Abdominoplasty

Patient Information sheet

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Abdominoplasty (tummy tuck)

Abdominoplasty is an operation that has gone through a prolonged evolution. A key change was the understanding of the effect of pregnancy on the normal abdomen.
Essentially the child’s head pushes apart the rectus muscles which give and in many cases do not return to their pre-pregnant state. The effect of this is to lose definition of the hips as the muscles move out from the mid line. The lower abdominal bulge is accentuated so the shape becomes that of a box with a bulge.
Taking up exercise is useful but does not alter the basic situation which is mechanical. Dieting is often tried and is mostly frustrating. If you are overweight then weight loss helps and makes any operation that much more effective and safer. For the average women however the lower bulge will not budge.
Extreme dieting can shift it temporarily, but under normal conditions it will soon reappear.
Liposuction was another big advance when it was discovered fat could be removed safely by suction assisted curettage. Liposuction is used to shape the hips thus defining them more in this operation. It is also used to shape the remaining skin of the new lower abdomen during the procedure.
It is not however a substitute for the operation and repair of underlying structures as it would move one from having a full prune to an empty out with unsightly folds.
Liposuction works well in defined situations where there are no structural changes to make. e.g. the hips.

PRE-EXISTING SCARS
Can often be removed especially if they are in the lower abdomen where they often are tethered making the fat pad overhanging them a feature many women loathe in particular.
Scars in the upper abdomen are more of a problem and need to be thought through carefully as they may compromise blood flow in the remaining skin at operation.

MALES VERSUS FEMALES
Males generally pack the fat beneath the abdomen around the viscera and cannot have this operation. Diet and exercise is the best option.
The only exception is after extreme weight loss after gastric banding then there is a role for this procedure.

THE OPERATION
A pressure garment is measured and fitted before you have your surgery. The support this garment gives you makes it easier to move around after your surgery particularly after the underlying structures have been repaired. The garment also helps in speeding up the resolution of swelling in the first week or two and also helps the settling of lymphoedema (mild swelling) and scar tissue over the next month. There are several manufacturers of these garments and we have catalogues for you to peruse at your leisure.
The operation is performed at Kensington Hospital where you are hospitalised for 2 days or so and takes about 4-5 hours to perform. Drains which are placed during surgery to prevent any accumulations of fluid are removed on the second day at dressing change and then the garment fitted and you are sent home. Swelling and bruising peak at 36 hrs and they subside over 10 days.
The garment is worn for about 6 weeks.
You will be seen a week after discharge when the dressing is removed and generally no dressing is required thereafter. Stitches are removed around the new tummy button at one week and the remainder at two weeks. They are all dissolving stitches but take a while to do so.
If there are delays in healing then the district nurses are asked to supervise any dressing changes required. Follow up is weekly at first for about three weeks and then tails off quickly. A final review is done at one year when all scars have settled fully. There are rarely small trims required at this time under local anaesthetic.

COMPLICATIONS
The commonest complication is fat that has a poor blood supply under normal conditions can die.
This may produce a firm knot that subsides over time. In some cases particularly in the moderately obese it may delay the healing of the lower wound and need  dressings for a few weeks before healing.
Numbness of the skin is normal and goes over a few weeks. Deep venous thrombosis during operation is guarded against with calf stimulators for all cases. A prior history would require specific medication.

LIMITATIONS
If a significant roll of fat is present in the upper abdomen then a separate procedure may be needed after one year. The reason for this is the blood supply for the lower skin cannot be interfered with and must be done at a separate time. It can be substantially improved but if well developed may need separate attention.

BACK TO WORK
Patients are off work for about three weeks after an abdominoplasty.
The total repair takes six months to get to full strength, however much of this strength is gained in the first three months. Moving around freely should be comfortable by four weeks.

COSTS
The surgeon’s fee is given in advance of surgery.This procedure can also be combined with liposuction of additional areas. The cost includes shaping of the abdominal hip/flank area. Some people choose to have this extended down to the lower hips depending on the situation.
These costs will be discussed at the time of the consultations.
A separate charge is made by the hospital facility which is a separate company.
These charges are based on the time in theatre and the consumables used.
A separate charge is made by the anaesthetist. This charge is based on time spent in theatre.

YOUR RESPONSIBILITIES
• To reveal all medications, conditions, history, allergies, recreational drug use AND SMOKING STATUS
• To understand all aspects of the information discussed at consultation and all written information given and to seek clarification if needed.
• To understand that you are entering a process where your surgeon is dedicated to the best possible outcome. This requires engaging in the complexities of biology, healing and individual differences
• That additional stages or further surgeries are occasionally required and that the surgeon’s best efforts are the basis of the charges. Further surgeries will incur additional charges in pursuit of a particular result.
• To understand that the initial consultation is charged for but all subsequent pre operative consultations pertaining to this surgery are at no charge.
• To understand and accept the above conditions.