Mr Neil Toft

Consultant Plastic Surgeon

BSc MBChB MD FRCS (Plast)

 

0845 094 5657

 

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ABDOMINOPLASTY INFORMATION

General Background

Abdominoplasty is the medical name for a "tummy tuck". This operation aims to flatten the abdomen by removing the excess skin and fat tissue and also tightening the muscles underneath. It is most often used in female patients who have had children and their tissues have been stretched by the pregnancies. Often such patients cannot alter the shape of their abdomen despite exercise or going to the gym regularly. This is due two factors. Firstly, the skin has been overstretched and has lost its elastic recoil, and secondly, the deep muscles have been pulled apart. Abdominoplasty corrects both of these problems. In addition, it is possible to do some liposuction to the flank areas at the same time, and improve any unsightly Caesarian section scars. Patients are advised to finish having children before embarking on the operation, as further pregnancies after the operation are likely to undo its benefits!
The main aim of the operation is to improve the shape and contour of the abdomen; it is not designed to remove weight. Ideal patients are relatively thin with skin laxity and poor muscle tone. Such patients usually get excellent results. Average-sized patients can also do very well from the operation. However, very large patients whose main problem is excess fat do not do as well with abdominoplasty and would do better with either liposuction or a "bodylift" operation.

Before the operation

There is nothing special or complicated to be done by the patient. If you are on the oral contraceptive pill or HRT you should continue to keep taking it, and inform the surgeon or anaesthetist in the hospital. If you smoke it would be a good ideal to try to stop for a month before and two weeks after as this will significantly improve wound healing and your post-operative recovery. It would be advisable to stop any herbal medicines and avoid aspirin or ibuprofen-like drugs for 2 weeks before the operation.

The operation itself

You will come into the hospital on the morning of surgery. The operation is performed under general anaesthetic and takes about two hours. Many patients find that an overnight bladder catheter very helpful. This catheter is not essential and you may opt before the operation not to have one. When you wake up you will have a dressing over the abdomen and be wearing an abdominal binder (this is a tight velcro dressing similar to a corset).


Post-operative follow-up and after care.

You need to stay in hospital overnight. All being well, you will be discharged home the following day with some painkillers. It is import to leave the dressing alone and wear the abdominal binder 24 hours a day. At home you should take life easy for the first few days, and if feeling tired during the day resting in a chair rather than a bed. It is critical that during the day that you walk around the room at least once per hour to improve the circulation of blood in the legs and avoid a blood clot in the deep leg veins. You wound be advised to take to 2 weeks off work and it is essential to avoid all strenuous activity during this period. The binder needs to be worn day and night for a month to give the best result possible, and failure to wear it without doubt diminishes the final appearance. Vigorous sport such as jogging or the gym should be avoided for 6 weeks.
Most of the post-operative pain is in the first 48 hours and is related to the muscle tightening. This can be lessened by taking the painkillers on a regular basis and avoiding bending down too much. At between 5 and 7 days you will be seen in the clinic and the dressings removed and the wounds checked. A check up clinic appointment at 3 months after the surgery will be arranged for you. The final result of the abdominoplasty is best viewed at 3 months after the surgery.


Complications

All operations carry a risk of complications, and abdominoplasty is no exception. The risk of infection and significant bleeding are between 1 and 2 % and precautions are taken to avoid this with antibiotics and careful operating. In virtually all patients drains are inserted at the time of surgery. These drains are removed on the ward the following day and their function is remove any excess fluid that has accumulated under the skin. In a small group of patients - less than 5 % - a collection of fluid persists and this is called a "seroma". It is completely harmless and does not affect the final outcome. This "seroma" is easily treated in the clinic with a syringe.
It is impossible to perform any abdominoplasty operation with out a scar. Such scars run from one side of the lower abdomen to the other. If any attempt is made to shorten the scar more problems are actually created due to lumpiness at the ends of the incisions, known as "dog ears". Occasionally, scars may be red and thick for a few months but they usually settle down by themselves without any treatment.
In order to get a flat appearance, the skin on the abdomen is pulled tight. This does not usually cause problems in the fit, healthy patients. However, in patients who are diabetic, or smoke heavily, or are obese, this skin tension can cause problems with wound healing. Small areas of skin that have not healed well can be treated with dressings in the clinic.
The most serious problem is a deep venous thrombosis (DVT) in the leg and possible pulmonary embolus in the post-operative period. Great care is taken to avoid this problem by using compression stockings and inflatable calf pumps in theatre. In addition, these calf pumps are continued overnight and early mobilization is encouraged.

Summary

Abdominoplasty is best suited to women who have finished their family and wish to improve the contour of their lower abdomen. In carefully chosen patients who are motivated, the complication rate is low and many are very happy with the final result.


Operation Time 3 hours
Anaesthetic General
Nights in hospital 1
Time off work 2 weeks
Return to normality/exercise 4 - 6 weeks