Abdominoplasty

In todays figure conscious society, greater attention is directed to the size and shape of our bodies. In an attempt therefore to control any bodily changes which may occur in this respect, we try to make use of exercise and diet to the best of our abilities. However certain areas of our body can become stubbornly resistant to any improvements.  In some individuals the localised deposits of fat in the abdominal region combined with muscle laxity can make any hopes of a "flat tummy" very difficult to achieve. In women this becomes all the more difficult if stretched and loose skin appears following pregnancy.

Alternatively there are individuals who may have lost a large amount of weight and subsequently find as a result that they have an "apron" of skin which hangs down in front of the abdomen. 

In cases where improvements can not be made despite even the most diligent efforts, an abdominoplasty may be appropriate. Abdominoplasty or "tummy tuck" as it is commonly known is an operation to tighten the muscles of the abdominal wall and to remove excess skin folds and fatty tissues from the middle and lower abdominal region. There are a number of variations in techniques with this surgery. As such it can dramatically reduce the appearance of a protruding abdomen and lead to a flatter, firmer, tighter stomach and when liposuction is also used, a thinner waist as well.

Many times however the problem is basically confined to only localised fat in the abdominal region without any associated skin laxity or stretch marks. In these cases liposuction alone may be suitable

The surgery

In the full abdominoplasty, you must understand that there is a long incision made within the so called "bikini line" just above the pubic area, from hip to hip. The skin and fat is then peeled off the abdominal wall up to the umbilicus (tummy button). At this point a second incision is made around the umbilicus, in a measure to free this from the surrounding tissue. Once this is done, the skin and fat layers of tissue (called a flap) initially lifted, is continued to be peeled off the abdominal muscles, leaving the umbilicus on a stalk, and continued all the way up to the border of the lower rib cage. The exposed muscles are then tightened as necessary by stitching them together creating a firmer abdominal wall and a narrower waist.
The peeled back flap of skin and fat is then stretched downwards towards the initial incision and any extra tissue is removed. The incision is subsequently stitched closed but not before a new hole has been made for the umbilicus, which as mentioned is sited on a stalk, in order for it to pop through. Drainage tubes are usually placed under the skin to collect any excess fluid that may accumulate in the first 24 hours after the operation. These are removed when fluid production has ceased (usually 24-48hrs).

In the "mini tuck" technique the skin is separated only between the lower incision line just above the pubic region, and an area just below the umbilicus.  The umbilicus is left in place without the need for a further incision. Liposuction may be combined with this procedure if the distribution of fat calls for this.

Risks

As in any procedure the risk of significant infection is always possible. This is minimised by careful surgical technique and the preventative administration of antibiotics both at the time of surgery and after. However despite these measures mild infection is relatively common and can occur around the incision site, but usually subsides over a period of about 2 weeks.

Risks such as blood clots are rare. You will be asked to wear special stockings (TED) just prior to coming to theatre, to reduce this likelihood. Furthermore during your operation special pump devices (Flowtron) are wrapped around your calves to stimulate continued blood flow to this region and avoid any stagnation of blood which can lead to blood clots. Early mobilisation by moving around as soon after the surgery as possible also reduces this considerably.

As mentioned earlier, swelling should be expected after this operation. When mild or moderate swelling is present, the body rapidly reabsorbs this. Very rarely, increased bleeding can lead to more significant swelling and the development of a haematoma (a collection of blood under the skin). If this were to happen, surgical drainage to evacuate this would be required. Ultimately however this should not affect the final outcome.

Another possible complication is the formation of a collection of fluid called a "seroma". This fluid is clear and yellow in colour. It is seen as a swelling in the lower abdominal region, and many times patients report that they can feel this fluid moving under the skin. It is usually noticed at about 10 days after surgery. The treatment will depend on the amount of fluid present. If this is deemed to be small and is not causing any discomfort, then only a pressure garment is applied and the body reabsorbs this, usually by about a month’s time.  If however the amount of seroma is significant and causes pain or discomfort, then the initial treatment is to draw out this fluid with a needle (called aspiration). Following aspiration the swelling rapidly disappears. If necessary this procedure may be repeated in a week’s time.

During the first 2 -3 weeks after surgery, some patients may experience a minor loss of wound adhesion at any point of the incision site. This is a temporary complication, which will require regular dressing changes initially

Gallery