ABDOMINOPLASTY

This procedure is a way of tightening the abdominal muscles, and/or removing excess fatty tissue and sagging skin from the middle and lower abdomen.

Many abdominoplasty patients are women whose abdominal muscles have been over-stretched and have not returned to normal after one or more pregnancies. In older candidates, a significant weight loss may have resulted in sagging skin (loss of elasticity). With any surgical procedure, it is important to be informed. However, because of the significant scar that abdominoplasty produces, it is even more important for you to educate yourself. The following section will help you. Here are some important facts about abdominoplasty.

• Liposuction on the flank and hip areas may be performed in conjunction with a tummy tuck to achieve a better contour.
• This procedure is not recommended for smokers

ALTERNATIVES TO SURGERY
A good choice is to exercise and strengthen the muscles before committing to surgery. When no changes result from that effort, an abdominoplasty may be considered. Often, if the underlying muscles are not disturbed or too stretched, liposuction can act as an effective tool to contour the stomach area. If the muscles require repair, for example, as a result of multiple pregnancies, an abdominoplasty is the procedure of choice.

PREPARING FOR SURGERY
Your physician should evaluate and assess the location of the fat in the abdomen, along with the laxity of the skin and abdominal muscle. Your doctor may recommend the endoscopic approach, a mini-abdominoplasty, complete abdominoplasty, and/or liposuction. Liposuction may be performed in the hip and flank areas in conjunction with the abdominoplasty to contour the area. It is critical to have a thorough assessment. Be absolutely clear and in agreement with your doctor about your desired look.

Discuss with your physician the location of the incisions. You may want to bring your bathing suit to your consultation. Put it on to show your physician its lines so that the location of the incisions can be planned. Also, take into consideration the type of undergarments you wear. If the location of the incisions is a major concern for you, you may even want to bring your bathing suit the day of surgery. In that way, your physician can mark the location of the incision with the suit as a guide. Your doctor may attempt to accommodate your choice for the location of the incisions, but this is no guarantee that the scars will not be visible once healing has taken place.

THE PROCEDURE
Abdominoplasty does produce a noticeable scar. If the skin has lost its elasticity, liposuction of the abdomen will not be sufficient; loose skin will remain. Some patients are willing to trade a firm abdomen for a scar. Remember that different doctors use different techniques and usually recommend the one(s) in which they are trained and experienced. You and your physician must take into consideration your desired look. In general, if you do make the decision to undergo an abdominoplasty, here's what you can expect.

A number of different options are available for the abdominal area depending on the elasticity of your skin and laxity of your abdominal muscles. There are three main approaches to achieve your desired look. Liposuction may be recommended if there is just excess fat and the skin has not lost its ability to shrink back (elasticity) or redrape. An endoscopic abdominoplasty may be recommended if the only concern is the laxity of the abdominal muscle, and there is minimal skin and/or fatty tissue. Tiny incisions are made in the navel and just above the pubic bone, and the abdominal muscles are pulled together and sutured.

A complete abdominoplasty may be recommended to remove excess fatty tissue and skin above and below the navel, as well as to tighten the abdominal muscles. An incision is usually made from hip to hip across the lower abdomen as well as an incision around the umbilicus (navel). The skin is separated from the underlying tissue and lifted all the way up to the rib cage. The navel is left attached to the underlying abdominal tissue.

If there are deep layers of fatty tissue, some may be removed by cutting them away from the skin, or liposuction may be performed. Liposuction may also be used at this time to contour the hip and flank areas. The abdominal muscles are then pulled together and sutured. The resected skin is then pulled down very tightly, and the excess skin below the navel is removed. The surgeon repositions the navel and sutures it into place. The incisions are then closed either with staples or sutures.

Anesthesia
An abdominoplasty may be performed under general anesthesia or spinal anesthesia. However, the type of anesthesia used is dependent on the procedure to be performed, the doctor's choice, and the patient's medical history or desires.

Length of Surgical Procedure
A complete abdominoplasty should take from two to five hours
Level of Pain/Discomfort
Generally, with an abdominoplasty there is moderate to severe discomfort during the postoperative period. Some patients describe the discomfort as a burning sensation, which results from the muscle repair. This usually subsides in a few days.

PRE- AND POSTOPERATIVE INSTRUCTIONS
These suggestions are intended to make you more comfortable and help you heal. To learn more, turn to the section on recovery in this chapter. Your doctor may have different or additional instructions. Follow them to the letter.

• Stop smoking, discontinue the use of alcohol, and stop taking vitamin E and any medications containing aspirin or ibuprofen (two weeks pre- and postoperative is usually recommended). Check with your doctor regarding any other medications (including homeopathic/herbal products) that you are currently taking.
• Have someone stay with you the first night after surgery (the first twenty-four to forty-eight hours preferably). Most physicians require an overnight stay in the hospital or surgical facility.
• Dressings and/or drains, if required, should be applied by the doctor or nurse immediately after the procedure. Your physician will instruct you as to the amount of time an abdominal binder is to be worn-usually between four and six weeks.
• Most physicians recommend that you get up and start taking short walks around the house by the second day, increasing the amount each day.
• For the first week to two weeks, when lying down, lie on your back, keeping your head and knees elevated (jack-knife position). Place pillows to support your head and upper back and prop up your knees with pillows. A recliner works perfectly.
• When you are up and walking, at first you will need to bend over at the waist to prevent tension at the suture line. You will be able to straighten up gradually as the skin on your abdomen stretches.

RECOVERY
Many physicians require an overnight stay in the hospital or surgical facility because respiration needs to be monitored, and the general anesthesia may cause nausea. The swelling should lessen daily, with some minor swelling remaining after the first few weeks. The bruising may last, on the average, anywhere from five days to several weeks but should diminish daily. You may also have some temporary numbness, which should dissipate in a maximum of six months. It can, however, last up to a year.

The physician or nurse may place an abdominal compression garment on you while you are still in the operating room. It helps reduce fluid buildup and supports and molds the skin. Most physicians require that this be worn twenty-four hours a day for four to six weeks. It should only be removed when you shower. If drains were inserted, they may be removed during the first twenty-four to forty-eight hours.

Your sutures/staples may or may not be removed during your twelve- to fourteen-day postoperative appointment, depending on how well you are healing. Your scar may remain red for four to six weeks. It may be wider than most scars because there is a lot of tension on the incision site due to its location.

RISKS/COMPLICATIONS
Although problems are unlikely, you need to be aware of what can happen and what action you should take. Most risks/complications will be avoided if you make an informed decision, choose a qualified physician, and follow your physician's instructions. Complications that can occur with abdominoplasty include infection, hematoma, scarring.

STILL YOU…ONLY BETTER
Many patients are extremely happy with the results of abdominoplasty. A flatter, firmer waistline will result that will look more appealing in a bathing suit or clothing.

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