What do we need to know about abdominoplasty?
 A tummy tuck is a major surgical procedure that tightens abdominal muscles and gets rid of excess skin and fat.
The purpose is to change your body shape, not to lose weight. If fat is localized in the abdomen, but there is no excessive skin, then liposuction is an alternative to a tummy tuck.
Tummy tuck surgery is to enhance the body shape, but it cannot create a perfect shape. You should have realistic expectations and understand that a tummy tuck is not a "quick fix" or a substitute for diet and exercise.
Who are the best candidates for abdominoplasty?
Candidates for abdominoplasty can be both men and women who want to get rid of excess skin and fat that cannot be removed by diet or physical exercise. From this operation, women can benefit who, owing to multiple pregnancies, or putting on and losing weight several times, evince abdomen muscles that are stretched too wide apart. Through this surgery, the stretch marks and the scars under the navel can be removed.
Abdominoplasty may not be carried out on women who wish to become pregnant again or on patients who intend to follow one or more slimming diets.
Who should postpone a tummy tuck?
Women who are considering future pregnancies often postpone the surgery until after their final pregnancy. The muscles that are repaired during the tummy tuck procedure can separate again during pregnancy. There may be other reasons to postpone a tummy tuck procedure, which your doctor can determine.
Instructions before surgery
- Do not eat and drink anything six hours before the surgery.
- Do not take aspirin or any medicine containing aspirin for two weeks before the surgery.
- The surgery of women must be performed outside the menstrual period.
- Inform your surgeon and anesthesiologist about your medical problems: hypertension, vascular problems, heart failure, diabetes, lung problems, bleeding problems, epilepsy, neurological problems, allergies to certain drugs, etc.
- Tell your surgeon if you’re wearing dental prosthesis or contact lenses.
- For smokers, please stop smoking for two weeks before surgery and avoid smoking at least two weeks after surgery;
- Avoid extra exposure to sun before and after the surgery.
- Do not keep a strict diet before the surgery because it may delay the healing procedure.
- Should you catch a cold or have any kind infection, the surgery must be postponed.
The procedure
 Abdominoplasty is usually performed under general anesthesia, but it can also be performed under local anesthetic with a sedative. Time in surgery is about two to five hours depending on the extent of surgery.
It begins with a long incision across the abdomen, immediately above the pubic area, from hip bone to hip bone. A second incision is made to free the navel from the abdominal tissue.
The skin is separated from the abdominal wall, up to the ribs, exposing the vertical abdominal muscles (rectus muscles).
The rectus muscles are then stitched into a new position, tightening the muscles and reducing the waistline. After the muscles have been repositioned and the abdominal wall skin tightened, the excess skin will be stretched and removed, and a new hole is formed to place the navel proportionally. Finally, the cut is stitched and a couple of drain tubes will be left on the spot for several days.
Hospitalization after a tummy tuck surgery
A tummy tuck is a major surgical procedure, and you can expect a considerable recovery time compared with other plastic surgeries. Your abdomen will be swollen and moderately sore for the first few days. Most people require one to three weeks before returning to work and a normal schedule. Tummy tuck patients may spend more days in the hospital depending on the extent of the procedure in order to keep complications down to a minimum. In this time, the patient will wear a bandage and an elastic girdle. Your surgeon will prescribe pain medication, anti-thrombotic medication and antibiotics. Right after the day of the operation the patient will be encouraged to exercise comfortably in order to avoid thrombo-embolical complications.
Post-surgery recovery
Stitches will be removed two to three weeks after the surgery. The patient must wear the girdle for a couple of weeks after the stitches have been removed. Recovery after abdominoplasty varies individually. Some patients return to work two weeks after surgery, others later. Light physical exercise is recommended in order to strengthen the abdomen muscles. The abdominal scars will appear to worsen during the first three to six months, and may take nine months before they flatten and lighten in color. They never completely disappear, but they are in a location that can be easily hidden by clothing.
We recommend avoiding sun exposure one year after the surgery or your scars may turn darker. In order to maintain the obtained results it is important that you should follow a diet and take up a sport.
Expectations
All patients must have realistic expectations. The repair and tightening of the abdominal muscles, along with the removal of the excess skin, may greatly improve body contour and appearance, and it may improve your self-confidence. However, you must be aware of the fact that the surgery cannot bring back your youth or create the ideal figure.
Abdominoplasty does produce a permanent scar, typically across the full width of the bikini line. However, the goal during the procedure is to make the incision in a natural crease and location that is easily hidden by clothing.
Surgeons usually have before-and-after photos so you can see the results of other patients and learn more about your expected outcomes. The surgeon can explain the details of the procedure, the type of anesthetic to be used, the extent of skin removal and muscle repair, and the expected recovery period.
Complications
There is no surgery without risk. As it is a large scale operation, the risks should be discussed in detail with the surgeon and the anesthesiologist before the operation.
Besides the risks that any complete anesthesia may involve, infections, hematoma, embolic conditions or bad looking scars may occur.
- One of the most possible complications is bleeding that generally occurs in the first 24-48 hours.
- Another problem can be skin necrosis (the stretching may hinder the circulation). Skin necrosis is also a serious complication caused by damage to the circulation. Most commonly it occurs under the navel in a small area, but in serious cases it can be palm-sized or larger. Normally, it recovers spontaneously, but the healing may take months. The area involved will differ in its color and condition from the surrounding healthy skin.
- In the first weeks, increased production of mucus and serum can cause problems.
- Thrombus-embolism is the most dangerous life threatening complication. The reasons may be the large wound surface, obesity, smoking, lack of exercise and varicose veins. A blood clot in smaller veins may get into the main circulation and possibly cause severe occlusion in the lungs.
- In the first weeks, the possibility of inflammation also endangers the health of the patient. This may lead to intense suppuration and development of abdominal abscesses.
- The quality of wound healing is significantly affected by the long line of incision. The wound may often widen and abnormal scar formation (keloid) may sometimes occur.
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