The
tummy tuck is an operation that is designed
to remove excess skin from the abdomen, at the
same time tightening the abdominal muscles.
It is indicated in cases where there is laxity
of the abdomen resulting in bulging due to abnormal
stretching of the abdominal muscles and skin.
Unlike liposuction surgery, which just removes
fat, this operation involves removal of skin
and fat, with tightening of the abdominal muscles.
For this reason, it is more extensive than liposuction.
The actual extent of surgery will depend on
the amount of excess skin and the laxity of
the abdominal muscles.
In
some cases, liposuction surgery can be combined
with excision of excess abdominal skin instead
of a more complete tummy tuck. Although this
does not give as good a skin tightening, it
does result in much smaller scars and a shorter
recovery period. When a full tummy tuck is contemplated,
however, extensive liposuction is best delayed
until a later time or has to be done before
abdominoplasty since there seems to be a higher
chance of complications when the two procedures
are combined. Occasionally, minor additional
liposuction is done after the original operation.
The
Procedure
Prior
to tummy tuck surgery, the amount of skin that
is to be removed is carefully marked. The operation
is usually carried out under general anesthesia.
An incision is made in the bikini line and the
excess skin is pulled down and is removed along
with underlying fatty tissue. The muscles are
tightened as required, the skin is carefully
redraped and the incision closed with several
layers of suture. In most cases, the belly button
will have to be relocated with an incision around
it in a circular fashion because of the amount
of skin removed. Contrary to what you may think,
the belly button is not excised during the operation!
Recovery
Following
surgery, a compressive girdle and stockings
are worn for a few weeks. There may be considerable
discomfort for several days following surgery
but most patients resume limited activity in
a day or so. A urinary catheter is normally
left in place for several hours after surgery,
and wound drains are kept in place for a few
days to help prevent the accumulation of fluid.
Because
of the extent of the surgery, there are risks
involved which can result in serious complications.
Infection or collections of blood or fluid in
the wound may delay recovery and could result
in skin loss, fat necrosis or scarring. These
could lead to the need for additional corrective
surgery. The abdominal wall is stretched during
surgery and the blood supply to the skin may
be damaged. This may lead to loss of skin. If
this happens a skin graft may be needed if the
wound does not heal, although usually, in these
circumstances primary healing will occur, though
it could take months. This is much more likely
with patients who smoke; therefore, we require
patients who use tobacco products to completely
quit for a minimum of 2 weeks before and after
tummy tuck surgery.
Fortunately,
most tummy tucks are uncomplicated, but
patients must be prepared for the added time
needed for recovery when complications occur.
In addition, patients must realize that there
is a sizable scar which, although hidden, may
thicken or widen requiring later revision. It
is also important to realize that it will take
many months for the scar to fade to its final
appearance. In spite of these considerations,
the operation is generally very gratifying.
Many patients realise relief of functional symptoms
such as low back pain, rash and abdominal discomfort
following the surgery.
Although
a more major procedure than liposuction surgery,
in many cases, abdominoplasty will provide the
type of contour improvement that patients are
seeking, which cannot be provided by other means.
Instructions
following typical tummy tuck procedures
Dressing
– Starting
the first postoperative day, wear support garment
full time for three weeks and half time for
three weeks.
Sutures
– Dissolved in about two weeks.
Wound
Care – Incisions and tape may be cleaned
through tape by dabbing area with dilute peroxide
after showering. Incisions may be coated with
Bactroban or Betadine as needed.
Activity
– Increase activity as tolerated with
no heavy exercise for 4 weeks.
Special
Instructions – Drain care: Drains will
be left in until there is less than 50 cc. of
drainage in a 24-hour period. Antibiotics must
be taken as long as drains are in.
Signs
of Hematoma – Painful extreme hardness
often accompanied by bruising, usually unilateral
causing asymmetry.
As
numbness subsides, it is common to feel tingling
or sharp sensations that are transient.
