Abdominoplasty (tummy tuck) is a procedure for reducing skin and improving muscular laxity of the abdomen and, if indicated, correction of an associated hernia of the abdomen. It is usually done under general anesthesia in an approved surgical center or hospital, and is routinely an outpatient procedure. Eligible patients should have no major current illnesses, a stable body weight, and no more than modest excess fat (body mass index <30). Before scheduling surgery the prospective patient should undergo an in-office history and physical examination, discussion of their personal goals and expectations, discussion of the risks and potential benefits of surgery, and have all relevant questions answered by the surgeon. The risks, although statistically small, can be serious. Among the risks are: bleeding, infection, skin and muscle injury, intestinal injury, wide scarring, and possible need for surgical revision.
A hernia is a true interruption of the fascial covering and/or the abdominal muscle(s) and is frequently associated with natural childbirth. If a hernia is present it can and should be repaired at the same operation with the abdominoplasty. Hernia repair may be covered by insurance plans.
A standard abdominoplasty entails an incision across the lower abdomen just above the pubis and another incision around the umbilicus (belly button). The main incision scar should be coverable by a bikini/panty. The skin and underlying fat are dissected from the pubis up to the rib margins. If the muscles of the abdomen are lax, they are tightened by sewing the overlying fascia with a quilting type maneuver. Next, the excess skin and fat are pulled down to a desired position and the excess is cut away. The umbilicus is re-established in its normal position with an opening in the pulled down skin. Any additional fat trimming at the skin margin is completed. Drains are placed with an exit through the primary incision and a double layered suture closure of the incision is done. A bulky dressing and abdominal binder are placed to limit bleeding and serum accumulation and for patient comfort.
An abdominoplasty procedure typically requires two hours in total time in my hands. Patients are seen 2 days after surgery and drains are removed in about 4-5 days post-op. Acute swelling requires about 10 days to subside and residual swelling may need 8-10 weeks for final resolution. The skin sensation is mostly absent for several weeks. Tightening of the fascia and muscles can also take several weeks before healing is comfortable. Full exercise can resume after one month.
There are modifications of this standard abdominoplasty that can be considered in individual cases.
