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Tummy Tuck

Overview

of tummy tuck surgery

Tummy Tuck

A tummy tuck or abdominoplasty is a procedure that mainly treats excess lower abdominal skin and laxity of the muscles of the abdominal wall. When a protruding abdomen is primarily due to problems with the skin and abdominal wall muscles, this operation can have a truly dramatic effect.

Although this procedure can be combined with liposuction to some degree to treat the fat layers, a tummy tuck is not the right procedure for patients whose main problem is excess abdominal fat without a component of skin and muscle laxity. The biggest drawback of this operation is the size of the permanent scar that is required. Most commonly this scar extends from hip to hip, but this depends on the degree of excess skin.

The procedure begins with an incision just above the pubic area and another around the navel to free the skin and fat layers from the vertical muscles of the abdominal wall. This access allows the muscles to be tightened with stitches, producing a much flatter abdomen and narrower waistline. The skin and fat layers are then stretched down and the excess is removed. This also contributes to a flatter, firmer abdomen.

Finally, a new opening must be made for the navel, which remained attached to the muscles during the operation. The final result is a tighter abdomen, but a circular scar around the navel and a fairly long scar above the pubic area.

In rare cases a mini-abdominoplasty can be performed, which does not include an incision around the navel. The muscles can still be tightened, but a much smaller amount of skin is removed since only the lower abdomen below the navel is treated.

Who are good candidates for tummy tuck surgery?

A tummy tuck can improve your appearance and self-image, but it can’t necessarily change the contours of your body to meet your ideal. The best candidates are healthy individuals who are not significantly overweight and have excess lower abdominal skin and muscle laxity.

The best example of this is a woman who after one or multiple pregnancies has stretched her abdominal muscles and skin beyond a point where they will return to normal. This is commonly associated with stretch marks on the abdomen, which are evidence that the skin has been damaged and lost much of its ability to shrink back to the pre-pregnancy state.

Unfortunately, this deformity will not respond to diet or exercise and requires surgery to significantly improve the appearance of the abdomen. However women who plan on having more children should delay their surgery until they have completed having children.

Patients who have good skin and muscle tone but a protruding abdomen due to localized fat deposits are much better candidates for liposuction only. This is a less invasive procedure and can sometimes be an option, even in women after pregnancies, although it’s not the most common scenario. When excess skin with significant stretch marks is present, liposuction alone is definitely not the right choice.

Tummy Tuck

What is my initial
consultation at Dr. Elyassnia's
office in San Francisco like?

During the first meeting at our San Francisco location, your surgeon will determine if you are a good candidate for surgery while at the same time you will decide if he or she is right for you. This starts with a full health history with a focus on any major illnesses or prior abdominal surgeries. Your surgeon will want to know about past pregnancies, your diet and exercise habits, and a history of any major weight loss or gain.

It is important to tell your surgeon if you smoke and if you take any medications, supplements, or other drugs as these can have a big impact on your surgery.

During the exam, your surgeon will do a general evaluation of your fat content and distribution, skin tone, and muscle tone. They will look for any hernias and abdominal scars including c-section scars. Certain body measurements may be made as well. Finally, photographs are taken of all patients; these assist with the planning and evaluation of your surgery.

Based on this thorough assessment, the surgeon will describe not only what approach is best for you, but also the various alternatives and all of the risks and limitations associated with each of these. This should include a discussion of whether you are a better candidate for abdominoplasty, liposuction, or a combination of both and fully explain the rationale behind this recommendation.

It is very important to listen carefully to the various limitations of each approach and to openly discuss your expectations with your surgeon. Many times a poorly informed patient or surgeon is the direct cause of an unsatisfactory result, even when there are no complications with surgery. The surgeon should also go over the details of the procedure including the type of anesthesia used, the facility where surgery will take place, and the costs involved.

At the end of the consultation you may decide to go ahead with surgery and schedule a date, but if you are unsure or don’t feel fully informed don’t hesitate to ask your doctor any questions. A second meeting may be necessary and should always be available as an option.

Tummy Tuck
“I gained almost 60 lbs during my pregnancy. I worked really hard to get the weight off and was finally at my pre-pregnancy weight. However, the stretch marks and loose skin from gaining so much weight really really bothered me, so I decided to get a tummy tuck, and I picked Dr. Dino as my surgeon. He's brilliant...his aesthetic sense is great, and he is methodical, focused, and precise....has all the technical skills I was looking for in a plastic surgeon. Plus, he is extremely compassionate, kind, honest, and caring. I also see him for Botox, and he has performed other procedures on me. I'm a huge fan of Dr. Dino. I think he's fantastic."

M.L

What is the
day of my
tummy tuck like?

You will need to begin fasting 8 hours prior to your procedure, which means you cannot eat or drink anything at all during this period including chewing gum or water. If you have been instructed to take any medications in the morning, this is permitted with a few sips of water.

Abdominoplasty is usually done under general anesthesia, which means you are completely asleep and feel nothing during surgery. The surgery takes about 3 hours and maybe longer if more extensive liposuction or other procedures are done.

Most surgeons use drainage tubes that exit the skin and remain in place for a week or so. The surgery can be modified to make the drains unnecessary. This does not affect the result, but can add a small amount of time to your surgery. Your incisions will be covered loosely with surgical tape, gauze, and an abdominal compression wrap. This is usually worn for several weeks after surgery to help support the abdominal muscles during your recovery.

After surgery, you will stay in the recovery suite until you are ready to go home or to an overnight facility.

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How do I
prepare for
tummy tuck surgery?

Within 1 month of surgery, all patients over the age of 50 or with medical problems should have a medical evaluation by their physician or primary care provider. Depending on your health, this may require blood tests, an EKG, etc. You will be given a list of medications, vitamins, and supplements to refrain from taking at least two weeks before and after surgery. You should also stop smoking for at least 1 month before and after surgery.

A tummy tuck can be an outpatient procedure, but most patients stay in our overnight facility or hospital for one night. If you and your surgeon have decided that you will go home, you will need to arrange for someone to drive you.

It is a very good idea to have someone at home who can help you out for a few days during your recovery. Although it can be quite variable, most patients require two weeks off from work so this needs to be arranged as well. Your surgeon will give you a prescription for the medications you will need after surgery and these can be obtained ahead of time.

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What are the
risks of
tummy tuck surgery?

All surgical procedures carry some uncertainty and risk and a tummy tuck is no different. Although there are many possible complications, the good news is that the combined risk of having any major complication is still rare, as long as your surgeon is properly trained and the procedure is performed in a well-equipped facility.

The following represents some of the major complications but is not meant to be comprehensive. In rare instances major complications such as blood cots that travel to the lungs can occur resulting in major illness. Bleeding and infection are also rare with this operation but may require antibiotics, drainage, or another operation.

Occasionally some fluid can accumulate below the skin that may need to be drained. Usually small drainage tubes are placed at the end of the procedure and are removed around one week after surgery. Occasionally fluid can re-accumulate after the removal of these tubes, which requires a small procedure usually done in the office to evacuate the fluid.

Most women report a loss of sensation of the lower abdomen below the navel initially after surgery. This improves over time but can take more than a year to resolve. A small number of women do have areas of permanent numbness, but most are not bothered by it.

Unsatisfactory scars are another potential complication. It is very difficult to predict how patients heal. Sometimes scars can be very prominent and may require a scar revision surgery. Most often scars fade well and when planned properly, are always covered by undergarments or a bikini.

More significant problems with healing are also possible. Smokers are at high risk for this and should not smoke for 1 month prior to surgery. When it occurs it is usually at the central position just above the incision and below the navel. This can result in conspicuous scars and, in worse forms, a large area of skin death below the navel resulting in an open wound that takes many months to heal.

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What is the
the recovery process for tummy tuck surgery?

Most women feel a significant amount of abdominal soreness after surgery, but the pain can be controlled with your prescribed medication. Women also find it hard to move around for the first week after surgery since the core abdominal muscles are involved with most movements.

You are encouraged though to walk around as soon as you are able and it is normal to have increased soreness after activity. Usually for the first week you will not change any of the dressing and only care for the drains. These require emptying and recording the outputs. The dressings along with any sutures and drains will then be removed in a week, at which time you will be able to shower. You will likely be instructed by your doctor to wear the compression wrap continuously for several weeks.

The majority of people are able to return to work after 2-3 weeks, but this depends on your job. You will have to refrain from any exercise for 1 month and heavy exercise for 2 months, although you should be walking around several times a day beginning as early as the day of your surgery. Much of the swelling resolves in 2-3 weeks but it takes about 3-4 months until almost all of the swelling resolves and you see your true results.

Your scars will also be firm and red for several months. They will actually appear to be getting worse before they begin to fade, although they will never go away completely. This process takes 6-12 months or longer. Although your surgeon makes every attempt to keep your scars as inconspicuous as possible, sometimes patients have problems with healing and this is unpredictable.

Tummy Tuck

Abdominoplasty can produce a dramatic change in your body contour even though the actual weight loss from the procedure is quite minimal. It is important that you eat right and exercise regularly so that you maintain and improve upon your results. If you have realistic expectations and are prepared for the type of scar that results from this surgery, then this may be the right operation for you.

It is important to follow up with your surgeon as directed so that any potential complications can be detected and treated early. For the most part these are rare and you will spend most of your time enjoying your new look!