Tummy Tuck

There are a number of reasons you might have excess fat, poor elasticity of the skin or weakened connective tissue in your abdomen. These include:

• Significant changes in weight
• Pregnancy
• Abdominal surgery, such as a C-section
• Aging
• Your natural body type
• A tummy tuck can remove loose, excess skin and fat, and tighten weak fascia. A tummy tuck can also remove stretch marks and excess skin in the lower abdomen below the bellybutton. However, a tummy tuck won’t correct stretch marks outside of this area.
• If you’ve previously had a C-section, your plastic surgeon might be able to incorporate your existing C-section scar into your tummy tuck scar.
• A tummy tuck can also be done in combination with other body contouring cosmetic procedures, such as breast surgery. If you’ve had fat removed from your abdomen (liposuction), you may decide to have a tummy tuck because liposuction removes tissue just under the skin and fat but not any excess skin.

• Plan to lose a significant amount of weight
• Might consider future pregnancy
• Have a severe chronic condition, such as heart disease or diabetes
• Have a body mass index that’s greater than 30
• Are a smoker
• Had a previous abdominal surgery that caused significant scar tissue

A tummy tuck poses various risks, including:

Fluid accumulation beneath the skin (seroma). Drainage tubes left in place after surgery can help reduce the risk of excess fluid. Your doctor might also remove fluid after surgery using a needle and syringe.

Poor wound healing. Sometimes areas along the incision line heal poorly or begin to separate. You might be given antibiotics during and after surgery to prevent an infection.

Unexpected scarring. The incision scar from a tummy tuck is permanent, but is placed along the easily hidden bikini line. The length and visibility of the scar varies from person to person.

Tissue damage or death. During a tummy tuck, fatty tissue deep within your skin in the abdominal area might get damaged or die. Smoking increases this risk. Depending on the size of the area, tissue might heal on its own or require a surgical touch-up procedure.

Changes in skin sensation. During a tummy tuck, the repositioning of your abdominal tissues can affect the nerves in the abdominal area, and infrequently, in the upper thighs. You’ll likely feel some reduced sensation or numbness. This usually diminishes in the months after the procedure.

Like any other type of major surgery, a tummy tuck poses a risk of bleeding, infection and an adverse reaction to anesthesia.

A seroma collection or hematomas is considered a relatively common complication after surgery, and occurs in up to a third of cases.

If left untreated, it can lead to necrosis of the flap due to insufficient blood supply or inflammation that can damage the flap and be life-threatening.

The placement of closed suction drainage systems can help reduce the incidence of this fluid build-up, although high-quality data is not available to demonstrate effectiveness.

Injury to the vessels of the navel is an important complication that must be avoided. Care should be taken to maintain an adequate amount of fat around the navel to maintain an adequate blood supply.

Complications from superficial wounds remain the most common complication of this patient group

Initially, you’ll talk to a plastic surgeon about a tummy tuck. During your first visit, your plastic surgeon will likely:

Review your medical history. Be prepared to answer questions about current and past medical conditions. Talk about any medications you’re taking or you have taken recently, as well as any surgeries you’ve had.

Tell your doctor if you are allergic to any medications. If your desire for a tummy tuck is related to weight loss, your doctor will likely ask detailed questions about your weight gain and loss.

Do a physical exam. To determine your treatment options, the doctor will examine your abdomen. The doctor might also take pictures of your abdomen for your medical record.

Discuss your expectations. Explain why you want a tummy tuck, and what you’re hoping for in terms of appearance after the procedure. Make sure you understand the benefits and risks, including scarring. Keep in mind that previous abdominal surgery might limit your results.

Before a tummy tuck you might also need to:

Stop smoking. Smoking decreases blood flow in the skin and can slow the healing process. In addition, smoking increases the risk of tissue damage. If you smoke, your doctor will recommend that you stop smoking before surgery and during recovery.

Avoid certain medications. You’ll likely need to avoid taking aspirin, anti-inflammatory drugs and herbal supplements, which can increase bleeding.

Maintain a stable weight. Ideally, you’ll maintain a stable weight for at least 12 months before having a tummy tuck. If you’re severely overweight, your doctor will recommend that you lose weight before the procedure. Significant weight loss after the procedure can diminish your results.

Take medication to prevent complications. Shortly before your tummy tuck, you’ll need to begin taking an anticoagulant to prevent blood clotting.

Arrange for help during recovery. Make plans for someone to drive you home after you leave the hospital and stay with you for at least the first night of your recovery at home.

A tummy tuck is done in a hospital or an outpatient surgical facility. During a tummy tuck, you’ll be under general anesthesia — which makes you completely unconscious and unable to feel pain. In some cases, you might be given a pain-relieving medication and be moderately sedated (partially asleep).

There are a number of different procedures for a tummy tuck, depending on the extent of change you would like to see. During the typical tummy tuck, your plastic surgeon makes incisions to remove most of the skin and fat between your bellybutton and pubic hair in a horizontal oval or elliptical shape. Connective tissue (fascia) that lies over the abdominal muscles is then tightened with permanent sutures.

Your plastic surgeon will then reposition the skin around your bellybutton. Your bellybutton will be brought out through a small incision and sutured in its normal position. The incision from hip to hip above the pubic hair will be stitched together and will leave a scar that falls along the natural crease within the bikini line.

During the procedure you might be given an antibiotic to prevent infection.

The procedure typically takes about two to three hours.

After a tummy tuck, your abdominal incision and bellybutton will likely be covered with surgical dressing. Small tubes might be placed along the incision site to drain any excess blood or fluid.

Members of your health care team will help you walk as early as the first day after a tummy tuck to help prevent the formation of blood clots.

You’ll likely feel moderate pain, which will be controlled by pain medication. It’s normal to have swelling in the surgical area.

Drains might be left in place for several days after surgery. Your doctor or another member of your health care team will show you how to empty and care for your drains. You might need to continue taking an antibiotic as long as the drains are in place.

Your surgeon might also prescribe a blood-thinning medication for a short time after your tummy tuck.

You’ll wear a supportive abdominal garment (abdominal binder) for about six weeks after your tummy tuck. This helps prevent fluid buildup and provides abdominal support while you heal. Your doctor will explain how to care for your scar.

For the first six weeks after a tummy tuck, you’ll need to be careful when moving around. You’ll also need to avoid positions that strain your incision line — such as quickly bending at the waist — to prevent the reopening of the wound.

You’ll need to schedule regular follow-up visits. Ask your doctor how often you need to be seen.

Postoperatively, it is important that the patient remains in a flexed (Semi-Fowler) position for 2 weeks. This positioning helps avoid excessive straining on the incision and reduce the risk of hypertrophic scar formation. A belt lipectomy can be considered in patients with significant flank, buttock, and thigh fat. This is a circumferential lipectomy which can add the benefits of a thigh and buttock lift to the abdominoplasty. Closed suction drains and oral antibiotics are used at the discretion of the surgeon but have shown only anecdotal benefits in preventing infection and other complications such as seroma and hematoma formation.

By removing excess skin and fat and strengthening your abdominal wall, a tummy tuck can give your abdomen a more toned and slimmer appearance.

Tummy tuck results are usually long lasting if you maintain a stable weight.