Abdominoplasty | Tummy Tuck

Dr. Vincent Zubowicz discusses how a tummy tuck (abdominoplasty is performed).

Dr. Vincent Zubowicz discusses how long the scar is after tummy tuck (abdominoplasty) surgery.

Dr. Vincent Zubowicz discusses how a tummy tuck (abdominoplasty is performed).

Dr. Vincent Zubowicz discusses how long the scar is after tummy tuck (abdominoplasty) surgery.

Abdominal (tummy) contour problems may be the product of one or more of three possible factors: excess subcutaneous fat, excess skin, or abdominal wall laxity. When excess subcutaneous fat alone is the cause of the abdominal protrusion, liposuction works wonderfully. However, many patients, particularly women who have had previous pregnancies, have more complex reasons that cannot be fixed by liposuction alone. Due to stretching to accommodate an expanding uterus, the abdominal wall gets lax and the skin expands in surface area. After the pregnancy is completed, often the abdominal wall remains lax and the skin excessive. This combination of problems is also seen in patients who have large weight fluctuations. All the crunches in the world won’t fix these problems.

Abdominoplasty, also known as a tummy tuck, gives the surgeon the ability to address any situation contributing to a protuberan abdomen. Excess skin and fat is removed and the abdominal wall is tightened. It is done at the expense of an incision along the bottom of the abdominal wall.

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Frequently Asked Questions About Abdominoplasty

An abdominoplasty requires an incision along the lower abdomen, in the “bikini line”, to allow the necessary corrections. After the incision is made, the skin drape is elevated off the abdominal muscles exposing them for later repair. The umbilical stalk (navel) remains attached to the abdominal wall.

The abdominal muscles are tightened to flatten the abdomen and narrow the waist. No muscles are cut but the tightening results in abdominal soreness common for several days after an abdominoplasty. The abdominal recontouring is performed when the patient’s trunk is flexed to obtain the flattest abdomen possible.

After muscle repair, the excess skin is amputated and the umbilicus is reconstructed. Generally this is a generous amount of skin-extending from above the umbilicus to the pubic region. Any stretch marks or scars in this area are thus removed with the skin redraping. The incision, which extends for several inches in each direction from the midline, is then closed meticulously. It is the intent that the scar, although long, will be narrow and flat.

Often times small hernias may be encountered, especially in the umbilical area. These are repaired as part of the operation.

The length of the scar is proportional to the amount of skin removed. The skin is removed by a “cut as you go” or freehand method. That is, the length of the resulting scar across the lower abdomen is only as long as is necessary. Every effort is made to limit the length of the scar and plastic surgeons have techniques that help them somewhat.

I no longer use drains when perfoming this operation. The abdominal drape is resecured to the abdominal wall with multiple quilting sutures. This obliterates the space where drains used to be placed. These sutures also are positioned so as to allow for shaping of the waist and eliminating any tension along the final skin closure (makes for a better scar).

The main drawback of the technique is the resulting incision across the lower abdomen. In all patients, this incision will begin somewhat red and thick. Over the course of months to even a couple of years, the scar will fade and flatten. Almost always, after wound healing is complete, the scars are narrow and flat.

To aid in the healing process, pressure, moisturizers, steroid cream, injections, or silicone sheeting may be used to generate a more favorable scar. The choice of adjunctive treatment is made in the office and is individual for each patient. Most of the time, though, the healing process yields a good result with only the passing of time.

The risks of the procedure are small although blood loss, infection, and wound problems are occasionally seen. The most common complication is a seroma, or a collection of fluid beneath the skin that can be aspirated in the office.

The most dangerous complication is pulmonary embolus, or a blood clot that forms in the legs or pelvis and later breaks off and gets stuck in the lung. Tightening of the abdominal wall increases intrabdominal pressure. This increases the risk for pulmonary embolism. Special precautions are taken to minimize the risks including hydration, leg pumps, and early ambulation of the patient.

Most of our patients need not spend the night after an abdominoplasty. Because abdominal discomfort was substantial after this operation years ago, patients would spend the night with a nurse in attendance to assist with pain management and to guarantee enough physical activity to avoid blood clots in the legs. With the advent of newer long acting local anesthetics that are injection into the abdominal wall at the time of repair, the post-operative pain is substantially diminished and most patients can ambulate without assistance. However, overnight care is an option and may be the better choice in our more fragile patients.

Recovery from an abdominoplasty is a lot easier than it was 10 years ago. We now have long acting anesthesics (Exparel) that are injected into the abdominal wall at the time of the repair. Patients are expected to walk immediately. Driving is permitted when it can be done so comfortably. Patients cannot drive if they are taking any narcotics.

Most patients will be fit enough to return to work, provided it requires no heavy lifting, in about 1 to 3 weeks. Light athletic activity may begin in about 3 to 6 weeks depending upon the way the patient feels and the extent of the abdominal surgery. Exercise that targets the abdominal muscles is forbidden for 6 weeks. Over the next 6 weeks this sort of activity is resumed in graduated fashion. By 3 months, full athletic activity is permitted.

The Body Contouring Guide Dr. Zubowicz Plastic Surgery Atlanta, GA
The Body Contouring Guide Dr. Zubowicz Plastic Surgery Atlanta, GA

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VINCENT N. ZUBOWICZ MD VNZ Plastic Surgery Emory University Hospital & Health Clinic 5 Star Rated Facelift and Breast Aug Makeover

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