Plastic Surgery - Abdominoplasty (Tummy-Tuck)



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Plastic Surgery

Abdominoplasty (Tummy-Tuck)

With age, after pregnancies and in obesity the elasticity of the connective tissues and skin can decrease resulting in folds and rolls on the abdomen. After heavy weight reduction the same phenomenon can occur with skin hanging like an apron. There are no physical activities or medicines capable of tightening the skin.
Often a weakness of the abdominal musculature makes the abdomen protrude like in pregnancy, a condition that can benefit from gymnastics or tightening of the muscles by an operation. In cases of significant obesity an operation will hardly be beneficial.

Principle: Stretching and removing redundant skin and tighten a protruding abdominal wall.

Technique: Endoscopic tightening of the protruding muscles is possible when no skin redundancy is present. Otherwise the incisions runs low on the abdomen from the iliac crest to iliac crest and around the umbilicus. There can be variations concerning the placement of the incisions depending on the deformity. The pants will hide the scars. The skin is mobilized up to the ribcage and pulled down and shortened. The musculature can now be tightened. If there is only little skin to be stretched, a shorter incision is possible. Drainages are inserted and a compressing garment is applied. This operation is regarded to be a big operation and the immediate course is rather discomfortable. One has to walk and stand in a light forward bent position in order to release tension and to avoid dehiscence of the wound.

Anaesthetic: General anaesthesia.

Operating time: 2 - 3 hours.

What happens afterward?

	In spite of the big operation the postoperative course is rather painless. At rest no pain is present but changes of position can cause some discomfort which hardly is prevented by painkillers.
	3 - 4 days of fatigue are common.
	You should walk and stand in a light forward bent position in order to release tension and to avoid dehiscence of the wound.
	You should "roll" in and out of the bed.
	You should care for a soft bowel.
	The stitches are removed in 2 intervals.
	The white bandage can be removed after 3-4 days where after you should take shower daily.
	The skin feels numb for a couple of months.
	A swelling over the incisions can persist for several months.

COMPLICATIONS
Referred unwanted biologic events can occur with a certain low frequency and must be regarded as calculated risks. Other risks not mentioned can also occur. For patients this must be considered before a decision for plastic surgery is made.

Bleeding: All operations can cause postoperative bleeding. These risks increase by the intake of analgesics and Vitamin E. These should be avoided 2 weeks prior to the planned operation.

Infection: All operations can cause infections, which in case it happens will be treated with antibiotics. The placement of the wounds in surgical "unclean" areas increases the risk of infection.

Numbness: The sensory nerves to the skin are cut during operation and the skin will be numb for some months. Normally the sensation returns.

Seroma formation: The skin lies like a cover over the musculature and with normal healing the skin is "glued" to the bottom. If you move to forceful the woundcavity will not glue normally and bodyfluids will accumulate and obstruct healing. The fluid can be aspirated. The best prevention is slow motions and a girdle.

Healing problems: The blood supply to tissues is essential for proper healing. At upright position the pull in the scar and the adjacent skin is great and the blood supply in this area can be impaired. The bent-overposition is therefore essential.

Scarring: All scars are red for a couple of months and they fade away during the fist year. Direct sun or solarium against the scars should be avoided to prevent them for permanently become red or pigmented.

Embolism: The combination big operation - staying in bed is the greatest risk for embolic disease. Overweight increases the risk further. Therefore early mobilization is essential. Patients at risk will receive diluting pharmaca.

Smoking: Smoking does compromise bloodcirculation and healing. Smoking should be abandoned prior to a planned operation

This text is edited and controlled by Dr. Per Gunnar Opitz, Opitz plastikkirurgiska klinik i Malmö Sweden