The Tummy Tuck Procedure
Most commonly a tummy tuck procedure involves the surgeon making a long incision from hipbone to hipbone, just above the pubic area. A second incision is made to free the navel from surrounding tissue. With partial abdominoplasty or tummy tuck, the incision is much shorter and the navel may not be moved, although it may be pulled into an unnatural shape as the skin is tightened and stitched.
Next, the surgeon separates the skin from the abdominal wall all the way up to your ribs and lifts a large skin flap to reveal the vertical muscles in your abdomen. These muscles are tightened by pulling them close together and stitching them into their new position. This provides a firmer abdominal wall and narrows the waistline.
The skin flap is then stretched down and the extra skin is removed. A new hole is cut for your navel, which is then stitched in place. Finally, the incisions will be stitched, dressings will be applied, and a temporary tube may be inserted to drain excess fluid from the surgical site.
Length: Complete abdominoplasty usually takes two to five hours, depending on the extent of work required. Partial abdominoplasty may take an hour or two.
Anesthesia: The surgeon may select general anesthesia so you sleep through the operation or local anesthesia, combined with a sedative to make you drowsy. With local anesthesia, you'll be awake but relaxed and your abdominal region will be insensitive to pain. (However, you may feel some tugging or occasional discomfort.)
In/Outpatient: Abdominoplasty is performed either as an outpatient or inpatient, depending on individual circumstances and extent of the surgery required.
Side Effects & Risks
Postoperative complications such as infection and blood clots are rare but can occur. Infection can be treated with drainage and antibiotics but will prolong your hospital stay. You can minimize the risk of blood clots by moving around as soon after the surgery as possible.
Temporary pain - swelling, soreness, numbness of abdominal skin, bruising - and tiredness will be experienced for several weeks or months.
INCISIONS (SCARS): After a full abdominoplasty, you will have a long scar above the pubic hairline extending toward the flanks or beyond, as well as a scar around the umbilicus (bellybutton) and possibly a shorter vertical scar in the midline just above the pubic hairline. You should discuss your incision lines with Dr. Patterson, and plan the incision to accommodate, within limits, different clothing and bathing suits styles. (In cases of extreme skin redundancy--that is, after massive weight loss--a vertical scar extending from the pubis hairline to the lower end of the breastbone may result).
After a “mini-abdominoplasty,” you will have neither a scar around the umbilicus nor any possibility of a vertical scar. The horizontal scar above the pubic hairline will be shorter than the scar after a full abdominoplasty. Redness, thickness, and some widening of these scars to a variable extent will occur once you return to normal activities. Incisions placed in high tension areas (i.e., abdomen, shoulders, knees) tend to create slightly wider scars.
If you have chosen an extended abdominoplasty, the scars will extend around the hips toward the back.
UNEVEN SKIN CONTOURS: Following abdominoplasty, the skin contours maybe slightly uneven and areas of slight depression or wrinkling can occur. As healing progresses, most of these problems (if present) usually improve dramatically.
ASYMMETRY: Minimal asymmetry of abdominoplasty scars occurs frequently as healing is not always even from side to side. The mild asymmetry is usually not cosmetically significant*. If the asymmetry is significant, revisional surgery of the scars may be considered.
BELLYBUTTON (UMBILICUS): The bellybutton may be slightly off center, heal poorly, suffer necrosis (loss of circulation), protrude or be unusually retracted. Significant problems are uncommon.
LOSS OF SENSATION: Patients commonly experience areas of partial and/or complete numbness of the abdominal skin. Few experience permanent loss of feeling, but it may take several months or longer* for sensation to return. Rarely, areas of numbness persist.
FAT NECROSIS: In rare cases, some of the underlying fat can necrose (die) because of infection or excessive tension. An uncommon problem, it is usually nothing more than a severe annoyance, requiring additional healing time, dressing changes, sometimes revision of the scar later. It usually does not seriously affect the ultimate outcome.
SKIN LOSS: Like fat necrosis, skin loss can result from infection or excessive tension. The treatment is the same regardless of the cause. Careful preoperative planning and resisting the urge to make the tummy “as tight as possible” reduces but does not eliminate the possibility of this problem occurring.
“DOG EARS”: When Dr. Paterson closes the angle at the end of the skin incision during the repair, a nipple or projection of bulging tissue called a “dog ear” can occur. Liposuction under the area or extension of the incisions can solve or reduce the problem. If a small “dog ear” appears at the end of surgery, it will usually flatten or disappear with time* and healing. If it remains visible, a small procedure under local anesthetic can solve the problem at a later time.
FAT EMBOLI AND BLOOD CLOTS: These problems can occur rarely with any surgery, but occur a little more frequently after an abdominoplasty. Shortened operating time, postoperative leg movements, and walking soon after surgery help to avoid these problems. Although fat emboli and blood clots can be life threatening, they usually resolve completely with hospitalization and care by a medical specialist.
FLUID ACCUMULATION: Rarely, tissue fluids collect under the abdominal skin flap (usually after the drains have been removed). If this occurs, aspiration of the fluid with a needle, two or three times a week for 2-3 weeks* usually solves the problem. Few patients require further surgery.
For the first few days*, your abdomen will probably be swollen and you're likely to feel some pain and discomfort which can be controlled by medication. Depending on the extent of the surgery, you may be released within a few hours or you may have to remain hospitalized for two to three days*.
Surface stitches will be removed in five to seven days* and deeper sutures, with ends that protrude through the skin, will come out in two to three weeks. The dressing on your incision may be replaced by a support garment.
After surgery, a flatter, trimmer abdomen. Scars are permanent but will fade with time*.
Abdominoplasty, whether partial or complete, produces excellent results for patients with weakened abdominal muscles or excess skin. In most cases, the results are long lasting if you follow a balanced diet and exercise regularly.
If you're realistic in your expectations and prepared for the consequences of a permanent scar and a lengthy recovery period, abdominoplasty may be just the answer for you.
Q. Who are the best candidates for tummy tuck procedure?
A. The best candidates for a tummy tuck (abdominoplasty) are men and women who are in pretty good shape but have large fat deposits or loose abdominal skin that won’t respond to diet or exercise.
Q. How soon can I return to work after abdominoplasty?
A. Some people return to work after a couple of weeks*, while others take three to four weeks to rest and recuperate.
Q. What kind of results should I expect after a tummy tuck?
A. By removing the sagging excess skin and accumulated fatty tissue, you'll immediately enjoy a flatter, firmer abdomen and a thinner waist line. The effects should be noticeable as soon as the swelling has subsided. You should see full effects develop more clearly as your body heals from the procedure.
Q. What sort of scarring should I expect after a tummy tuck?
A. Although every effort is made to minimize scarring, the scars will be permanent but will fade over time. Within 3 to 6 months*, your scars should get flatter become lighter in colour and improve considerably. Even though they will never disappear completely, your scars will not show under most clothing, even under bathing suits.
Q. How long do the effects of a tummy tuck last?
A. Provided there is no excessive weight gain or pregnancies following surgery, the results should be mostly permanent. There will be some loosening of the skin associated with age, but your body will not revert to its pre-surgery condition.