TUMMY TUCK, ABDOMINAL REDUCTION
(ABDOMINOPLASTY)
Introduction
The tummy tuck operation eliminates excess skin and fat from the abdomen. The abdominal muscles can be tightened at the same time.
Tummy tucks are performed in those patients whose abdomens have stretched and sagged after weight loss and pregnancy. This is not a procedure designed to remove large amounts of weight from the obese patient. Usually there will be hardly any weight loss as a result of the operation.
Patients who have lost massive amounts of weight often have an apron of skin hanging down in front of the abdomen. They often find that they get skin problems such as chafing and rashes under this apron and these are difficult to control. Also it is difficult to find clothes that fit and those, which do, are not flattering.
Apart from improving the profile, the procedure also helps to remove stretch marks and scars from the lower part of the abdomen.
Nature of the operation
The patient is admitted on the morning of surgery. A general anaesthetic is necessary. In selected cases fat is sucked away from the abdomen first. A long horizontal incision is made in the lower abdomen inside the so called "bikini line". ( Fig. below ) . The skin and fat layer is lifted off the muscles of the abdomen as far upwards as the rib cage.
An incision is made around the whole circumference of the umbilicus (navel) and it is freed from its attachments to the skin and fat of the abdominal wall to look like a 'mushroom on a stalk'.
The abdominal muscles are tightened if they have been stretched. The excess skin and fat layer is suitably trimmed and the wound is closed under tension so that the abdominal wall is as tight as possible. The umbilicus is re-sited, after a small circular area of skin at the new site of the umbilicus is removed, so that it effectively ends up in its original position.
The length of stay in the clinic is no longer than two days and the sutures if they are not dissolvable are removed at about ten days.
Postoperative events
See Factors Common to All Surgical Procedures
Haematoma This is a collection of blood caused by bleeding occurring beneath the abdominal flap after the operation. It is a rare complication but may require drainage under a general anaesthetic.
Seroma This is a collection of fluid that has accumulated under the abdominal flap in the postoperative period. It can usually be removed easily with needle aspiration but this may need to be repeated several times as the accumulation of fluid can recur.
Stretch marks will generally be removed if they lie below the umbilicus. In some skin types stretching the abdominal flap after surgery can lead to new stretch mark formation. These newly formed stretch marks may even lie above the level of the umbilicus.
Skin loss can occur if there is an inadequate blood supply to any part of the abdominal flap after the operation. This may happen if the skin has been closed under too much tension or it is sometimes a consequence of the patient's heavy smoking. It can also occur if overzealous liposuction has been performed previously. Further surgery will be necessary at a later stage to improve the situation.
Scars may become stretched or thickened (keloid) and may require revision at a much later date.
Loss of the navel is a rare complication resulting from an inadequate blood supply to the navel after reimplantation. Further surgery may be required to reconstruct a new navel.
Malposition of the navel rarely occurs . The new navel may be placed too high or low or not in the middle. Further surgery may be required to move it to a more favourable position.
Abdominal asymmetry is a rare problem that occurs if more tissue has been removed from one side than the other. Further surgery may be required to correct the difference.
Loss of sensation There will be an area above the long horizontal scar that will have a loss of sensation in nearly all cases. This may take a while to return.
Postoperative management
Most patients feel well enough to get out of bed the day after the operation. Thereafter short walks are encouraged. However activities are limited by the discomfort that will invariably be present initially.
Strenuous exercises should be avoided for at least six weeks. After full recovery, a regime of a good diet and plenty of exercise will ensure that the result of the operation is permanent.
This procedure should only be carried out in women after they have completed their family, as a further pregnancy after the operation will mar the original result.
Result
A tummy tuck procedure will flatten and tone up a previously flabby stomach. All patients must be aware that a long horizontal scar will result which may stretch or thicken and take time to mature fully.
The procedure often encourages patients to adopt a healthier regime of diet and exercise. The operation should only be performed in women who do not intend to have more children
