A flat and well-toned abdomen is something many of us strive for through exercise and weight control. Sometimes these methods cannot achieve our goals. Even individuals of otherwise normal body weight and proportion can develop an abdomen that protrudes or is loose and sagging. The most common causes of this include:
- Significant fluctuations in weight
- Prior surgery (e.g. caesareans, laparscopies, laparotomies)
- Existing abdominal hernia
Also known as a tummy tuck, an abdominoplasty removes excess fat and skin, and in most cases restores weakened or separated muscles creating an abdominal profile that is smoother and firmer.
What it won't do: An abdominoplasty is not a substitute for weight loss or an appropriate exercise program. Although the results of an abdominoplasty are technically permanent, the positive outcome can be greatly diminished by significant fluctuations in your weight. For this reason, individuals who are planning substantial weight loss or women who may be considering future pregnancies may be advised to postpone an abdominoplasty. Also, an abdominoplasty cannot correct stretch marks, although these may be removed or somewhat improved if they are located on the areas of excess skin that will be excised, generally those treated areas below the belly button.
Procedural Steps - What happens during tummy tuck surgery?
Abdominoplasty is done under a full general anaesthetic. Medications are administered for your comfort during the surgical procedures
A full tummy tuck requires a horizontally-oriented incision in the area between the pubic hairline and navel. The shape and length of the incision will be determined by the degree of correction necessary.
Through this incision, weakened abdominal muscles are repaired and sutured and excess fat, tissue and skin are removed. A second incision around the navel may be necessary to remove excess skin in the upper abdomen.
Repair of Abdominal Muscles
In some individuals (especially those post multiple pregnancies), the rectus abdominus muscle may sit far apart (diastasis or diverication of rectus). This is approximated with permanent sutures during an Abdominoplasty. Sometimes, laxity of the lateral abdominal muscles is also present, which can be tightened using permanent sutures for muscle plication. Rarely there is a horizontal excess that contributes to a bulge, this also is strengthened and repaired.
Repair of Abdominal Hernias
Co-existing with a weak abdomen wall or in particular, with previous abdominal surgery, weakened areas on the abdominal may be associated with herniation of intra-abdominal contents. This may be protrusion of the fat surrounding the bowels or even the bowel itself. Usually, these protrusions occur between layers of the abdominal muscles, or at a weak point such as around the belly button, or even through a previous abdominal surgery site. During the repair, the hernia will be pushed back and the weakened area oversewn. At times, the abdominal defect is large enough to warrant placement of mesh. The mesh is like a flat piece of fishing net made of a mix of dissolving and non-dissolving suture material; this is sewn into the abdominal wall to reinforce its strength as well as preventing future herniation of intra-abdominal contents.
With Additional Liposuction
Sometimes additional liposuction is used during an abdominoplasty to assist in creating a better contour for you. Concurrent liposuction is commonly used, especial for those with excess hip or thigh volume. It is also useful for flanks and upper abdominal fat.
Closing the Incisions
Sutures and skin tapes are used to close the skin incisions.
To watch an animated demonstration of abdominoplasty, please click here
Specific Risks of abdominoplasty
The decision to have an abdominoplasty is extremely personal and you'll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Dr Vrtik or our staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.
Possible risks of abdominoplasty include:
- Unfavourable scarring
- Bleeding (hematoma)
- Fluid accumulation
- Poor wound healing
- Skin loss
- Necrosis or loss of the umbilicus (belly button)
- Blood clots
- Numbness or other changes in skin sensation around the scar and on the abdomen
- Anaesthesia risks
- Skin discoloration and/or prolonged swelling
- Fatty tissue found deep in the skin might die (fat necrosis)
- Major wound separation
- Recurrent looseness of skin
- Pain, which may persist
- Deep vein thrombosis, cardiac and pulmonary complications
- Persistent swelling in the legs
- Nerve damage
- Possibility of revision surgery
- Suboptimal aesthetic result
Most of the risks are very uncommon, and some people (with particular health problems or specific body shapes), may be at higher risk for specific complications. Dr Vrtik will discuss this with you during your consultation if any of these risks are specifically pertinent to you.
Although abdominoplasty surgery can be an effective procedure where the benefits significantly outweigh the risks, like everything in the practice of medicine and surgery, it is not an exact science. The degree of surgical success can be altered by how each individual's body responds to surgery and healing. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure; revision surgery may be necessary.
Be sure to ask questions: It's very important to ask questions about your procedure. It's natural to feel some anxiety, whether it's excitement for your anticipated new look or a bit of preoperative stress. Don't be shy about discussing these feelings and any specific concerns with Dr Vrtik or any of our staff members.
Following your surgery, dressings are applied to your incisions, and you will be wrapped in an elastic foamy tape to minimize swelling and to support your abdomen as it heals. Two draining tubes will be placed under the skin to drain any excess blood or fluid that may collect.
You will be put placed in a bent position with pillows under your legs to prevent excessive stretching force on your wound. In-hospital physiotherapist will also teach you how to get out the bed to minimise straining of the abdominal muscles and skin. Your posture will often be hunched over for at least 2 weeks. Hospital stay varies from 3-5 days depending on the drains. Once drainage has stopped, the tubes will be removed. Often, your dressings will be replaced by a garment prior to your discharge. Restrictions after an abdominoplasty include no driving for 2 weeks and no lifting or heavy activities for 8 weeks.
To find out more about postoperative care, please click here.
The Costs associated with Abdominoplasty
Most private health insurance plans will not cover Abdominoplasty. However, there are specific criteria for a medicare item number in patients who have had massive weight loss, which may make you eligible for a rebate from your private health fund for hospital, surgical and anaesthetic fees. An application may need to be lodged with pre-operative photographs to Medicare in some borderline cases. You must carefully review your health insurance policy to make sure that you are covered for plastic surgery. Use the item number given to you when you talk to your insurer.
Results and Expectations
Your abdominoplasty surgery will result in a flatter, firmer abdominal contour that is more proportionate with your body type and weight. The final results may be initially obscured by swelling and your inability to stand fully upright until internal healing is complete.
Previous abdominal surgery may limit the potential results of a abdominoplasty. In women who have undergone caesarean section, the existing scars may often be incorporated into the new scar. As for those who have had a midline incision extending above the umbilicus (belly button), a midline scar will be present in addition to the lower horizontal scar.
Within a week or two, you should be standing tall and confident about your new slimmer profile. This result should be lasting. As mentioned before, any significant change in weight or pregnancy may compromise your long-term result.
Vocabulary to know
- Abdominoplasty: A surgical procedure to correct the apron of excess skin hanging over your abdomen.
- Diastasis: Condition in which abdominal muscles have separated.
- General anaesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
- Haematoma: Blood pooling beneath the skin.
- Hernia: protrusion of abdominal contents (fat and bowel) through or between the abdominal muscles causing a lump or bulge of the abdomen.
- Liposuction: Also called lipoplasty or suction lipectomy, this procedure vacuums out fat from beneath the skin's surface to reduce fullness.
- Sutures: Stitches used by surgeons to hold skin and tissue together.
- Tummy tuck: A surgical procedure to correct the apron of excess skin hanging over your abdomen.
- Umbilicus: the belly button.
(Some Information & Illustrations are courtesy of the American Society of Plastic Surgeons).