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 (for) a more complete tummy tuck. When a full Tummy Tuck is contemplated, extensive Liposuction is best done at the same time. Liposuction helps shape the thighs, back and sides. Abdominoplasty takes care of the hanging abdominal skin. Occasionally, minor additional liposuction is done after the original operation.
The
Procedure
Liposuction is first carried out of the Abdomen and Sides through small incisions. 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 may be 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 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 hardness often
accompanied by bruising, usually unilateral causing
asymmetry.
As
numbness subsides, it is common to feel tingling or
sharp sensations that are transient.
