|
The Tummy Tuck (Abdominoplasty)
Tummy tucks can improve the look of an abdomen, which has loose skin with stretch marks, and a loss of muscle tone in the lower and upper portion. To a certain extent excess fat is also removed. Women more commonly seek this type of assistance than men. Women who plan to have children are advised against this procedure, since pregnancy stretches the skin and muscle. Slender women with a history of anorexia and bulimia are considered poor candidates due to unrealistic expectations and psychological instability.
The tummy tuck is a procedure designed to remove excess skin and fat in the lower portion of the abdomen (from the belly button to the pubic hairline and from the hipbone to hipbone) as well as to tighten up the muscles.
Prior to surgery a photograph is taken. It provides an accurate record of the problem, and will demonstrate the improvement accomplished with surgery. The plan for surgery is then drawn on the abdomen while the patient is standing. This is necessary since the skin falls differently while standing than sitting. Due to the fact that the surgery is performed with the patient lying down, the map for surgery is essential to help ensure proportionally correct results.
A tummy tuck is performed under a general anesthetic and takes approximately 1 ½ to 2 hours either on an outpatient basis or with an overnight stay in the hospital. This depends on the patient and the surgeon. The incision for a tummy tuck extends just over the pubic hairline from hipbone to hipbone in a flattened W-shape. A keyhole incision is made up the center of the lower abdomen and around the belly button. The belly button is left intact, but excess skin and fat from the lower part of the abdomen is removed. The exposed underlying muscle is tightened. The abdominal skin above the belly button is released from its fibrous attachments and is stretched downward to the pubic hairline. A small incision is made in the new skin cover for the belly button. The large incision is closed so that the scar is within the bikini line. Two small openings are left for drainage tubes. These allow any accumulation of fluid or blood to drain into the dressing. The dressings are changed and the tubes removed 48 hours after the procedure. Incisions usually heal in two weeks and no further dressings are necessary. The sutures are removed in 10 to 14 days unless they are self-absorbing. Smokers tend to heal more slowly than nonsmokers because smoking inhibits the blood supply to the wound. The patient is instructed to wear a girdle or compression garment over the entire abdominal area to provide support and comfort while healing. This decreased the chance of a seroma (pocket of fluid) from developing.
Swelling and bruising are inevitable and will subside in 10 to 14 days.
Tummy tucks are one of the most uncomfortable cosmetic procedures. Due to the amount of skin removed and the tightening of the muscle, it often takes 1 to 2 weeks before the patient can stand. Full recovery takes at least two weeks. Oral painkillers are prescribed to help control the discomfort. Some patients experience a burning sensation or tingling over the thighs which gradually subsides within 3 to 4 weeks.
A scar is unavoidable. It extends from hipbone to hipbone in a flattened W-shape within the bikini line. At first it is quite red and itchy, but eventually turns pink, then fades to a white line. This may take anywhere from 1 to 2 years.
Normal activities should not be resumed for at least two weeks. Assistance at home with young children and normal household duties should be arranged prior to the surgery. Heavy lifting, strenuous exercise, or any activity which causes discomfort should be avoided until 6 weeks after surgery. As the discomfort subsides, the level of activity may gradually be increased.
Ideally, a person's weight should be stable and at a level which can easily be maintained without extensive dieting. The same level of fitness and weight established before surgery needs to be maintained after surgery or the results will be less than optimal. Losing weight after a tummy tuck improves the surgical result and the overall contour of the torso. Gaining weight after surgery causes the problem to recur, and a lower abdominal paunch may develop. This is because excess abdominal skin and fat will hang over the abdominal scar, which acts like a tight belt.
The following is a list of possible complications that could occur during a tummy tuck:
1. Sensory Loss - Sensory loss over the lower part of the abdomen is common. Generally, 3 to 4 months are required before feeling in this area returns to normal, but the problem may persist for up to a year or two after surgery. Occasionally, a loss of sensation may be felt over the front of the thighs, but this eventually returns.
2. Poorly positioned belly button - Occasionally, the belly button may be placed too high, too low, or off to the side. This is usually due to an error in surgical judgement. Fortunately, it can easily be relocated with a minor procedure under local anesthetic.
3. Hematoma - Blood may collect under the skin of the abdomen, and is characterized by a sudden increase in swelling, pain, and tightness of the area. The drainage tubes which are put in place after surgery are used primarily to relieve small collections of blood or fluid. Large hematomas must be surgically drained.
4. Seroma - A persistent accumulation of fluid underneath the lower abdomen called a seroma may develop. In most instances, the seroma gradually subsides on its own, although in some cases surgical drainage may be required.
5. Contour Irregularities - Small puckers of bulging skin may occur on the hip side of the incisions. The obese are more prone to this problem because excess skin and fat have been removed from the abdomen, but nothing has been done to the hips. This is easily remedied with liposuction to feather, sculpt, and contour the area, eliminating these irregularities.
6. Skin Slough - The skin which was stretched over the lower abdomen may, in rare cases, die due to an inadequate blood supply. This occurs most frequently in smokers and in people who are older, obese, or have other medical problems, such as diabetes and high blood pressure. An untreated hematoma or an infection can also cause skin sloughing. When this happens, the dead tissue is removed and the area is allowed to heal, although the healing process often takes up to 3 months and leaves an unsightly scar. A scar revision procedure is often necessary once healing is complete.
7. Infections - Infections rarely occur, but, when they do, they are usually managed with antibiotics. Surgical drainage is rarely required.
8. Scars - Scars usually fade to a white line and in women are hidden by most bikinis. If excessive scarring occurs, it can be flattened with a laser or injected with cortizone to make it less obvious.
Dermatologists and plastic surgeons trained in tumescent liposuction are qualified
to perform the procedure. Tummy tucks are usually performed by plastic surgeons. |
