Tummy Tuck / Abdominoplasty

In todays figure conscious society, greater attention is directed to the size and shape of our bodies. In an attempt therefore to control any bodily changes which may occur in this respect, we try to make use of exercise and diet to the best of our abilities. However certain areas of our body can become stubbornly resistant to any improvements.  In some individuals the localised deposits of fat in the abdominal region combined with muscle laxity can make any hopes of a "flat tummy" very difficult to achieve. In women this becomes all the more difficult if stretched and loose skin appears following pregnancy. The children are, of course, worth every inconvenience. Nonetheless this does not stop us from thinking whether or not anything can be done to improve this.
Before Tummy Tuck SurgeryAfter Tummy Tuck Surgery

Alternatively there are individuals who may have lost a large amount of weight and subsequently find as a result that they have an "apron" of skin which hangs down in front of the abdomen.  This occasionally can lead to problems of chafing and rashes appearing under this "apron".

Surgical procedures can selectively be employed to improve situations in which these problems arise. These operations however are not directed toward weight reduction, which is still primarily a dietary problem. In cases where improvements can not be made despite even the most diligent efforts, an abdominoplasty may be appropriate. Abdominoplasty or "tummy tuck" as it is commonly known is an operation to tighten the muscles of the abdominal wall and to remove excess skin folds and fatty tissues from the middle and lower abdominal region. There are a number of variations in techniques with this surgery. As such it can dramatically reduce the appearance of a protruding abdomen and lead to a flatter, firmer, tighter stomach and when liposuction is also used, a thinner waist as well.

Many times however the problem is basically confined to only localised fat in the abdominal region without any associated skin laxity or stretch marks. In these cases liposuction alone may be suitable. Other times, as mentioned liposuction can be performed in conjunction with one of the many variations of an abdominoplasty procedure. Mr. Karidis will assess and advise you which would be more appropriate at your consultation.

Am I suitable for this type of surgery?

This will be decided at your consultation. During your consultation Mr. Karidis will ask you about your general medical history including details about any previous abdominal surgery, or childbirth (where relevant!). Women who plan to become pregnant imminently should usually postpone the operation until after their family is complete.

If you are a smoker you will be asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin and certain anti-inflammatory drugs and other medications (discussed in DO'& DON'TS section) can cause increased bleeding, so you must avoid these.

A physical examination will determine if you are a candidate for an abdominoplasty procedure. Abdominoplasty should not be performed to correct obesity. Heavier patients will be disappointed with the overall result even if surgical measures or altering existing techniques such as extending the incision and liposuction are performed. This is because being significantly overweight will still leave you with substantial and significant fullness in the flanks, upper, and mid abdomen and buttocks. Furthermore, in overweight individuals there is usually a large proportion of fat deep behind the abdominal muscles among our internal organs. This fat is not accessible to surgery and can only be lost with weight reduction measures such as diet and exercise. Performing surgery in these situations does not lead to a flat tummy. To avoid this disappointment and to minimise the need for a secondary procedure, the best candidates are men and women who are within several pounds (i.e. 10%) of their ideal weight. If you are significantly more than this then you will be asked to reduce some weight before going ahead with any surgery.

In certain borderline situations however abdominoplasty can be performed in individuals who are perhaps slightly more than within their 10% of ideal weight (i.e. 15%). This can be technically performed with some success, but with the understanding of a couple of provisos. First is that, the result will not be as ideal as it would be by getting you to within your 10% of ideal weight, and that secondly further secondary procedures, i.e. liposuction may be required, or that further weight reduction will be necessary to further improve the result. Abdominoplasty in these situations is usually performed to basically remove the obviously loose, hanging skin, which does not go with even the most diligent of exercises and diet, and that the hope is that this will act as an incentive or motivation for you to pursue further weight reduction.

As mentioned above there are a number of variations in the technique of abdominoplasty. The decision will be based on the quality of your skin, the presence of stretch marks, the laxity of your muscles, and the amount and distribution of fat. A definite decision can only be made at the consultation after a proper examination. However, broadly speaking, if you have loose muscle and excess skin in both the upper and lower abdominal areas with only modest fat deposits you will most likely require a full abdominoplasty.

If however you have loose skin confined mainly to the lower abdominal area but have retained good skin and muscle tone above the umbilicus with little or no excess fat, then a "mini tuck" may be used. Alternatively if this is accompanied by modest excess fat in the upper abdomen then liposuction may be used in conjunction with the "mini tuck" to improve the result. It would be fair to say that the term "mini tuck" is actually a misnomer as the scar is still about 10 inches long and cannot be deemed very "mini".

Remember to always be open in discussing your expectations at the consultation. Mr. Karidis will also be frank with you and together you will work at choosing the procedure that is right for you and which will come closest to achieving the desired result.

What does the Operation involve?

In the full abdominoplasty, you must understand that there is a long incision made within the so called "bikini line" just above the pubic area, from hip to hip. The skin and fat is then peeled off the abdominal wall up to the umbilicus (tummy button). At this point a second incision is made around the umbilicus, in a measure to free this from the surrounding tissue. Once this is done, the skin and fat layers of tissue (called a flap) initially lifted, is continued to be peeled off the abdominal muscles, leaving the umbilicus on a stalk, and continued all the way up to the border of the lower rib cage. The exposed muscles are then tightened as necessary by stitching them together creating a firmer abdominal wall and a narrower waist.

The peeled back flap of skin and fat is then stretched downwards towards the initial incision and any extra tissue is removed. The incision is subsequently stitched closed but not before a new hole has been made for the umbilicus, which as mentioned is sited on a stalk, in order for it to pop through. Drainage tubes are usually placed under the skin to collect any excess fluid that may accumulate in the first 24 hours after the operation. These are removed when fluid production has ceased (usually 24-48hrs).

In the "mini tuck" technique the skin is separated only between the lower incision line just above the pubic region, and an area just below the umbilicus. The umbilicus is left in place without the need for a further incision. Liposuction may be combined with this procedure if the distribution of fat calls for this.

What type of anaesthetic is used?

Abdominoplasty is usually performed under general anaesthesia (completely asleep). You will usually require an overnight stay at the hospital.

How long does the surgery take?

Depending on the technique used, and whether this is combined with any other surgery such as liposuction, it usually takes between 1-2 hours.

What happens immediately after the Operation?

Once you've recovered, you will notice a compression garment around your waist and abdomen. This is to provide compression of the surgical site to reduce the postoperative swelling and bleeding. In addition you will notice the presence of 2 tubes or drains which are usually placed under the skin to evacuate any fluid build up following the surgery. These usually come out the following day although in situations where there is increased drainage these stay in for an extra day.

You will find that the abdominal area will be quite uncomfortable and that you will have 1-2 pillows placed behind your knees in order to keep these bent to reduce the tension in your abdominal muscles. Likewise you will need to walk slightly bent forwards once you are up and about, for the first couple of days. You will gradually straighten up after this time. All stitches used for this procedure are dissolving and therefore there is no need for any stitch removal.

Is it Painful?

Pain and discomfort are subjective sensations but it is true to say that an abdominoplasty is considered one of the more painful procedures. However compared to a caesarean section delivery, which requires cutting into the muscles to deliver the baby, an abdominoplasty, which only tightens the muscles on a more superficial level, is significantly less painful. Any pain is probably more noticeable when standing or and walking in the first few days following surgery and usually involves the upper half of the tummy. Some patients report the sides (flanks)-which sometimes need some liposuction to contour the waist- as being more painful than the abdomen. Thus for the first week or so you will need to take regular painkillers in order to minimise this.

What kind of after effects should I expect?

Following surgery you will experience considerable swelling and some bruising of the abdomen. This will be even more noticeable if the abdominoplasty was accompanied by liposuction. The bruising usually lasts about 3 weeks. While most of the obvious swelling will have dissipated by this time, subtle swelling will still be present for up to 6 months.

In addition you will notice that the abdomen will feel firm to touch, particularly along the edges of the incision site. This will be as a result of the normal healing process laying down elements of scar tissue to facilitate healing. When this occurs, massage as instructed by Mr. Karidis will speed up the recovery. It gradually resolves in time but may take a few months to complete. You should expect the sensation to the skin over the lower abdomen to be reduced after surgery. This is as a result of surgical trauma to the nerves in the region. Although this usually recovers in a few months, permanent numbness in the skin region between the scar and tummy button can ensue.

What are the Scars like?

As already explained the scar length will be substantial. These normally extend from hip to hip above the pubic area as a horizontal line. At times it may be necessary to add a small vertical component to this and therefore the appearance may be likened to an upside down T. Although all surgeons try to suture the incision as neatly as possible, it is ultimately impossible to predict a scars' eventual appearance. In fact very rarely can abdominoplasty scars be described as hairline. You must understand that due to the normal healing response these always appear red, raised and lumpy in the first few months after surgery, but do tend to settle with time. A silicone gel sheet will be provided for you and which will help the appearance of the scars. However it may take up to 18 or 24 months to do so. Stretching and prominence of all or parts of the scar however can occur. If necessary, and when deemed appropriate, it may be necessary to revise a scar to try to improve its appearance. This will be discussed at the follow up consultations.

Can I become pregnant after my abdominoplasty?

Yes, you can become pregnant after an abdominoplasty. Your skin will be capable of stretching and accommodating your enlarging uterus and baby. However this is not ideal, as further pregnancies will stretch and loosen your skin again, giving rise to unwanted skin laxity and stretch marks. Ideally, it is best to have finished with your pregnancies before undergoing any abdominoplasty procedure.

Will the results of my abdominoplasty be permanent?

Any stretched or loose skin removed from this operation will not return. However this is provided you maintain your weight and do not subject yourself to large weight fluctuations. Furthermore if you become pregnant following your abdominoplasty you must remember that the skin will stretch again because of the enlarging womb and baby and that therefore it is likely you will develop further loose and stretched skin afterwards.

What could go wrong?

Whilst it is true that when an abdominoplasty is performed by a qualified plastic surgeon the risks are small, nonetheless, specific complications with this procedure can and do occur.

As in any procedure the risk of significant infection is always possible. This is minimised by careful surgical technique and the preventative administration of antibiotics both at the time of surgery and after. However despite these measures mild infection is relatively common and can occur around the incision site, but usually subsides over a period of about 2 weeks.

Risks such as blood clots are rare. You will be asked to wear special stockings (TED) just prior to coming to theatre, to reduce this likelihood. Furthermore during your operation special pump devices (Flowtron) are wrapped around your calves to stimulate continued blood flow to this region and avoid any stagnation of blood which can lead to blood clots. Early mobilisation by moving around as soon after the surgery as possible also reduces this considerably.

As mentioned earlier, swelling should be expected after this operation. When mild or moderate swelling is present, the body rapidly reabsorbs this. Very rarely, increased bleeding can lead to more significant swelling and the development of a haematoma (a collection of blood under the skin). If this were to happen, surgical drainage to evacuate this would be required. Ultimately however this should not affect the final outcome.

Another possible complication is the formation of a collection of fluid called a "seroma". This fluid is clear and yellow in colour. It is seen as a swelling in the lower abdominal region, and many times patients report that they can feel this fluid moving under the skin. It is usually noticed at about 10 days after surgery. The treatment will depend on the amount of fluid present. If this is deemed to be small and is not causing any discomfort, then only a pressure garment is applied and the body reabsorbs this, usually by about a month's time. If however the amount of seroma is significant and causes pain or discomfort, then the initial treatment is to draw out this fluid with a needle (called aspiration). Following aspiration the swelling rapidly disappears. If necessary this procedure may be repeated in a week's time.

During the first 2 -3 weeks after surgery, some patients may experience a minor loss of wound adhesion at any point of the incision site. This is a temporary complication, which will require regular dressing changes initially. Eventually a scab develops over this, which subsequently separates after 3-4 weeks. However some distortion of the skin around the scar may ensue particularly if this has occurred over the hip region. Further revision surgery may be required if necessary.

How many Abdominoplasties does Mr. Karidis perform?

In accordance with the National Healthcare commission guidelines, according to the last five years (2002 -2006) of annual audit figures submitted to the Hospital of St. John and St. Elizabeth in London, Mr. Karidis performed on average 36 abdominoplasty procedures per year. In the last 10 years he has performed over 350 abdominoplasty procedures.

How long before I get back to normal?

Abdominoplasty is a relatively major operation and should always be respected as such. Therefore you should expect a few weeks to pass before you feel yourself again. Remember variations do occur in the time individuals take to heal. Although many people go back to light work duties by 2 weeks others may find it more appropriate to take a further 1-2 weeks to rest. Walking is helpful in the first 3-4 weeks as this improves the circulation and helps reduce the swelling, and the chance of blood clots developing. Heavy lifting or strenuous activity is prohibited in the first 6 weeks after surgery. Overall common sense rules in the recovery period. If what your doing is uncomfortable then don't do it!

Summary

Abdominoplasty has always been a popular cosmetic surgery request. It is an excellent solution to difficult situations in which individuals are troubled by redundant abdominal skin, lax muscles and excess fat. Providing one accepts the lengthy scar and recovery period, the results are quite pleasing. The procedure will give confidence to the individual and allow them to wear clothes that were previously unsuitable. The effects are generally long lasting provided you follow a balanced diet and exercise regularly.

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