Abdominoplasty (Tummy Tuck) and Body Contouring

Author: Dr Bryce J Cowan BSc MSc MD PhD FRCSC
(Reconstructive & Cosmetic Plastic Surgeon, The Skin Care Centre, Vancouver, BC)

Abdominoplasty (tummy tuck) is a procedure that is designed to combat hanging skin folds or skin laxity, which can be caused by a combination of aging and sudden weight changes. Skin damage resulting from sudden weight change or pregnancy is often permanent, and untreatable by lifestyle change alone. In fact, weight loss can often accentuate the skin's laxity and folds. It is important to remember, however, that abdominoplasty will not replace healthy lifestyle choices such as proper diet and exercise, as these will have a much more profound effect on your health.

For those who have undergone significant weight loss in a short period of time, large skin folds may be present. In these cases, a procedure called panniculectomy may be appropriate. Again, it is important to understand that body contouring methods like these are not designed to correct obesity.

The Ideal Candidate:

A young woman with a healthy body height to weight ratio, who has excess skin below the umbilicus following pregnancy, is a good candidate for abdominoplasty.

In or Out-Patient Procedure

Generally, abdominoplasty is performed under general anesthesia, and a one night stay in a hospital or alternative clinical setting is required. In some cases, limited abdominoplasty can be performed as outpatient procedures under local anesthesia.

Relative Contraindications

1. Abdominal scars above the umbilicus (restricts blood supply to distal flap)
2. Obesity
3. Likely or planned future pregnancy
4. Medical conditions prohibiting elective surgery
5. Unrealistic expectations

Preparation

Prior to any body contouring procedure, it is important to take appropriate preparations to increase safety, and maximize the benefits of the procedure. First, patients should maintain a stable weight for 6 to 12 months. Additionally, patients should not take anti-inflammatory drugs such as Aspirin®, Motrin®, Ibuprophen, or Advil®, due to their effects on the body's blood clotting, for at least two weeks prior to surgery. Tylenol ES®, is a painkiller that can be used for those who suffer from chronic pain. Any use of herbal supplements or other alternative medicine should be discussed with your surgeon. Finally, alcohol should be avoided for at least a week prior to the surgery date.

Additionally, any medical condition or medications that are used must be disclosed to your surgeon prior to the procedure. Conditions such as high blood pressure are important considerations in a procedure like abdominoplasty where bleeding and hematomas are a real risk.

Smoking is a very important factor in abdominoplasty surgery. Chemicals from smoking can cause vasoconstriction of blood vessels, which restricts the blood supply to the newly re-draped and transferred tissues. Smoking must be stopped at least 2 to 3 months prior to surgery in order to eliminate the risk of further tissue loss. It is important to understand that all smokers, regardless of quantity, are at an increased risk of tissue death following body contouring procedures like abdominoplasty.

The Procedure

The abdominoplasty procedure involves removing large amounts of abdominal fat and skin below the belly button, contouring the stomach and thoracic area. The excision of skin below the belly button is beneficial in reducing permanent stretch marks that are the result of rapid weight gain, pregnancy, or sudden growth. Unfortunately, scarring will occur from this procedure. Loose skin cannot be removed without incisions that are significant to cause scars. While scars will fade over time, it is important to ask your surgeon about scar extent, and location so that there is no misunderstanding over expected results.

The removal and re-draping of the tummy skin may require the permanent repositioning of the belly button. The belly button is repositioned through incisions within the depression of the belly button itself.

This procedure can be combined with other procedures such as liposuction or structural reinforcements for greater benefits. Common procedures concurrent with an abdominoplasty are liposuction, hernia repair, and hysterectomy. In each case, however, the cases must be reviewed with all participating surgeons for overall safety.

Convalescence

Abdominoplasty is a major procedure with a significant recovery time. The final surgical result is often seen after 9 to 12 months following surgery. Patients will likely be uncomfortable walking in an erect position, especially early within the week of operation. For the first few weeks, patients are required to wear an abdominal binder. Work activities should be avoided for at least 2 to 3 weeks, and manual labor should be avoided for longer. It can take 2 or more months to be able to play sports. Finally, patients will often have a numb feeling in the stomach area for several months, and longer lasting change of sensation in the abdominal walls.

Potential Complications

Any surgical procedures have an element of risk, and abdominoplasty is no exception. Although the relative risk of complication is low, it is important that patients be cognizant of the potential risks. The list below are some of the possible complications due to abdominoplasty. Note that expected side-effects such as change in abdominal numbness are not listed, as they are inevitable and predictable in the process of operation.

Intra-operative	Early Post-operative	Late Post-operative
Drug reactions Bleeding	Bleeding / Hematoma* Infection Seroma* Wound dehiscence Tissue loss (necrosis) Fat necrosis Pulmonary embolism Phlebitis	Abnormal scars Painful scars Umbilical deformity Persistent lower abdomen numbness Persistent lower abdomen swelling

*most common complications

Hematomas (blood collecting under the skin) are the most common complication following abdominoplasty. Hematomas can frequently be avoided by careful surgical technique and the use of closed suction Drains.

Expectations

Scarring from the procedure will take approximately 12 to 18 months before they can be assessed. Prior to assessment, it is essential that the scarred area is protected from the sun (using 45 o 60 SPF sunscreens) to prevent permanent darkening of the scars. Residual abdominal wall numbness may occur. After post-operative swelling is controlled, many patients note a major change in their abdominal contour. Despite this, patient satisfaction with this procedure is typically high.

Other Excisional Body Contouring

There are many forms of body contouring such as Arm-lifts (Brachioplasty), thigh lifts, and total body lifts. The procedures are similar to abdominoplasty, requiring incisions, removal of excess fat tissue and skin, and re-draping of the remaining tissues. All of these procedures are designed to provide an overall improvement in the shape and contour of the body. Scarring and skin numbness is also common in these procedures. Please consult your surgeon about specific risks and rewards of these procedures.

DISCLAIMER

This website does not cover all of the medical knowledge related to abdominoplasty and body contouring nor does it deal with all possible risks and complications of surgery on the abdominal wall and associated structures. Although it is designed to provide the patient with greater depth of information in some areas, it is not intended to substitute for the in depth discussion between patient and surgeon that must occur prior to any surgical procedure.