Abdominoplasty (Tummy Tuck)

INDICATIONS

This procedure is recommended for patients who exhibit flaccidity in the abdominal tissues and have a bulging and pendulous abdomen (sagging down over the pubic region). The best candidates for this type of intervention are those patients who, while being close to their ideal weight, show fatty deposits in the abdomen and skin flaccidity that will not respond to diet and exercise. It is a technique recommended for both male and female patients although it is especially useful for women who suffer from an irreversible stretching of abdominal skin and muscle because of past pregnancies.

ANAESTHESIA

This procedure is always performed under general anaesthesia, although lesser cases can be done under epidural anaesthesia.

SURGICAL TECHNIQUE

Current practices involve the surgeon making an incision following the approximate shape of a bikini or a thong so that the scar is occluded by those garments. The incision runs flush with the mons Venus and usually reaches the anterior iliac spines. The skin between the navel and the pubis is then stretched, its excess is trimmed, and the navel, which has previously been separated through an incision in the skin, is repositioned.

Once the tissue is detached, the surgeon applies suture to the muscles of the abdomen in order to repair the diastasis or muscle separation produced by the same causes of the skin distention (pregnancy, diets, illness, etc.). Bringing the muscles together again also reduces the waist’s contour.

DURATION OF THE PROCEDURE

It lasts around two and a half hours, although it can extend beyond that, as it is usual to combine abdominoplasty with other surgical procedures, such as a waist liposuction for example.

RECOVERY

After recovering from the anaesthesia, the patient returns to his room, carrying small drain tubes that are held in place for 4 to 5 days. Their purpose is to evacuate any excess blood or fluids released by the detached abdominal wall. During this time the patient must rest. Afterwards, over the next month she must avoid any physical efforts in order to preserve the abdominal muscles’ inner sutures (as those muscles take longer to heal and gather strength than does the skin).

The stitches are removed 12-15 days after surgery. For a few months the patient will experience swelling and an odd feeling of sensitivity in the abdominal skin.

Any patient who has undergone an abdominal dermolipectomy under normal conditions can return to her usual daily routine a month after the procedure, depending on the degree of abdominoplasty and the intensity of their work activity. However, a full year will have to pass for the full effect of the intervention to become visible, at which time the scars will lose their reddish appearance and become less conspicuous.

RISKS

• Haematoma:
  Is the abnormal collection of blood in the intervened area. To avoid it, a rigorous coagulation process must be followed and drainage is to be applied.
  If the haematoma is too large, it must be evacuated via surgery.
• Seroma:
  Is the accumulation of serum liquid. It must be evacuated.
• Infection:
  The risk of infection is very rare nowadays, as it is preventable with the use of antibiotics. In the event of its occurring, depending on its intensity it could affect the scars’ appearance.
• Hypertrophic scars and keloids:
  Depending on the patient’s physical make-up and age, scars can appear to be of low quality, be too thick (hypertrophic) and slow to whiten and fade. Keloid is a scarring disorder that produces an excessive growth of scar tissue. It is a rare condition in white people, but not an unusual one in black patients.
• Necrosis:
  Necrosis and ischemia, although uncommon, are usually serious complications that occur when both arterial and venous blood circulation are compromised.
  They are more frequent in smokers, obese and diabetic patients, and the main causes are: presence of previous scars, excessive tension or vascular destruction by liposuction of the skin flap and the presence of infection or an undiagnosed haematoma. The latter causes ischemia (tissue damage due to restricted blood supply) not just due to the pressure increase but also because of its toxic effects on the flap. A superficial epidermolysis in the upper edge of the wound, especially in its middle part, also isn’t rare.
• Deep venous thrombosis:
  It’s the formation of clots that circulate freely and impede blood circulation in the lung (pulmonary embolism) by plugging a blood vessel. Its appearance is very sporadic.
• Fat Embolism:
  It’s the interruption of blood circulation in the lung, due to fat accidentally entering the blood vessels. It has a very low incidence.
• Respiratory failure due to abdominal compression:
  Caused by the use of too tightly fitting compressive garments (girdles) after the intervention.
• Scar Hyperpigmentation:
  Due to the patient’s physical make-up, exposure to sunlight, or the use of certain medications. It is treated with the application of creams, chemical peels or laser depigmentation therapy.

RECOMMENDATIONS

Do not smoke for three weeks before the procedure and for three weeks after.

To prevent excess bleeding it is advisable to stop the intake of acetylsalicylic acid (Aspirin), anti-inflammatory products, and vitamin E a week before surgery. Patients prone to pass wind should take antiflatulent agents a few days before the intervention.

It is also necessary to avoid the ingestion of both solid and liquid food and water for at least six hours before the time of hospitalization.