Complete Guide to Abdominoplasty Surgery

Do you desire a flatter tummy, Have you ever looked at yourself in the mirror and hoped for a flatter abdomen? Is your daily exercise routine not helping you enough? And are you one of those people who have lost as much weight as they possibly can and yet the lower abdomen is lax and hanging?

The first thing to know is that you are not alone. All humans must age and must lose collagen. Loss of collagen and elastin makes the skin and abdominal muscles lose. The lax muscles will not tighten with diet and exercise alone. This is especially evident in women after multiple pregnancies. 

The only way to get a flat tummy and remove all the extra skin is an abdominoplasty.

What is a tummy tuck?

A tummy tuck is a common name for abdominoplasty, it is a plastic surgery technique to reshape the body. Tummy Tuck removes excess skin and tightens the abdominal muscles. A new cosmetically pleasing small-sized umbilicus is also created. Abdominoplasty is performed along with Liposuction to achieve a better body shape.

Abdominoplasty may also be combined with breast augmentation or breast lift surgery. When liposuction or abdominoplasty is done with breast reshaping surgeries the entire process is called a “Mommy Makeover” 

What can tummy tuck do for you?

A Tummy tuck procedure addresses a lot of problems at the same time. The three commonly faced issues are excess abdominal fat, loose skin and abdominal muscle weakness. 

• Abdominoplasty helps to get a better shape by removing excess abdominal skin and fat. It also creates new and better-looking umbilics or a belly button. 
• Repositions the abdominal muscle to its natural place to get a flat abdomen.
• Muscle repositioning also corrects the body posture. Protruding belly because of weak abdominal muscle action causes inwards bending of the spine called Lordosis. It can cause back pains and poor posture.
• Abdominoplasty surgery will also correct any ventral hernia or umbilical hernia.
• A better body shape will increase your confidence which can have a major impact on your life.

What are the limitations of a tummy tuck?

Abdominoplasty is not a weight-loss tool. A tummy tuck is not a weight reduction surgery. Although it helps to regain a better shape by removing extra skin and fat, it is not helpful in reducing weight. Weight reduction is achieved by proper diet and exercise.

The second limitation is Lower Abdominal Scar. A tummy tuck surgery will leave behind a long scar. A tummy tuck incision is given in the lower abdomen from one side to the other. After healing there will be a scar of the same length. However, the incision line is placed low enough to let the scar remain hidden below the undergarment.

Who are the best candidates for a tummy tuck?

Ideal candidates for a tummy tuck surgery may be divided onto three groups.

• Patients with extra fat and loose abdominal skin: Excess fat can be removed by liposuction but the skin is loose and will not retract enough afterwards. Thus liposuction alone will not suffice. Such patients will require a tummy tuck to get rid of all the extra skin as well.

• Patients with protruding bellies due to rectus muscle diastasis (abdominal wall weakness): Repeated pregnancy and gym workouts with hefty weights can cause rectus muscle to drift apart. Ideally, the two rectus muscles, which are the same ones which give six-pack abs, lie in the midline. Once they lose their position muscle contraction becomes weak. Loss of muscle tone causes the abdomen to bulge outwards.

• Patients of massive weight loss: Hanging extra abdominal skin on the abdomen after a massive weight loss either by dieting or surgery is called panniculus. Abdominoplasty or panniculectomy is needed in such patients to have a proper shape.

• Other than the three conditions mentioned above a good candidate should be within a normal body weight range. Abdominoplasty is not suitable for obese patients. The patient should also be in good general health.

Who should not consider tummy tuck surgery?

Planning to conceive:

• Abdominoplasty works by rearranging abdomen muscles and reducing skin and fat so if you are planning to conceive it is better to delay the surgery after you have been through pregnancy and delivery.

• Abdominoplasty will not affect pregnancy in any way or the ability to bear children. But the results of abdominoplasty will get reduced so it is a good idea to get a body reshaping tummy tuck only after completing your family.

Obese Individuals

Overweight people should not consider a tummy tuck the first choice for body contouring. It is advisable to reduce body weight through proper diet and exercise first.

At this point, most people will think then why have an abdominoplasty plastic surgery if we have to reduce our weight with the help of diet and exercise? 

let me explain.

An abdominoplasty surgery will get rid of hanging extra skin and fat and at the same time realign the abdominal musculature. The bulging abdomen will become more streamlined but at a cost and the cost is increased intra-abdominal pressure.

Fat deposits are not only below the skin but also around the intra-abdominal organs. Whether we do liposuction or a tummy tuck the intra-abdominal fat can not be manipulated. Intra-abdominal fat will prevent proper abdominal muscle tightening and skin closure it will also contribute to an increase in abdominal pressure and cause breathing difficulties in the postoperative period. 

How to prepare for tummy tuck surgery?

There are mainly three things to do prior to undergoing a tummy tuck surgery. 

• The first is proper consultation. Meet your surgeon face to face, and let him/ her examine you. Ask all your doubts and tell them about any other medications you may be on. At this stage, your plastic surgeon expects you to be truthful and would appreciate a detailed clinical history.

• The second thing to be done is to make sure that you have the results of all the investigations your surgeon asked for and that they have been evaluated by the surgeon. Most of the time these include complete blood counts, renal and liver function tests along with a chest X-ray and ECG.

• The third is to make arrangements for aftercare. You will not be able to manage life alone after the procedure. You will need help. A close friend or relative by your side would be a very good idea. I will come to the specifics of aftercare when I deal with post-operative instructions.

How is tummy tuck surgery done?

Tummy tuck surgery or abdominoplasty is a broad word for a lot of similar procedures. It is rather a collective noun not a single entity. Let me begin by explaining the classic Tummy tuck procedure. In a classic tummy tuck, 

• A broad spindle-shaped piece of skin along with the underlying fat is removed. This extends from side to side and from just about the pubis to the umbilicus above just like in the diagram.
• The two abs muscles lying in front of the abdomen are called the Rectus Abdominis these are the same ones which form the beautiful six-pack abs. The skin overlying these muscles is explored and the LAX and separated muscles are brought together to tighten the abdomen.
• Now the skin is pulled down-words and sutured to the lower margin after creating a beautiful new umbilicus. 
• Sometimes a negative suction drain needs to be placed which is removed in a couple of days.

The tightening of muscles and removal of all the extra skin and fat gives a beautiful flat tummy. 

What are the post-operative care instructions after a tummy tuck?

I divide the post-operative period of tummy tuck into 3 parts. 

the first one is the immediate postoperative period, the second is the early postoperative period and the third is the late postoperative period. 

Immediate postoperative period

• In the immediate postoperative period, which is around 7 days from the day of the surgery, you will have maximum discomfort. The first 48 hours are the most uncomfortable. 
• You will find yourself in the recovery room after the surgery with a couple of pillows placed below the legs to keep the legs folded both at the hips and at the knee joint. This is done to minimise the stretching of the skin and to reduce as much tension on the suture line as possible. So in the first week after the surgery, you will not be able to stretch your legs. 
• There will be a dressing over the stitch line which is changed after 2 days. Most of the time subcutaneous sutures are placed. They don’t require removal.
• You will be allowed to walk from the second day onwards but for the first few days, you will have to walk with your back bent at the hip. You can do that with the help of a walking stick. This is to prevent you from pulling apart the newly made stitch line.
• A snuggly fitting pressure garment has to be worn like a vest 24-7. The pressure garment is essential to control edema and prevent fluid collection.  It also helps to reduce pain. Ideally, the pressure garment is worn for 2 months after the surgery 

Early Postoperative period

The early postoperative period is the first month after the surgery. 

Gradually the swelling will reduce, the suture line will heal and you will be able to walk straight. It is advisable to take things slow. 

By the third week after the surgery, you will be able to perform all your day-to-day tasks.

Late Postoperative Period

The late postoperative period begins in the second month after the surgery. 

During the late postoperative period, you need to resume a healthy exercise routine.  The difficulty of exercises is raised gradually and in accordance with physical healing. Being too enthusiastic is usually counterproductive.  

An abdominoplasty surgery physiologically changes the mechanism and functioning of the abdominal musculature. The laterally placed ab muscles are brought together in the midline and held together with sutures.  Exercises that strain these muscles are begun gradually.

When will you see the results of the tummy tuck?

The results of a tummy tuck surgery are visible immediately. You may not be able to appreciate that because of the dressings that are in place. You will be able to fully appreciate the result only after 6 months but you will see the preliminary results after 7 days when you stand fully erect.  There will be swelling in all the regions which subside gradually in a month’s time. 

What are the possible side effects and complications of a tummy tuck?

Other than the routine problems of general anaesthesia the specific ones associated with a tummy tuck can be divided into Side Effects which are sure to happen and complications which might or might not occur. It is essential for you to have detailed information about both so that you can make an informed decision.

let’s talk about the side effects first. By side effects, I mean the drawbacks of an abdominoplasty procedure. 

The immediate side effects of an abdominoplasty surgery are swelling bruising and hardness of the areas where the surgery was performed especially the lower abdomen and flanks. But this is to be expected and is a part of the healing process. Such side effects disappear in a couple of months. The only long-term drawback is that there will be a long scar from one side of the pelvic bone to the other. Although the scar is hidden below the undergarments still there will be a scar. The scar is unavoidable.

The complications of a tummy tuck procedure may be divided into immediate postoperative complications arising during the healing period and long-term complications that might occur due to various other reasons. Sometimes the complications get resolved but other times they may leave a tell-tale mark.

Immediate postoperative complications.

• Complications in the healing of suture line. Since the suture line is always under tension some parts of the stitch line may not heal properly because of necrosis of the skin edges. Usually, this is not a problem and can be conveniently managed by antibiotics and dressings for a couple of weeks. But after healing, the scar will be a little broad. Later on, a scar revision process can improve the scar.

• Shortness of breath. Abdominoplasty surgery changes internal physiology by tightening the abdominal muscles. This increases intra-abdominal pressure. The increase in intra-abdominal pressure prevents the diaphragm from moving properly hence causing shortness of breath. This is one of the reasons why it is advised that obese patients should not get an abdominoplasty they should first try to get rid of as much intra-abdominal fat as possible through diet and exercise. The shortness of breath is seen only in the immediate post period for a couple of days. Gradually the body adjusts to the raised abdominal pressure and breathing becomes normal.

• Pain is the most common complaint after an abdominal plastic surgery any strain on the abdominal muscles will cause pain. Movements as simple as setting up from the bed will cause pain. The pain and discomfort are controlled by pain medication and by learning the proper way to get up from bed and move around without straining the abdominal muscles. The pain and discomfort will resolve in a couple of weeks. 

Long-term post-operative complications.

• Scar. Broad scar line. Higher lying scar-line.  hypertrophic scar/keloid formation of The suture line.
• Umbilicus. Improper position of the umbilicus.
• An imbalance between both the sides and the flank region. 
• Abdominal Muscles: There may be suture dehiscence of the muscle repair due to improper strain during the healing phase. In such a case the muscles may not stay together and drift apart and later cause protruding belly and tenting which is the classical sign of rectus abdominis diastasis.