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What is abdominoplasty?
I am glad you asked that question. An abdominoplasty is the
formal name for the procedure most people call a “tummy
tuck.” This procedure is most often considered by women,
even though now more and more men are considering the procedure.
An abdominoplasty is a procedure that is considered by many
women several years after the birth of their children, when
their body weights have returned to normal and they find that
they have a “pooch” or a saggy area around their
mid abdomen. This also is a consideration by many men and
women who have now regularly gone to the gym and find that
they are successful with their weight loss and find that they|
are now left with a lot of loose skin. The last group are
the women who fortunately have been successful with their
weight loss but find that they are now left with a great deal
of stretch marks that simply will not fade away. For all of
these groups, an abdominoplasty procedure
is a possibility.
As for the procedure itself, it involves making a cut from
one side of the abdomen to the other. Of course, this is done
under general anesthesia so as to make sure the patient has
no pain. The incision is made to the layer above the muscle
layer and the dissection is then carried out all the way up
to the ribs or the costal margin in a triangular fashion.
The umbilicus or the belly button is freed and preserved still
attached to the abdominal wall. When the tissues are freed
up, one would be surprised at how much the skin will then
stretch. In some cases the skin is able to stretch up to 6
to 8 inches. When this is done, the patient is then placed
in a flexed position and the old and the new area are put
together. In this way the saggy skin or the stretch mark area
is taken off. The patient is left with good, nice, non-saggy,
non-stretched skin. Once the skin is attached, the belly button
is brought out through a new hole and reattached.
Once it is said and done, the patient (you) is left with
an incision going from one side of the abdomen to the other,
and an incision around the belly button. The sutures used
are absorbable and do not need to be removed. We do also use
some staples in some cases for support but these are usually
removed by the end of the first week.
How painful is the procedure?
Like any surgical procedure, there is pain involved. Most
patients comment that they have a moderate amount of pain
but compare it to a C-section. Most note that the pain accompanied
by a C-section is more than an abdominoplasty. Also to help
with the pain, we regularly give patients oral pain medicine
upon their discharge from the hospital. In an attempt to also
help with the more immediate post-operative pain, we place
indwelling pain pump catheters. These are placed during surgery
and enable a self-contained system to dispense local numbing
medicine (marcaine) into the area of the incision and help
with anesthetizing the incision and wound area for the first
48 to 72 hours. The pain pump is heat activated so as long
as it is taped to the body it will work. It is a continuous
pump and does not need to be activated or regulated by you,
How long do I have to take off from work?
Great question. Most often I suggest to patients that they
consider taking about 2 to 3 weeks off from work. Each patient
is different but in my experience I have seen most patients
be active and up to most of their usual tasks by 3 weeks after
surgery. Again each person and each body is different. One
thing I need to mention is that I would require as most plastic
surgeons do that you wear an abdominal binder, a corset of
types, to give you additional support during your recovery
period. I would recommend you wear this binder for approximately
6 weeks time
Can I combine this procedure with any other procedure?
Yes and no. Like any surgical procedure, there are limits
to what can be done and what is safe. As for the yes, it can
be combined with some other procedures. For example, I routinely
do this procedure with a hysterectomy. Most of the OB/Gyns
in the area can easily do their part of the surgery and then
I can complete the procedure with an abdominoplasty, allowing
for a precise plastic surgical closure. I also routinely do
an abdominoplasty with a breast augmentation or a breast lift.
Any procedure that may be too long or too arduous and place
the patient at risk for significant bleeding or significant
anesthetic exposure would have to be deferred and done in
two stages. Please understand I say this without knowing exactly
what you, the patient, may have in mind. I can only speak
from my experience.
What are the possible complications?
I am glad you asked that question. An abdominoplasty has several
possible complications. Of these the most common seen are
infection, bleeding, seroma, numbness and dehiscence. One
by one we will discuss these. Infection is an issue here because
most of these operations leave the patient with large incisions.
We do our best to hide the incisions but we cannot make them
smaller. Therefore, we do our best to give the patient the
best coverage and anti-bacterial support with preoperative,
intra-operative and postoperative antibiotics. This helps
to reduce the chances of getting an infection. The patient
also helps with this by being diligent with the care of the
incision. Bleeding is a possibility. However, this tends to
be easily managed in the operating room. We are diligent in
stopping all bleeding points that we can see. As for bleeding
however, the patient plays the most important role; Bleeding
can best be prevented by the patient. Patients need to be
off of any type of blood thinners such as coumadin, aspirin,
plavix, and must also be off of vitamins and additives for
at least three weeks. It may sound strange but many of the
bleeding complications seen are due to the use of vitamins.
So again the patient by being diligent and thoughtful can
be the best asset.
Seroma is a fluid collection and its formation is understandable
when there are incisions on the body and a large dissected
pocket. A seroma tends to accumulate in an area with an open
space. In patients undergoing an abdominoplasty, this can
be a definite problem. To help with this, we tend to keep
drains in place for several weeks. These drains help to evacuate
any excess fluid and keep the underlying tissues as dry as
possible allowing for maximal healing. The abdominal area
is also usually helped with the use of an abdominal binder
that can help tighten tissue spaces and hinder the formation
of a fluid collection. So again patient compliance can help
reduce the chance of this complication.
Dehiscence is the breakdown of a wound following surgery.
This can occur when two areas are tightly forced together.
To prevent this we do exact measurements of the patient’s
body contour and mark our incisions carefully. This gives
the patient a certain amount of leeway and ensures that stress
and movement do not cause breakdown in the incisions.
Last but not least, numbness. Numbness is common in and around
the incision areas. This again is not unexpected. When incisions
are made and tissues are moved, nerves can in some cases be
cut and in other cases stretched. Because of this numbness
is an expected complication. Most often the nerve sensation
returns in time. Unfortunately, when exactly the function
returns is unknown. Most often nerve sensation returns within
6 months to a year.
What is a “mini-“ tummy tuck?
Another commonly asked question. To clear up any confusion,
there is a difference between a “mini-“ tummy
tuck and the regular tummy tuck. As opposed to the regular
tummy tuck, a mini tummy tuck is considered in some patients
who have an excess amount of skin and not a great deal of
underlying fat. This is a critical difference. In all my years
of education and training, I think I have only seen a few
patients that may again may be candidate for a mini tummy
tuck. I will explain. A mini-tummy tuck only involves resecting
the skin without doing any major dissection or any major mobilization
of the underlying skin and tissues. Some patients may consider
this a plus. However, as everyone knows, no one can escape
gravity. As time goes on, many of these patients who underwent
a mini- procedure return, and want to get the regular abdominoplasty.
So in the long run, they have not really saved themselves
any money or time. They end up undergoing two procedures and
getting charged twice.
Am I a good candidate?
Plastic surgery is not for everyone. It involves certain risks
like any operative procedure. As long as you are aware of
this fact, you can be considered for the procedure. However,
in every case, the patient is best served by a thorough evaluation
of their history, their body and
their overall expectations. You as a the patient have to be
realistic and cognizant of what is possible and what is reasonable.
Trust me I am from Beverly Hills and I have had the privilege
of working with many of the famous groups of plastic surgeons
in LA. I can simply tell you there is no magic. We offer an
opportunity to help you with surgical procedures in correcting
what you may think is abnormal about your body. Also please
understand that for many patients no surgery is needed; just
a friendly word of encouragement and confidence from the local amarillo