Article by Adam David Lowenstein, MD, FACS
Santa Barbara Plastic Surgeon
Abdominoplasty, also called a tummy tuck, is a plastic surgery procedure performed in order to remove excess skin and fat from the abdomen while tightening the abdominal muscles and repairing any weakness in the abdominal wall. It is an operation that requires general anesthesia in an operating room and should only be performed by an experienced plastic surgeon. In the Doctor’s hands, the abdominoplasty procedure often produces results that are dramatic and can create a significant improvement in lifestyle as well as body shape.
Who is a candidate for a tummy tuck?
The ideal abdominoplasty candidate is not significantly overweight, but has at least skin excess if not some fatty excess in the abdominal region. Even thin women who have had children can often see an excess in the abdomen after their pregnancy has stretched the skin in this area. Many mothers will also have a weakness in the central abdomen, between the “six-pack” muscles called the rectus abdominus muscles. This weakness, called a diastasis, results from stretching of the connective tissue between the muscles in the central abdominal wall. In these cases, a weakness in the abdomen can often be felt during a sit up or leg lift, and often patients will see a bulge in this area corresponding to the weakened tissue.
Because a tummy tuck removes tissue excess and additionally tightens and repairs the abdominal muscle, this operation may be indicated for mothers and non-mothers alike who have varying degrees of dissatisfaction in the abdominal region.
How is abdominoplasty performed?
The tummy tuck procedure begins in the consultation room on the morning of surgery. The Doctor will place pre-operative markings on your abdomen corresponding to the incisions to be made and the tissue to be removed. You will then be brought to the A AAAASF certified operating room and made comfortable while the appropriate anesthesia is administered. Once you are asleep, your abdomen will be cleaned and sterilized with Betadyne soap and solution, and sterile drapes will be placed around your abdominal region.
The abdominoplasty operation itself is begun with an incision in the lower abdomen that is brought down to the level of the abdominal muscles. At this level, the fat and skin are lifted away from the muscle layer. In order to free up the skin layer, an incision is made around the umbilicus or belly button, because the stalk of the belly button stays attached to the muscle layer. This can be thought of in a similar fashion to unbuttoning a button on your shirt- the button stays down but the button hole is freed.
Once the umbilicus is freed, the skin and fat is continually lifted away from the muscle layer up toward the upper abdomen. Now that the entire abdominal muscle layer is exposed, it can be repaired and tightened. Both temporary and permanent sutures are placed to bring each muscle toward it’s match on the opposite side, serving to tighten the abdomen and turn a rounded abdominal contour to a flat one. The skin is then stretched down toward the lower abdomen, and the excess is removed- like cutting off the bottom portion of an apron.
Before closure of the wounds, the Doctor carefully re-examines for bleeding and irrigates with antibiotic to minimize infection. Two drains are place into the wound and exit near the mons region in order to avoid fluid from collecting between the flat abdominal wall and the stretched skin. A new “button hole” is made fore the belly button to come through, and all of the wounds are closed with absorbable staples and sutures, with meticulous care to minimize scarring.
Because of the tight nature of your torso following your tummy tuck, you will find yourself flexed at the hip, in a seated position as you awaken from anesthesia. While you are sleeping, the staff will have placed you into a compression garment, similar to a girdle, to aid in comfort and healing in the postoperative period. The remainder of your stay with us that day will occur in the recovery room where you will enjoy a plush recliner and nursing attention to your every need.
Expectations after abdominoplasty or tummy tuck…
Following a tummy tuck by the Doctor, you will be asked to wear your compression garment for a few weeks to aid in healing. Your drains will need to be attended a few times each day to measure their drainage, and will be removed when they drain less than 30 milliliters in a 24 hour period. You will find that in the early postoperative period, you will be a bit hunched over because of the new tightness at your belly region, but over the next few days you will find yourself standing straighter and taller.
You will be given pain medications and antibiotics for comfort and safety, and will need some help at home in the early healing period as the Doctor will not want you doing much in the way of lifting. It will be very important that you walk around periodically and stretch your legs at least a few times each day.
Because an abdominoplasty is an involved procedure, you will be asked to limit your physical activity for the few weeks following surgery. After 3-4 weeks you will be able to gradually increase your level of exercise and after 6 weeks you will be ok to do whatever activities you like with your new body form. It is likely that one of your first activities will need to be buying some new clothes that fit the slim new you.