Tummy Tuck (Abdominoplasty)
WHO IS A CANDIDATE?
If your abdominal skin is stretched out, it may droop down or collect as folds on the lower tummy, and an abdominoplasty can help. Some people even get yeast infections under the sagging skin, which can be hard to keep dry, and surgery can eliminate the skin "apron" that allows this to happen. Also, if your abdominal muscles are soft and the tummy bulges forward, even without your having overlying fat, an abdominoplasty can make the tummy flatter and tighter.
WHAT CHANGES ARE EXPECTED?
The abdomen is less bulging, flatter. The skin is tighter. Although there is no good treatment for stretch marks, an abdominoplasty removes skin from the lower abdomen, sometimes all the way from the pubic area to the belly button, so the stretch marks that are on this skin patch will be discarded with the skin. The skin (and the stretch marks on it) remaining on the abdomen is pulled down to meet the bikini-line scar. The scar must extend as far out to the side as skin excess is present, so that it usually passes from hip bone to hip bone. Usually all sutures are under the skin, and only paper tapes are placed on the skin.
If you have a thick layer of fat on the tummy, you may require liposuction to decrease this. Aggressive liposuction and abdominoplasty both decrease blood supply to the tummy temporarily, and it is not healthy for the skin to do both at the same operation. At the time of office consultation Dr. Cedars will make a recommendation to you regarding whether abdominoplasty or liposuction is better for you. Some people may even require two operations to treat both the fat collection and the skin and muscle looseness.
This operation is not for smokers. If you smoke after surgery, you will probably kill some skin on the lower abdomen and create a large patch of scar. If you are an ex-smoker your risk is considerably less, but still higher than for a never-smoker.
HOW IS ABDOMINOPLASTY DONE?
An incision is made from hip bone to hip bone, or even out to the side of the hip in people with much skin excess. The exact location of the incision (and therefore the eventual scar) can be adjusted to your request to suit different panties or swimsuits. The skin and fat layer is lifted free from the underlying tummy muscles all the way up to the rib cage. Doing this requires cutting the skin all the way around the belly button so that the belly button can be left attached by its stalk to the muscle wall.
The exposed muscle layer is then tightened by placing a row of permanent sutures in it. This closes over any midline separation of the muscles that commonly occurs after pregnancy and helps make a flatter and firmer tummy.
The excess skin is then trimmed away and the skin closed with several layers of sutures under the surface. A new hole is made to expose the belly button and sew it to the tummy skin again.
After surgery there will be some stretching out of the abdominal skin over time, more in some people than in others. At the end of the operation, enough skin has usually been removed that you will be unable to stand fully straight for about a week. Dr. Cedars usually places permanent sutures under the skin at the bikini-line scar, which helps keep the scar skinny even though the skin has been pulled fairly tight.
Narcotic pills are typically taken for 5-7 days, and most people take 2 weeks to return to desk work. There is nevertheless no period of enforced bed rest, and we will want you out of bed during the day from the first day.
Skinny drainage tubes, usually 2 or3, are placed under the skin during surgery and tunneled out through the pubic area. They are connected to rubber bulbs that apply continuous gentle suction to keep blood from pooling under the abdominal skin. While these do not cause pain, they require some care while they are in. Most commonly one is removed each week in the office.
Because of the snugness of the tightened muscle layer, most people find that they fill up early when they eat. This can be an excellent time to form new eating habits, training yourself to eat smaller meals.