Abdominoplasty is a cosmetic procedure where the abdomen is flattened by removing excess skin and fat and the abdominal wall muscles are tightened.
The abdominal wall skin and muscles may become stretched from multiple pregnancies or repeated weight gain and weight loss.
This may result in stretch marks, areas of excess fat, loose folds of skin, and weak muscles.
Although diet and exercise may help lose some of the excess fat and tighten the abdominal muscles somewhat, it usually will not tighten the loose folds of skin.
PREPARING FOR THE SURGERY
In preparation for the surgery, it is important to have a stable appropriate weight in relation to one’s height to ensure long term success of the surgery. It is also important to do the surgery after you have decided not to have any more pregnancies.
It is also vitally important to stop smoking. At a time when the tissues are trying to heal from the surgery, the presence of the chemicals found in cigarettes can cause significant harm to your tissues. It does this by greatly reducing the blood flow (due to nicotine) to the areas needing it the most and by reducing the oxygen level in your red blood cells (due to carbon monoxide). This has a combined effect of killing the tissues that are vulnerable. It can lead to loss of skin and fat along the edge of the incision. This can be very difficult to repair afterwards and quite often causes poor scarring. It is best to avoid this situation by stopping smoking for a period of time before and after surgery as recommended by your surgeon.
Any medications or supplements which increase the risk of bleeding during and after the surgery should be temporarily stopped a week or two before surgery and restarted whenever it is safe to do so. Your surgeon will be able to advise you about this. Examples of medications that will have to be stopped include aspirin, warfarin (coumadin), anti-inflammatory medications (Advil), dietary supplements (some vitamins, echinacea, cod liver oil, garlic, omega-3, flax seed oil, etc.), green tea and so on.
The procedure itself consists of 3 steps
Removal of the excess fat (Liposuction):
Liposuction involves injecting a special fluid into the areas requiring liposuction to loosen up the fat cells and then applying suction through a tube to remove the fat to change the shape of the treated area. It may be necessary to do this on the front of the abdominal wall as well as the sides (the “love handles”).
Tightening of the overstretched muscles (Rectus Muscle Plication):
Next the abdominal muscles which have become overstretched are tightened using sutures (rectus muscle plication). This step contributes greatly to the flattening of the abdominal wall.
Removal of the excess skin (Lipectomy):
Finally the excess skin is removed (lipectomy) and the incision is closed. The bellybutton (umbilicus) is sewn in place and a drain is inserted into the wound to drain off the excess fluid that forms after the surgery. Also a catheter for pain control called the On-Q Pain buster is placed on the abdominal muscles to reduce post-operative pain.
There are 2 possible types of incision for abdominoplasties. For most people a horizontal incision made above the pubic area is sufficient. For people who have lost a lot of weight and have a lot of loose skin, a vertical incision in the midline of the abdomen is also necessary, resulting in a T-shaped scar.
For people who require the horizontal incision, but have very little excess abdominal skin, a “mini-abdominoplasty” is probably the best option. This involves a shorter scar and no incision around the bellybutton, as compared to the standard abdominoplasty.
AFTER THE SURGERY
Follow Up Appointment
Follow-up appointments are usually at 1 week, 6 weeks, 3 months and 1 year after surgery.
It will take approximately 6 weeks to recover from the surgery. During this time it is recommended to do only light activities. Do not lift anything heavier than 5 pounds. Do not do any housework (carrying laundry, groceries, garbage, vacuuming, etc.). Do not exercise (running, jogging, jumping, treadmill, pilates, weight-training, etc.) until it is safe to do so. You can walk whenever you feel up to doing so. You can also drive whenever you feel capable. At the end of the 6 week period, if everything is healing well, you can gradually resume your normal level of activities. You will be given an elastic binder to wrap around your abdomen to minimize post-operative swelling. This should be worn for 3-4 weeks.
For the first week or two, the incision will leak small amounts of fluid. Apply gauze to the wound until it stops on its own. The sutures you have are all dissolving. They do not need to be removed. The white tape on your incision (Steri-Strip) will fall off by itself in about 2-3 weeks after the surgery. At the end of the 4th week, if your incision has healed well, apply skin cream and massage the scar to maximize scar healing.
The drain is used to remove the excess fluid that the body produces after the surgery. It is usually removed after about 1 week. The On-Q pain buster catheter consists of a 2 small catheters that are placed during the surgery through the skin and placed on top of the abdominal muscles. It is attached to a small pouch that contains local anesthetic medication, which anesthetizes the muscle layer which was tightened during the surgery to reduce post-operative pain. It works automatically and does not require any adjustments. It usually lasts 4-5 days and is removed at the same time as the drain.
Everyone undergoing surgery is automatically prescribed pain medications and antibiotics. The pain medication should be taken as needed. Your prescription should last you for 1 week. If you need more, please ask the surgeon to re-prescribe it for you. The antibiotics are usually needed for as long as the drain is in (1 week).
POTENTIAL RISKS & COMPLICATIONS
As a result of the space created between the skin and muscle during the surgery, the body produces fluid to fill in the space. This fluid can be mixed with blood. If it collects under the skin, it is called a seroma or hematoma. The risk is about 1%. Placing a drain in the wound greatly reduces the chance of this occurring.
There is a 1-2% risk of a wound infection. In order to reduce this risk, you are given antibiotics during and after the surgery.
If the blood flow and/or oxygen supply to the tissues is compromised, the affected tissue can die (wound necrosis). The area that is the most vulnerable to this is the area of skin just above the pubic area. This is why smoking is so hazardous and must be stopped before surgery. With non-smokers, the risk is 1% or less. With smokers, it is much higher.
It is important not to be overactive in the first 6 weeks after surgery or there is a risk of the sutures giving way and the wound opening (wound dehiscence).
Deep Vein Thrombosis
It is also important not to be too inactive either or there is a risk of developing a deep vein thrombosis (DVT) in the legs. During the surgery your legs are massaged by a special pump, but when you return home, you will need to move out of bed as soon as you feel capable. This will stimulate the circulation in your legs and minimize the risk of developing a DVT.
It is very common for the skin of the lower abdomen to feel numb after surgery. This sensation will eventually return. It may take up to 1 year to do so.