound is closed in several layers, mostly with absorbable stitches. Drainage is inserted under the skin and the abdominal wall is relieved by compressing bandage which is recommended for a month.
A part of abdominoplasty is in most cases lipectomy - surgical excision of subcutaneous fatty tissue. Your surgeon may elect liposuction as a part of abdominoplasty for the best results.
This procedure is somewhere between the complete surgery and mini abdominoplasty. The incision is shorter, does not reach the lower part of hip bone only its top, which means 0-15 cm less than by complete surgery. The surgeon is able to tighten the loose abdominal wall with the sutures up to the navel. It is important to sleep half-seated during the first night. This type of surgery is suitable for patients with loose abdominal wall in the area of navel and fat prolapses in the lower part of abdomen.
Partial abdominoplasty (Mini abdominoplasty)
Partial abdominoplasty is often performed in patients with fat deposits located in the dermis in the lower part of abdomen. The advantage is short incisions. Mini abdominoplasty takes approximately one hour. It is not suitable for patients with extra skin excess. The incision is in shape of ellipse approximately 5-10 cm long. It is located in the line of pubic hair. The surgeon can solve loose muscle in the lower abdomen not the diastasis of rectus abdominis muscle though. The patient sleeps half-seated the night after the surgery. There is also endoscope type of mini abdominoplasty. The scars are only three points of one cm in average. Those are scars after inserted endoscopes (devices containing camera, work instrument and light). The surgeon performs the surgery without directly accessing the operated area. The client cannot count with resection of skin excess in this type of surgery. It is therefore suitable for skinnier patients with main problem of diastasis of abdominal muscles.
There is also method called reverted abdominoplasty. It is used mostly in patients with fat deposits in the upper part of abdomen.
There is also surgery called umbilicoplasty (plastic surgery of belly button). The surgery is not complicated, it is performed under local anesthesia and the scar is only inside the navel. By this surgery the belly button is not moved from its place but its shape is changed. Most of the patients request to modify navel that curves outward.
Who is a suitable candidate for abdominoplasty?
Abdominoplasty is suitable for men and women with a good general state of health. Their fat deposits are caused mainly due to genetic and hormonal disposition. Even relatively slim people can have big fat deposits in abdominal area. Patients who intend to loose substantial part of their weight should postpone the surgery.
This surgery is particularly helpful for women who, after multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where it can return to normal. Women who still plan to have children are recommended to postpone the surgery. However, the surgery does not hinder another pregnancy and childbirth. If you are less than a year after the childbirth, postpone the surgery and give time to your body to recover. Do not plan the surgery if you still breast feed.
Even elderly clients with loss of skin elasticity can improve substantially the look of their abdomen.
You can even support the effect of abdominoplasty with liposuction of subcutaneous fat in the area of thighs. These two procedures are not performed at the same time. Both are pretty complicated and therefore most of the surgeons prefer to perform them separately. There are more reasons to it, those are very painful surgeries in a relatively large extent, where we fear significant complications.
Through abdominoplasty, you can get rid of scars (after Cesarean section etc.) after previous surgeries in lower part of abdomen. Abdominoplasty causes a long scar which is the price to be paid for a flat abdomen. The scar is usually hidden under the underwear.
During you initial consultation, the surgeon will evaluate your state of health, determine the extent of fat deposits in your abdominal area and carefully assess your skin tone. During the consultation the surgeon will take a picture of you from front and side. They will be used to plan the surgery. Be sure to tell your surgeon if you smoke or take any medications, vitamins or other drugs.
Be open when discussing your expectations with your surgeon. He/she must be able to describe to you all possibilities and risks, including the limitations of each procedure. Abdominoplasty is a severe surgery, therefore take your time and do not rush with your final decision.
Your surgeon will give you instructions to prepare for surgery, including guidelines on eating, drinking, smoking and taking or avoiding certain medications and vitamins. You may be asked not to use any medications containing acetylsalicylic acid (such as Acylpirin, Aspirin, Alnagon, Mironal etc.). They can increase bleeding during and after the surgery.
It is assumed that no acute illness occurred in the period of at least three weeks before the planned operation (viral illness, cold etc.). Report any illness to your surgeon. Avoid overexposure to sun before the surgery, especially to your abdomen and do not go on a strict diet, both can limit your ability to heal.
Scars in the lower part of abdomen are mostly removed by skin reduction. Complications may occur in scars in the upper part, there it may come to purulence and necrosis of tissue. Sometimes the shift of navel is complicated and the surgeon must create another horizontal scar. Abdominoplasty is an extensive procedure and therefore it is associated with severe and less severe complications such as: bleeding, bruises, infection. The patient is warned on the possibility of loss of perception in the operated area. Often it is only temporary complication caused by small damage of superficial nerves. Another possible complication is opening of the wound. By large abdominoplasty there is a danger of asymmetry of the abdomen after the procedure or asymmetric placement of the navel. Surgeons also fear keloid scars (scars with overgrowth of tissue) or creation of pseudocysts (that is frequent, not severe complication in the place of surgery, the tissue is shifted and that forms small spaces that fill with liquid).
How long will the effect of abdominoplasty last?
The results of either complete or partial abdominoplasty are usually effective. In most cases, the results are long lasting, if you follow a balanced diet and exercise regularly. Having tummy tuck does not mean that there will never form fat deposits in this area.
Health insurance contributes only on surgery of abdominal wall, which seems to be a solution to diastasis of abdominal muscles or abdominal hernia. These surgeries are not comparable to abdominoplasty. Correction of diastasis is performed through vertical incision in the centre line or in the area of navel.