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plastic surgery procedures

Abdominoplasty – Tummy Tuck

A gently contoured, firmer stomach area.

Tummy Tuck Plastic Surgery Sydney

Restoration of a healthy, natural shape will improve your confidence and physical appearance after weight loss or pregnancy.

Tummy Tuck Treatment

What is Abdominoplasty Tummy Tuck Surgery

Abdominoplasty is an operation designed to improve the shape and contour of the abdomen. Each of the relevant layers requires attention. The muscle layer, stretched by obesity or pregnancy, is tightened. The fat is removed by excision or liposuction and the excess skin is excised in a manner that hides the scar beneath the underwear.

Protrusion of the abdomen results from various life changes including pregnancy, increase in weight
and occasionally from surgical procedures on the abdominal wall. Some people are born with laxity of the muscle layer of the abdominal wall or an increase in fatty tissue of the abdomen, particularly below the umbilicus. This accounts for the “pot tummy” sometimes seen in younger people.

The Problem

In considering improvement of the shape of the abdomen, each layer of the abdominal wall affected has to be considered. There are three relevant layers, the skin, the fatty tissue and the underlying muscle. The skin can be stretched with pregnancy, the fatty layer can increase with weight gain and the muscle layer may also be stretched or weakened with pregnancy and tummy tuck surgery.

Who Is Suitable For This Procedure?

A suitable candidate for the correction of the abdominal wall laxity will have stretching of the skin and muscle, or accumulation of fatty tissue. Generally this is considered a cosmetic improvement but, occasionally, functional problems due to the laxity of the muscle layer can increase strain on the lower back causing backache. This usually occurs in older people. In addition, rashes can develop in the groin area beneath lax abdominal skin.

Pre-operative Tummy Tuck Evaluation

Doctor Olbourne will examine the layers mentioned above, noting the areas of skin looseness, areas of increased fatty tissue and whether there has been stretching of the abdominal muscles. Other abdominal surgery and scarring may modify the plan for the procedure and any areas of scarring will be noted.

From this evaluation, a surgical plan will be formulated. This may be a traditional “tummy tuck” operation involving correction of all layers, or there may be a combination of fat removal by liposuction together with tightening of the lower abdominal muscles and skin removal.

Occasionally, the fatty layer may be so thick, that extensive liposuction at the same time as a full lipectomy may be hazardous and increase the chance of complications such as postoperative wound breakdown. In these rare cases, Dr Olbourne will offer the alternative of a modification of the lipectomy procedure, or a two stage operation with extensive liposuction followed some months later by a full lipectomy and muscle repair.

The degree of scarring will depend on the amount of skin removed from the lower abdomen. It is a matter of simple geometry that the more loose skin that is present, the longer must be the final scar. There is simply no escape from this proposition. This usually necessitates a long scar running from hip to hip across the top of the pubic hairline. With the advent of endoscopic plastic surgery, significant improvement can now be achieved with minimal incisions and tiny scars. However, there are strict limitations to the type of deformity able to be treated with this “keyhole” surgery. Dr Olbourne will assess your problem and advise you accordingly.

Pre-operative Tummy Tuck preparation

Prior to tummy tuck surgery any routine examinations such as X-rays and laboratory tests that are considered necessary will be organised. Pre-operative photographs of your abdomen will be taken. It is advisable to shower with antiseptic soap at least twice and preferably three times prior to tummy tuck surgery. This decreases the level of skin bacteria and as such will decrease the possibility of infection which is always a potential risk in this group of operations. This type of surgery usually involves at least an overnight stay in hospital although if liposuction is performed with a small skin removal on the lower abdomen, it may be possible for you to go home the same day. Most of Dr Olbourne’s patients stay in hospital for longer periods, even up to three or four days.

It will also usually be necessary to organise assistance at home for the first few days after tummy tuck surgery as there will be some tenderness of the abdominal muscles and you may find difficulty with normal mobility. It may also be necessary to cease hormonal therapy prior to your tummy tuck surgery, but Dr Olbourne will advise you regarding this.

After admission to hospital, the areas of excision and fat removal are usually marked on your abdomen in an upright position before going to theatre. Dr Olbourne will require that you wear a girdle for some weeks after operation. Initially, a corset will be provided at the hospital. However, it is bulky, and when the swelling settles you should purchase an inexpensive corset or girdle to wear for up to six weeks. Our office will advise you on this.

Smoking is not advised prior to any tummy tuck surgery, but is particularly ill-advised prior to abdominal tummy tuck surgery. This can cause problems with the circulation of the skin as well as increasing the chance of post-operative chest infections. Smoking should be ceased at least two weeks prior to tummy tuck surgery. You must assume the responsibility that problems arise after tummy tuck surgery that are regarded as nicotine related if you do not desist from smoking as advised.

Types of Abdominoplasty Scars

Every patient needs to know about the position and length of the scar following their abdominoplasty.

This will, of course depend on the severity of the problem. The position of the scar can always be low down and is designed to be well hidden by your underwear or swimmers. Many patients are able to wear G-string underwear or bikinis after abdominoplasty surgery.

The length of the scar is determined by amount of skin that has to be removed. If there is a prior scar low down, from a Caesarian Section or hysterectomy, then the first incision is below that line. We try to remove all the skin and fat up as far as the umbilicus so that the belly button can be resited in the loose upper abdominal skin below the rib cage. The width of this excision usually results in a scar the runs from hip to hip.However, the length of the scar is less important than its quality.

A carefully sutured abdominoplasty scar will almost always fade to a fine whit line within six to twelve months.

The Tummy Tuck Operation

This type of procedure is performed under a general anaesthetic and requires at least one night’s hospitalisation and often three to four days in hospital.
The length of skin incision and therefore the type and position of the final scar will be determined by the deformity you have and the need to tighten the abdominal muscles to achieve a flat abdomen.

The looser the abdominal skin and the more pendulous the fatty tissue apron of the lower abdomen, the longer must be the scar across the abdomen. This is so because of the geometry of the operation and has to do with the relative lengths of the base and hypotenuse of a right-angled triangle. Dr Olbourne will explain this because you need to appreciate why the transverse scar may need to be as long as it is. All efforts are made to keep this scar as short as possible and to locate it low on the abdomen beneath your bather’s line or underwear.

Removal of skin

With recent developments in abdominal tummy tuck surgery, DrOlburne is now confident of thinning the tissue in the upper abdomen with liposuction at the same time as performing the abdominoplasty . By doing this, not only is the thickness of the abdominal wall modified to produce the definition of the “six Pack” muscle mass, but the tissues become more mobile and flexible, so that more unwanted skin is removed and a flatter tummy is achieved.

It is necessary to insert a drain tube into the wound at the time of tummy tuck surgery so that blood or fluid do not accumulate beneath the skin. This drain is usually left in place for approximately 48 hours, but does not necessarily prevent discharge from hospital. Dr Olbourne uses suction drains which accumulate blood in a closed bottle or bag. These bags are emptied every twelve hours and the discharge recorded. Once drainage is less than 15mls in each drain over 12 hours the drains are removed and you will be discharged. Where only a small incision is made on the lower abdomen it may not be necessary for you to remain overnight in hospital.

The wounds on the abdomen and around the umbilicus are sutured and often only dissolving sutures are used. Our preference where possible is to use dissolving sutures as this eliminates the need for suture removal and often gives a better scar. This wound is supported with adhesive tape for up to six weeks to give it every chance to develop a fine scar.

A supporting girdle is applied in the operating theatre to support the internal surgical repair.

Position after surgery

Movement of the feet and toes is important post-operatively and mobilisation out of bed is encouraged as soon as possible in order to limit the chance of clotting in the deep veins. I.V. fluids are usually given for the first 24 hours and this would require attachment to an intravenous drip. Where indicated, injections are given to thin the blood and minimise the risk of deep venous thrombosis.

Post-operative antibiotics are sometimes given as an additional prophylactic measure against wound infection. Infection or latnecrosis is more common when operating on fatty tissue which has a poor blood supply and as previously mentioned in patients who smoke.

Post Operative Course

The legs are usually kept bent for approximately 48 hours after the procedure although in this time you will be encouraged to mobilise and walk around the room and go to the toilet. It usually takes approximately four to five days for full mobilisation and for you to be able to leave bed comfortably without assistance. During the early stages, pain relieving medication may be prescribed. An indwelling bladder catheter may also be advised for your comfort.

The drain tubes are removed approximately two to three days after tummy tuck surgery and if hospitalisation has been recommended during this time you will then be allowed to return home. Sutures are left in place for approximately eight to ten days, but once the drains have been removed you will be allowed to shower and wash normally. A support garment or girdle will be necessary. It may have to be worn for up to six weeks after tummy tuck surgery.

Understanding The Risks And Complications

  • Scarring. Tightening of the skin of the abdomen and reduction of fatty tissue together with tightening of the abdominal muscles is achieved at the cost of an abdominal scar which can be quite long. The degree of tightening will govern the type, length and the site of scar and this will be discussed in your pre-operative assessment. However, it should be noted that abdominal scars are always red for a considerable length of time (some months) and even after the redness fades the scar is usually wider than a corresponding scar where no tension is applied to it. In some people and on some occasions, thickening of the scar can occur and this is called keloid or hypertrophic scar. Dr Olbourne has little control over this scar healing tendency in your body.
  • Treatments can now be applied to improve scar hypertrophy if this were to occur, but occasionally it does require additional revisional surgery. Generally speaking the scars take six to twelve months to become flat and pale. Postoperative support of the scar with adhesive tape can often improve the quality of the final scar. You will be given advice on this after your operation. Dr Olbourne will do all he can to help you achieve an optimal result.
  • Numbness. Areas of skin numbness will be present after surgery and these are most frequent below the level of the umbilicus. Over a period of months, the degree of numbness and the total area involved will reduce, but occasionally a small area on the lower abdomen will remain permanently numb. This does not usually influence normal activity and if it does occur should not be regarded as a complication of the procedure.
  • Bleeding. As with any operation bleeding can occur in the post-operative period. The drain tubes will cope with any small to moderate bleeding and this will usually settle within 24 to 48 hours. Occasionally however, the drain tubes will not cope if the degree of bleeding is excessive and swelling under the skin will be seen. If this were to occur it would be necessary to return to theatre for drainage of the blood collection (haematoma) and to find the vessel that is causing the problem. In the long term however, there are no substantial side effects from this. It is usually not necessary to transfuse patients undergoing an abdominoplasty procedure, except on the odd occasion where haemorrhage or bleeding is excessive.
  • Swelling. It is common in the early stages to find swelling of the lower abdominal tissues to be prominent and in some ways to detract from the initial results. This swelling is usually due to tissue fluid (oedema) and can be marked if liposuction is performed at the same time as skin excision. It will normally settle over a period of months. A tight girdle or surgical garment can be used to reduce the degree of swelling and Dr Olbourne will advise if this is necessary. Other treatments such as ultrasound can be used to improve irregular swelling or lumpiness under the abdominal skin.
  • If large amounts of fat have been removed from the lower abdomen the fatty tissue remaining in the upper abdomen can cause the appearance of the swelling in this area. This cannot usually be removed at the time of surgery as interference with the blood supply to the skin can occur causing lower abdominal skin death or necrosis. At a later date liposuction in the area of the upper abdomen adjacent to the rib margin can be performed to reduce the fatty tissue in this area.
  • Swellings at the outer end of the lower abdominal scar can be prominent and this may also require additional surgery either by excision or liposuction to reduce these prominences called “dog ears”.
  • Necrosis (skin death). If the skin is pulled too tightly or lifted too widely on the lower abdomen the blood supply to that skin can be decreased to the point where the skin can die. This is particularly the case if the fatty tissue in the upper abdomen is reduced too much or if liposuction is performed at the same time as a full abdominoplasty is performed. If this occurs it sometimes requires excision and skin grafting. Fortunately this is a rare complication. It is more likely to occur in patients who are or have been smokers. However, in all cosmetic procedures, your surgeon is attempting to achieve the maxiumum improvement with the minimal risk of complications. The situation is different in every patient and how far to go to push the envelope is always a difficult decision to take.
  • Wound dehiscence. This means that the skin has not healed fully along the lower abdominal wall and may separate. Occasionally, it is possible to re-suture this area, but again it may require a skin graft to the raw area, in the short term and after healing is established the graft can be re-excised to improve the ultimate scar.
  • Vein Thrombosis. With any large abdominal or pelvic operation there is a chance of thrombosis developing in the veins of the calf and extending up to the large pelvic veins. If these clots break off and lodge in the lung the condition may become extremely serious. It is known as “Pulmonary Embolism”. Various prophylactic techniques are employed to reduce this small risk and cessation of hormone treatment may be necessary. In addition early mobilisation, the prophylactic use of anti-coagulant medication, and calf pumps all further reduce the risk of vein thrombosis.
  • Seroma. A seroma is a collection of fluid beneath the skin somewhat akin to a large blister. Seroma is usually the result of friction of the skin flap over the underlying muscle layer. This friction causes fluid to form which is drained away by the post-operative drains. Occasionally seroma formation may continue after the drains are removed and the patient has resumed normal activity. This causes a swelling in the lower abdomen that must be aspirated – often more than once or twice. Occasionally a seroma is not obvious and remains undetected. It may then discharge through the wound (usually at night) and soil the bed linen. If this occurs, do not panic. You are in no danger. Notify Dr Olbourne as soon as practicable to have the problem managed until it settles.

Returning to normal activity

Dr Olbourne may recommend approximately two to four weeks off work to recover from this operation, although with more minor degrees of abdominal fat removal by liposuction and smaller skin excisions, lesser times may be acceptable. It is usually recommended to cease sporting activities and exercise for four to six weeks and during this time no heavy lifting should be undertaken. However specific instructions will depend on you, your operation and the activities you wish to pursue.

The outcome

As with all tummy tuck surgery there is no guarantee that a specific result will be achieved. It is also not uncommon for minor degrees of asymmetry to be present on the lower abdominal scar and with the amount of fat present in either side of the lower abdomen. The umbilicus may on occasions be not completely central, but this is not uncommonly the case on patients who have had no previous operation and should thus not be regarded as abnormal. At any time in the post-operative period, if you feel that there may be problems arising or if you are concerned about any aspect of your tummy tuck surgery, please contact Dr Olbourne or the nurse to discuss this or arrange for an appointment for review.

Tummy Tuck Before and After Photos

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Tummy Tuck Case Studies

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Tummy Tuck Treatment Appointments

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