Abdominoplasty (“Tummy Tuck”)
What is abdominoplasty?
An abdominoplasty is an operation which tightens the skin of the tummy resulting in a flatter tummy and (often) less stretch marks.
Who will the operation help?
Abdominoplasty can be a useful procedure for several groups of patients who have:
- a redundant fold of abdominal skin hanging over the pubic area
- thin wrinkly skin (often after childbirth or following massive weight loss)
- stretch marks on the skin of their lower tummy
- a “pot belly” due to stretching or laxity of their tummy muscles
- multiple or unsightly scars on the lower abdomen
Who will the operation NOT help?
An abdominoplasty is not an operation to help you lose weight. All surgery is potentially dangerous, so if you are overweight it is far better to lose weight by a combination of diet and exercise. However, despite losing weight, some people find the skin of the tummy does not retract and they are left with an excess of saggy skin on the lower tummy. This is a very good indication for a tummy tuck.
Is abdominoplasty available on the NHS?
Abdominoplasty is rarely available on the NHS, however, there are occasions when it may be offered:
- Massive weight loss: weight loss of more than 6 stones followed by a period of sustained weight loss in which a patients lower tummy skin hangs in folds.
- Unsightly abdominal scars: if a patient has had significant problems with wound healing from previous abdominal surgery and has been left with indented, tethered awful lower abdominal scars, it is possible to have these scars revised on the NHS and an abdominplasty can be offered as a good way of improving these scars.
How is the operation done?
The operation is done under a general anaesthetic (with you asleep). There are 4 elements to an abdominoplasty operation (see pictures):
- Skin and fat removal: An incision is made in the skin above the pubic region and the skin and fat of the upper tummy is then lifted off the underlying muscle. A second incision is made around the belly button, leaving the belly button attached to the underlying muscle. The upper abdominal skin is then stretched downwards towards the pubis, and any excess skin and fat is trimmed off.
- Muscle tightening: the underlying tummy muscles can be pulled together with stitches to tighten them. This provides a flatter tummy and also pulls the waist in a little.
- Reforming the belly button: the belly button is then resited by cutting a hole in the skin of the tummy at the correct place and pulling the belly button out through this hole. It is then stitched in place with buried dissolvable stitches.
- Liposuction: any minor bulges or excess fat is smoothed out by undertaking a little liposuction, to ensure the best possible cosmetic outcome.
Three drains are usually placed which emerge from your skin in the pubic hair area. The skin is then closed using buried, dissolvable stitches. Your wounds are then dressed and surgical tapes are applied all around the tummy. The tapes help to support your new wounds and prevent the collection of fluid beneath the skin and fat.
Which incision is best?
The final scar shape is tailored to be hidden within your choice of underwear. If you wish to wear the high leg thong type, the scar can be curved upward; or if you wish, the scar can be kept very low to allow you to wear “hipsters” and crop tops without showing your scar (see picture). You should bring your choice of underwear on the morning of surgery to allow me to plan your incisions accordingly.
How long is the operation?
An abdominoplasty usually takes about 2-3 hours.
How many days in hospital?
Most women undergoing abdominoplasty stay in hospital for 3 or 4 nights after surgery. Occasionally the drain bottles may continue to produce fluid and may need to stay in for a further day or two, delaying your discharge from hospital.
Postoperative period in hospital
You will be on bed rest for the first 24 hours after surgery. A catheter will have been placed into your bladder in theatre so you will not have to get up to pass water. You will have a drip in your arm and there will be 3 drains coming out of your lower tummy dressings.
If you have had a substantial muscle tightening procedure your tummy will be fairly tight and tender, but the regular painkillers you will receive will keep you fairly comfortable. It may be difficult to breathe in deeply due to the tight tummy but you should follow the physiotherapists instructions and do your deep breathing exercises every hour.
When you do start getting out of bed and walking on the second postoperative day, you will probably not be able to stand fully upright due to the tight tummy closure. It will take several days (usually 5-7 days) before you can straighten up fully.
Before being discharged from hospital you will be fitted with an abdominal binder which wraps around your tummy and adds additional support to your tightened tummy muscles. You should wear this constantly for the first 2 weeks (removing it for one hour a day for hygiene purposes) and then during the day time only for a further 2 weeks.
Postoperative Follow Up
After discharge you will be provided with written information to explain the postoperative course. An appointment will be made to see my Cosmetic Nurse one week after your operation. She will remove your dressings and inspect your wounds, which may or may not have healed at this time. If the wounds have healed you will be given advice on wound care, bathing and exercise advice. If they have not quite healed by this one week visit, she will reapply the dressings and arrange to see you again the following week. Once your wounds have healed you will be given an appointment to see me six weeks after your operation. At this appointment I will check on the early outcome of surgery; if all is settling satisfactorily I shall arrange to see you for a final visit six months later.
What are the possible risks?
Any surgery has the potential for complications. Although abdominoplasty is generally a very safe operative procedure, it does carry the following risks:
- Infection; infection is not an uncommon complication (5%) and can result in swelling, redness and tenderness along the abdominal scar at any time up to 3 weeks after surgery. This usually responds well to a course of antibiotics. Occasionally however, it can result in some opening of the wounds. This wound breakdown is not a disaster and is usually managed by regular wound dressing and usually heals in four to six weeks,
- Bleeding: bleeding can occur at any time over the first ten days after surgery, and therefore it is wise to avoid any strenuous exercise over this time. For the first week after surgery you should do very little and rely on your partner/friend to help do almost everything. Should a bleed occur under the skin, the tummy may swell quite dramatically, it can be quite painful and you may develop visible bruising and tenderness. If this happens you usually need to return to theatre to have the blood removed and the bleeding stopped.
- Delayed wound healing; this is one of the commoner complications (5%) after abdominoplasty. The wound may initially appear to be healing well but may, in the first 3 weeks become red and a small hole appear. This is not a disaster, and will usually heal spontaneously with regular district nurse dressings over the next 4-6 weeks. This can leave a somewhat wider scar. Delayed wound healing is far more common in smokers and you are strongly advised to stop smoking before your operation, and not to start again (if you must!) until the wounds have finally healed.
- Ugly scarring: most wounds will initially be red and a little thickened for the first six months or so, but will eventually settle very nicely to leave a thin, pale, flat scar. Occasionally however, scars may become red, raised, wide, itchy or ugly. This is fairly uncommon, but any wound breakdown which occurs in the early postoperative period may result in a stretched flat scar. If this is unsightly it can be revised 6-9 months later under local anaesthetic by cutting it out and stitching it up again
- Dog ears: dog ears are small folds of skin which occur at either end of the scar, caused by a natural folding of the skin when the wound is closed. Great care is taken during the operation to avoid producing dog ears, but occasionally (5%) they cannot be avoided. Small dog ears seen in the early postoperative period will eventually settle on their own in the first 6-9 months after surgery. If they do not settle after this time, they can be simply cut out in a minor procedure under local anaesthetic.
- Altered sensation; because the skin of the tummy has been lifted and stretched downwards, the nerves to the skin can be stretched or even cut. Almost inevitably, the skin of the lower tummy will be numb after the operation. Initially the patch of numbness will be very extensive, but gradually the size of this area of numbness will shrink to leave a small area of altered sensation just above the scar over the pubic hair area. It can take up to 2 years for this to recover. During this time, it is possible to injure or burn this skin without realising it. For this reason you should carefully inspect the skin of this area regularly, and in particular I recommend that you avoid using hot water bottles as you could easily develop a full thickness burn without realising.
- Thigh numbness: in a similar way, the nerves to the outer aspect of your upper thighs can be damaged resulting in numb patches over the top of your legs. Again, this usually improves with time, but can occasionally be permanent
- Seroma: occasionally (2%) fluid can collect beneath the skin and fat of the tummy. This results in a bulge or swelling of the tummy. It is treated by inserting a needle and sucking the fluid out, though it often recurs and can take several months to settle. To reduce the risk of a seroma, I use drains and an abdominal binder in the early postoperative period.
- Umbilical necrosis; the blood supply to the belly button can be damaged during the procedure resulting in the belly button turning black and eventually turning into a scar. This is a fairly uncommon complication and is usually only seen in smokers.
- Flap necrosis: this is perhaps the worst complication of an abdominoplasty. Fortunately it is very uncommon, and is usually seen only in smokers. Treatment requires either another operation to remove the dead skin and a skin graft is applied, or the black crust can be dressed regularly until it comes of spontaneously over the following months. Either treatment produces a very ugly result, though after about a year it can be improved by further surgery.
- Fat necrosis: if the blood supply to part of the skin/fat of the tummy is damaged during the operation, an area of fatty tissue may die. This usually becomes apparent about 2-4 weeks after the operation. The wound may appear to be healing well, but then a firm, tender lump may develop. This lump of dead fat is called fat necrosis and does not usually require any treatment. It usually settles on its own over the following few months; though occasionally may discharge old liquid fat and fluid through a small hole in the scar and need regular dressing until this heals on its own.
- Blood clots: occasionally a blood clot may form in the deep veins of the legs (deep vein thrombosis). These clots can have the potential to break off and travel inside the veins into the lungs (pulmonary embolism). Any surgery near the pelvis carries a slightly higher risk than average of causing a blood clot in the leg veins. To reduce the risk of this happening with an abdominoplasty, you will be given surgical compression stockings to wear throughout the first 2 weeks after surgery, special inflating compression devices will be applied to your legs in theatre and worn for the first 24 hours in hospital, and you will be given a daily injection to slightly thin your blood.