Tummy Tuck (Abdominoplasty)
Desire for an abdominoplasty to improve the appearance of the abdominal wall is a common concern.
Anomalies of the abdominal wall can result from many varied experiences. Weight fluctuations throughout life can lead to excess skin that will not go away with diet or exercise. Pregnancy can lead to not only excess skin but also a weakness of the abdominal wall that results in a protruding abdomen, also recalcitrant to exercise. Prior abdominal surgery or trauma can result in scars and contour irregularities that can only be corrected with surgery. Endogenous and exogenous hormones and medications can also have an effect on our body contours that may be permanent and only corrected with body contouring surgery. Finally our own genetics and age related changes can result in excess skin and fat that requires more than diet and exercise to correct.
Who Should Consider a Tummy Tuck?
The majority of individuals who seek a tummy tuck are women who have had a pregnancy resulting in excess fat and skin on their abdomens. Women who intend to have more children should wait to have a tummy tuck because pregnancy can negatively affect the results of their abdominoplasty.
Another major group of patients that inquire about tummy tucks are patients that have lost signficant amount of weight. No matter how much excercise is performed, the skin will not contour back down to the underlying abdominal wall.
Finally, men and women who have a protruding abdomen with excess fat and/or skin that is resistant to diet and excercise, are good candidates for this procedure.
During the initial consultation, Dr. Thomassen will go over your medical history, prior treatments and surgical procedures your medications, herbal supplements and vitamins, and allergies as well as lifestyle factors like smoking. The goal is to optimize your health status to have a safe procedure with quick recovery and excellent results.
A history of smoking is a significant risk factor for wound healing. Current recommendations are that patient stop smoking for a minimum of 4-8 weeks prior and after surgery. The use of nicotine patches is not an adequate measure in the perioperative period.
The physical exam focuses on evaluation of the entire abdomen, umbilicus, mons pubis, flanks and back rolls. Any prior surgeries and the resulting scars need to be considered when planning an abdominoplasty procedure. If an incision appears to interrupt the blood supply to the abdominal wall, then a variation of the surgery needs to be performed to ensure proper wound healing. The use of liposuction with an abdominoplasty helps address fullness noted in the mons pubis, hips and flanks, and dorsal back rolls.
The skin quality needs to be assessed as part of the exam. The presence of striae indicate a loss of elasticity of the skin and may affect the way the surgery is performed. Excess skin is the main indication for an abdominoplasty procedure and the amount of excess needs to be qualified to choose the right procedure for the patient. Patients who have abundance of adipose tissue but do not require skin or muscle treatment, i.e., have a good skin tone and reasonable potential for the skin to contract after removal of substantial volume, may be better candidates for liposuction alone as opposed to an abdominoplasty procedure.
The quality of the musculofascial layer is also important to evaluate for any weaknesses. More commonly, patients exhibit a weakness of this fascia termed rectus diastasis. This leads to a bulging abdomen that can only be fixed by plicating the fascia and restoring the rectus muscles to their original position. More severe defects of the fascia consist of hernias, particularly umbilical hernias and ventral hernias. These may need to be ruled out and if present, will be corrected at the time of the abdominoplasty.
The presence of intraperitoneal fat or fat inside the abdominal cavity deep to the fascia cannot be treated with an abdominoplasty procedure. This fat is only reducible through diet and exercise. If fullness due to intraperitoneal fat is excessive, this may preclude undergoing a successful abdominoplasty.
Preparing for an Abdominoplasty
Prior to a tummy tuck, Dr. Thomassen will most likely request that the patient visit his or her physician to have a thorough physical exam and routine blood work. Patients who are 50 years of age or older may need to have an electrocardiogram (EKG/ECG) prior to their tummy tuck procedure.
Certain medications need to be avoided for at least two weeks before surgery and one week after their surgical procedure. These medications include nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen. NSAIDs are known to cause bruising and abnormal bleeding.
The majority of Dr. Thomassen’s patients receive general anesthesia: All anesthesia is administered by a licensed anesthesiologist.
The Abdominoplasty Procedure
The procedure starts by making a low transverse abdominal incision that extends across the lower abdomen (directly above the pubic area) from hip to hip. Great care is taken to ensure symmetry and a low scar. Through this incision, the muscle wall of the abdomen is tightened. The patient is sat up in the OR table and excess skin is removed. The umbilicus is then transposed and the incision closed.
If an individual is also having liposuction, the liposuction procedure is performed first. Usually no additional incisions will need to be made.
A sterile dressing is applied over the incisions. Then, a compression garment is placed to help support the abdominal wall as it heals. Compression garments and abdominal binders also decrease post-operative swelling, which reduces the incidence of bruising.
The procedure takes about 3 hours.
Patients will remain in the recovery room for approximately an hour following their abdominoplasty. They can go home the same day with someone to stay with them overnight. A first visit is scheduled for 1-2 days after surgery.
During the first week, it is important to rest with your head elevated, bent at the hip, to avoid tension on the abdominal wall closure. Also, when walking, it is important to be hunched over for the same reason. A walker is sometimes useful during this first week.
Patients will notice an improvement in the contour of their abdomen immediately: As swelling subsides, the contour of the abdomen will continue to improve.
Patients will wear the compression garment or abdominal binder for approximately 4 weeks after their surgery.
If you are interested in learning more about abdominoplasty and liposuction, or any of the other procedures that Dr. Thomassen performs, please Thomassen Plastic Surgery today.
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