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Abdominoplasty (tummy tuck)

Introduction

An abdominoplasty or tummy-tuck operation is designed to improve the contour of the abdomen and waist. This is achieved by removal of excess skin and fat, and tightening of the tummy muscles. It is most commonly requested by people who have lost weight, or by women who wish to restore the appearance of their abdomen following completion of their family. It is also a useful procedure for improving the appearance of Caesarean section and hysterectomy scars, particularly where excess skin or bulging of the tissues is of concern. Like any body contouring procedure, it is important to realise that this procedure is a reshaping rather than a weight loss operation, and that the best results are achieved when you are at a stable weight, ideally within the ‘normal’ range.

ABDOMINOPLASTY/ TUMMY TUCK

  • Type of anaesthetic
    General anaesthetic
    Length of surgery
    2-4 hours
    Nights in hospital
    1-2 nights
    Scars
    Lower abdomen/ bikini-line scar ± around belly button

  • Recovery
    1-3 weeks off work
    4 weeks gentle exercise
    8 weeks strenuous exercise
    Follow-up
    2 weeks (dressing clinic)
    6 weeks
    6 months
    1 year

My approach

This is an operation in which the difference between a reasonable and good result is determined by attention to detail and subtle adjustments of surgical technique. I use as short a scar as possible, and may recommend combining the technique with liposuction in order to fine-tune contour adjustments.

The Surgery

I consider abdominoplasty as a term that describes a group of operations, the goal of which is to improve the appearance of the front of the abdomen, and sometime the function of the trunk as a whole. The procedure may have to deal with an excess or laxity of the skin, an excess or displeasing distribution of the fat layer under the skin, and/ or laxity of the deep tissues surrounding the muscles of the abdomen. This laxity of the tissues around the muscle can include a split between the six-pack muscles, known as a diastasis or divarication of recti. Many patients who attend me for this procedure have spent a significant amount of time and energy in the gym or physiotherapy, without resolution of their concerns about a tummy that protrudes more that they wish. I commonly hear that people have asked when the baby is due, because of the fact that the abdomen sticks out. This can be very distressing for people, and is an issue that an abdominoplasty is designed to address. Symptoms of back pain and stress urinary incontinence may also be addressed in some patients, although these outcomes are by no means guaranteed, and should be regarded as a bonus, rather than an expected outcome of surgery. I am delighted to accept referrals for this procedure from my physiotherapy colleagues, and will always encourage patients to continue with physiotherapy before a procedure, as well as in a careful and controlled manner from as early as six weeks post-operatively.

During a standard/ full abdominoplasty, the excess skin and fat between the pubic bone and the bellybutton are removed. This is achieved by lifting up all the abdominal skin at the front, pulling it down, and removing the excess. This leaves a long scar across the lower abdomen. The bellybutton is repositioned within the relocated skin, resulting in a scar around/ within the bellybutton. Any looseness of the abdominal muscles (e.g. diastasis recti) is repaired at the same time. A fleur de lis abdominoplasty involves removing both horizontal and vertical excess of skin, and is used where there has been dramatic weight loss, and there is a large amount of excess skin. The resultant scar is like an upside-down “T”, with a long low scar across the lower abdomen, combined with a vertical scar in the midline of the abdomen. A mini abdominoplasty involves removal of excess skin below the bellybutton, without disturbing its position. Limited tightening of the abdominal muscles may be performed if necessary during this procedure. During an extended abdominoplasty, surplus skin and fat of the loins and back are also removed so the scar extends around the flanks onto the lower back.

Consequences and limitations

An abdominoplasty is a major operation, with significant down-time in terms of lifting/ driving, etc.. The scars, even with short-scar techniques, are significant, and while positioned in such a manner as to be covered by most underwear, they will never fade completely. Like any surgical scar, there is a risk of slow healing or infection. The skin above the scar will be numb immediately following the operation: this is usually temporary but on occasion is permanent. Swelling of the abdomen may occur following the procedure, this can be due to oedema (tissue swelling), or a seroma (a collection of tissue fluid from the raw surfaces inside). Oedema will settle of its own accord over a few weeks to months, while a seroma may require a straightforward drainage procedure (which is generally not painful and is done in the office setting).

Significant changes in weight after the operation or subsequent pregnancies are likely to impact upon the long-term result, which is why I recommend waiting until after completion of your family and/ or reaching a stable target weight before proceeding. Another factor that needs to be considered are the fact that, while stretch marks on the lower abdomen, in the area that is cut away, will obviously be treated by the procedure, those on the upper abdomen or flanks will not be improved, and indeed may appear worse after the skin is repositioned.

A common query is whether some or all of the cost of this procedure might be covered by an individual’s health insurance. Unfortunately, this procedure will not be covered by health insurance companies, except in rare and exceptional circumstances, where patients have abundant extra skin as a result of massive weight loss, which arose as a result of a bariatric surgery procedure, which was itself funded by the health insurer.