Mass media depictions of cosmetic surgery often impact negatively on public perception of the specialty. Aesthetic procedures can work miracles: not only genuinely lead to remarkable physical improvements, but also revive one's self-esteem and confidence which are even more important. We should not be too judgmental about cosmetic surgery, but accept that modern medicine can improve quality of life and make us feel better, not simply treat illnesses. In my practice, patients who have undergone successful cosmetic intervention are among the most satisfied and grateful patients I have had the privilege to treat.
Tummy tuck (Abdominoplasty) improves appearance and contour of the abdomen. This is achieved by removal of excess skin, fat, scars and/or stretch marks from the lower part of the tummy and most commonly, tightening of the abdominal wall fascia and muscles. The operation can correct small weaknesses (hernias) in the underlying abdominal wall and can greatly help the lower abdominal dermatitis and skin irritation caused by tissue excess (often called “a skin apron”).
There are a variety of different techniques used by plastic surgeons for abdominoplasty. Surgical decision as to which one to chose depends on your personal preferences, circumstances and physical examination. Tummy tuck sometimes need to be combined with other forms of body-contouring surgery, including suction-assisted lipectomy (liposuction), or performed at the same time with other elective surgeries.
Abdominoplasty is not a surgical treatment for being overweight. Obese individuals who intend to lose weight should postpone all forms of body contouring surgery until they have reached a stable weight.
It always helps to plan things in advance of surgery and adjust work and life activities accordingly. Therefore, please consider the following issues prior to your operation:
- Anticoagulation medication (Aspirin, Brufen, Warfarin, Clopidrogel) should ideally be stopped few days before the operation to reduce the risk of bleeding, but advise from the clinician who prescribed them is wise beforehand. I would strongly advise you to stop smoking prior to surgery as this can badly affect the outcome of surgery and increase complication rates.
- Please make sure that you arrange to be collected from the hospital as you will not be able to drive after the surgery
- Plan your time off school / work / sports
- Allow at least few weeks after surgery before considering holiday
Surgery is carried out under general anaesthesia and takes approximately two hours. You will be treated as an inpatient and should expect to stay in the hospital for 1-2 nights.
The operation involves a long incision placed in the suprapubic area and the crease of the lower abdomen extending from one hip bone to the other. In most cases there is also a round incision around the naval (umbilicus) as the new hole needs to be created through the mobilised tissues in order to maintain normal (anatomical) position of the belly button.
Skin and fat layer are raised of the underlying muscles all the way from the lower tummy to the level of the ribcage. This undermining allows mobilisation of the upper abdominal tissues downwards, towards the belly button and pubic area and creation of a large segment of redundant skin and fat which is then excised. Exposure of the muscle wall offers an opportunity to repair minor muscle/fascia weaknesses and tightening of the vertical tummy muscles fascia (rectus abdominis muscles) with sutures which contribute significantly in flattening of the abdominal contour and to some extent, better waistline. In vast majority of cases only one long horisontal, suprapubic scar exists in the lower abdomen after the surgery. Occasionally, a scar may have “inverted T” shape. The later is indicated either in patients with mild skin excess, unsighty pre-existing scars, deformity and buldging in the upper abdomen or indeed, in those who have excessive tissue excess over the flanks too so it is important to excise and tighten tissues in both, horisonal and vertical direction.
Usually two drains (drainage tubes) are left outside the wound to prevent build up of tissue fluid and blood within the operated area. Drains are removed from the wound 24-48 hours after operation. In most cases, I close the wounds with dissolvable sutures and cover wounds with a very light dressings (just a fine surgical tape). Elasticated binder or corset is applied a day or two later aiming to provide external support for the whole abdomen for the first few weeks. As patients are encouraged to wear support for up to 4-6 weeks postoperatively, many find lycra-like cycling or gym shorts are very useful, comforting and more practical then surgical binders.
As you will be in hospital for one or two nights, you will be looked after myself, on call doctor and experienced nursing staff. You should be restful and comfortable after the surgery, but it is important that you begin to walk short periods as soon as possible after operation to stimulate blood flow and recover faster. You should not stand fully upright immediately and for the first few days after operation as wound will feel tight. Mild pain, bruising and swelling around the wound are almost inevitable, but are only temporary, rarely troublesome and “quickly forgotten”.
The skin will heal within the first two weeks, whereas tightened fascia and muscles will take up to 2 months to strengthen entirely. This is why you will be advised to wear the supportive pants for the next 12 weeks, during which time you should avoid vigorous exercise. The scars will continue to improve (fade and soften) for up to 12-14 months after the operation and eventually become hardly noticeable.
Unfortunately, complications can occur following any surgery and patients need to be fully aware of
this. I always tend to carry out surgery in a safe manner and take all sensible measures to minimise risks and complication rate. Below are the commonest, operation specific complications associated with abdominoplasty:
- Bleeding and haematoma (incl the need to return you to the operating theatre)
- Wound healing problems
- Numbness (along the scars, lower tummy, supra-pubic and thigh area)
- Diminished sensation below the umbilicus
- Prolonged swelling of mons pubis (suprapubic triangle)
- Hypertrophic (lumpy) scars
- Asymmetry between the sides
- Seroma (tissue fluid collection under the skin which might need repeated aspirations)
- Leg and ling clots
- Fatty lumps due to necrosis of fat
- Scar irregularities
Abdominoplasty is an extensive operation, but in trained hands considered very safe. It yields predictably good results and is associated with very high patients satisfaction rate. It is one of the most rewarding aesthetic procedures. Please note that If you experience significant weight change or become pregnant after the tummy tuck, the results from your procedure may be compromised.
I am keen to show patients schematic illustrations of the tummy tuck and pre and post-operative results achieved in some of my patients during our consultation. Some examples on what can be achieved are shown on the right.
This leaflet provides only basic and generic information. Full details and explanations are provided at the consultation as no two patients are the same and personal circumstances are highly individual. Patients will be provided with detailed leaflet, comprehensive informed consent on risks and complications associated with this operation, few of which are mentioned above.
|Hospital stay||1-2 nights|
|Surgery time||1.5-2 hours|
|Wound healing||12-14 days|
|Shower / Bath||from week 1|
|Time off work||2-3 weeks|
|Sports and exercise||from week 4|
|Full recovery||4-6 weeks|
Urgent concern after your surgery ?
Please ring the hospital where you have been operated on or my secretary and they will get in touch with me