Tummy Tuck Procedure
When women have had children, the lining of the abdominal muscles, the so-called fascia, can rip and the abdomen can develop a bulge. This is a type of hernia, and other types of hernia may develop as well. The patient can often feel a layer of fat on the lower abdomen. Liposuction alone removes excess fat, but cannot tighten the fascia or remove hanging skin; for that, an abdominoplasty is necessary. There are several types of abdominoplasty, ranging from a minor removal of hanging skin (a mini-tuck) to a major abdominoplasty where a new umbilicus is made and the entire abdomen is tightened.
Abdominoplasty is an operation performed to remove excess fatty tissue and skin folds in the mid and lower abdominal region and to tighten up the abdominal wall. Diet and exercise alone cannot provide correction, since this condition is often accompanied by separation and stretching of the abdominal muscles and weakening of the abdominal wall.
Abdominoplasty is not directed toward weight reduction. It is designed to remove only as much excess skin and fatty tissue as is practical and safe. Stretch marks, where possible, will be removed along with the excess skin. However, stretch marks on the remaining abdominal skin cannot be removed.
Photographs are taken before and after the surgery. Photographs are as important to the plastic surgeon as X-rays are to the physicians in other medical specialties; both help manage and track patient progress. Photos become a permanent part of the patient's confidential medical record.
Abdominoplasty is considered major surgery and usually is performed in our outpatient surgical facility.
The Anesthesia
Abdominoplasty surgery is performed under a "light" general anesthetic (patient is asleep). This technique provides excellent operating conditions while affording maximal patient comfort and safety.
The anesthetic is administered by a Board Certified Anesthesiologist (M.D.) who remains in attendance throughout the operation. Prior to surgery, our anesthesiologist will provide additional information and answer any questions you may have. Required monitoring, anesthetic delivery and emergency equipment are present at all times.
Pre-Operative Preparations
You must be in good health to undergo any elective cosmetic surgery. A physical examination and routine lab work needs to be performed by your own primary physician. If you do not have a primary doctor, we can refer you to a local one in your area; we do not provide these services. It will be required that all pre-op paperwork be in our office 1-2 weeks prior to surgery.
It is very important that our office be aware of any medical conditions and all medications you are taking.
It is imperative that you not smoke 2 weeks prior or 2 weeks after surgery. This would greatly impede your healing. Talk to us about your options.
It is a required that someone drive you home upon discharge. Also arrange for transportation to and from our office for your post-operative appointments until we give you permission to drive.
DO NOT take aspirin or aspirin-containing products for 2 weeks prior or 2 weeks after surgery.
An adequate diet with vitamin supplements, especially Vitamin C, is recommended. You should be in the best nutritional state possible prior to surgery.
If you will be preparing your own meals at home after surgery, have on hand, easy to prepare foods.
Prior to your surgery we advise you purchase 2 pair of Spanx garments. You will need to wear it 24 hours a day for 5 days after the removal of your drains (this can vary from case to case, depending on what the doctor recommends). We recommend the Higher Power with Tummy Control 032 by Spanx.
The Surgical Procedure
The procedure takes approximately 3 hours to complete. There are usually two incisions associated with this type of surgery. One incision extends along the lower abdomen just above the pubic hairline. The other is a circular incision around the navel, as the operation frequently requires repositioning the navel to a higher, more natural level. The abdominal skin and fatty tissue are raised away from the underlying abdominal structures. When necessary, repair of the abdominal wall and muscles is done at this time. The tissue is then stretched in a downward direction and the excess is removed.
Small rubber drains may be inserted in the wound to remove blood and serum that may accumulate. The incision is closed either with suture material, special tapes or metal clips. A large pressure dressing is applied followed by a supportive abdominal binder. An I.V. is routinely placed in the hand or arm prior to surgery for fluid maintenance and remains in place usually until the next morning. A urinary catheter may be inserted at the time of surgery and usually removed immediately after surgery; sometimes in 24 hours if staying in an aftercare facility.
Possible Complications
Complications are rare. In case of an emergency, we respond immediately, without unfavorably affecting the final result.
Bleeding:
If bleeding occurs after the operation, it may accumulate in the operative area and require reopening the wound to remove the blood and prevent further bleeding.
Infection:
This occurs rarely and usually responds to antibiotics.
Tissue Loss:
This is very rare. Should this happen, a reconstructive operation can be performed at a later date, with satisfactory results.
Keloids/Hypertrophic Scars:
For those prone to keloids, (overgrowth of scar tissue at the incision site) steroid injections can be administered to breakdown and flatten the scar.
What to Expect After Surgery
Activity:
Patient is encouraged to ambulate soon after surgery, with frequent periods of resting.
Pain:
There is a minimal to moderate amount of pain associated with this type of surgery. Medication is available to control any discomfort experienced while in an after-care facility or at home. Coughing, laughing, sneezing or anything that exerts the abdominal muscles may produce discomfort. Splinting (using counter pressure with a pillow) is best to reduce discomfort. After surgery, you will experience a feeling of tightness in the lower abdominal area, relieved by a somewhat stooped posture. This is temporary and usually lasts 7-10 days.
Dressings:
A large abdominal binder or garment will be applied immediately after surgery. Sometimes drains are placed in the lower pubic area, and are removed 5-10 days after surgery. This binder should be used for two weeks after surgery. A department store girdle may be purchased and worn for an additional two weeks. We've had patients get fitted at Ms. Stevens Lingerie, here in Beverly Hills (corner of Olympic Blvd and Maple) (310) 278-7987.
Scars:
The scars left by this procedure are generally predictable and although they fade with time, they are permanent. Occasionally, a scar revision procedure is necessary to attain the best cosmetic result. These procedures are minor and can be carried out in the office under local anesthesia. A pouching of the tissue immediately above the incision line may be apparent after surgery. This is usually temporary and gradually smooths out over a period of months. There are several options for scars i.e.: topical gels, laser treatments, steroid injections, all of which are offered when appropriate. We will discuss these options with you.
POST-OPERATIVE CARE
Avoid lying on your abdomen for 2 weeks. Optimal sleep position is elevated on your back with 2 pillows, a pillow under each arm and a pillow under your knees to keep your abdomen flexed.
If applicable, empty drains twice a day, morning and night. Call the office if experiencing excessive drainage.
On your third post-op day you may remove your dressing, discard any sponge padding (leave steri-strips alone) and sponge bathe. Once drains have been removed, a quick shower is ok. It is normal to experience oozing from the drainage site after the drains have been removed.
It is not unusual for a patient to experience a period of the "blues" during convalescence. This is temporary. It's helpful to remember that it is impossible to judge the final result of your surgery until all of the swelling has subsided and the operative area has smoothed out.
Take your temperature occasionally and call the office if your fever is over 100 degrees.
Resumption of Physical Activities - General Rules of Thumb: Two, Four, Six Rule
First week:
TAKE IT EASY!! PATIENTS WHO ARE TOO VIGOROUS FREQUENTLY DEVELOP COMPLICATIONS!
At two weeks:
Take long walks on a flat surface. No other kind of workouts. Any activity that would raise your blood pressure would compromise the healing incisions and newly developing blood supply.
At four weeks:
Lght exercise such as aerobics, but no weight training. Start light. For example, if you normally do 30 minutes on a treadmill, begin with 15 minutes, then increase as your body gets used to things. Use of vitamin C and E concentrate and scar-fade gel should begin as soon as the incisions are completely healed, usually 3-4 weeks.
At six weeks:
Resume all previous activities with clearance from Dr. Moelleken. Avoid sun exposure to incision site for months following surgery, as this may result in a hyperpigmented scar.
