A gently contoured, firmer stomach area.
Restoration of a healthy, natural shape will improve your confidence and physical appearance after weight loss or pregnancy.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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Call Sydney Institute of Plastic Surgery on 02 9411 3177 or email us at email@example.com