Abdominoplasty(Tummy Tuck)

    Abdominoplasty, known more commonly as a "tummy tuck," is a major surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The procedure can dramatically reduce the appearance of a protruding abdomen. But bear in mind, it does produce a permanent scar, which, depending on the extent of the original problem and the surgery required to correct it, can extend from hip to hip.
    A tummy tuck, or abdominoplasty, is an operation performed to improve the shape and contour of your tummy. The operation can remove excess skin, unwanted scars, stretch marks, fat and can tighten the stomach muscles. There are a variety of different abdominoplasty procedures and depending on your particular problem(s), the operation will be individualised and tailored to suit you.
    Younger patients who have not been pregnant before, who have good quality elastic skin and whose main problem is an excess of fat, are best suited to simple liposuction of the tummy. These patients typically have a little pot belly - a slight excess of fat in the lower tummy. Liposuction of the tummy is usually performed under sedation and local anaesthesia, although general anaesthesia may be used. These cases are usually performed as day case surgery. Often, other areas are also treated with liposuction simultaneously. Small incisions are made, excess fat is removed and the wounds closed. Not only will fat be removed, but some degree of skin tightening or shrinkage can be expected as well.
    Slightly older or middle aged patients who might have had previous pregnancies (causing the muscles below the belly button to splay apart a little) and who have a slight excess of skin and fat, especially below the belly button, may be best suited for a mini-tummy tuck. Mini tummy tuck is usually performed under local anaesthesia and sedation, although general anaesthesia can be used. Surgery is usually done as day case surgery. A wedge or ellipse of skin and fat is excised from the lower tummy leaving a scar horizontally above the pubic hair, similar to the scar from a Caesarian Section. In addition liposuction is performed of the upper tummy and waist and the muscles below the belly button are tightened. No scar is left around the belly button which is stretched slightly to become more elongated and generally more appealing.
    Some patients have an even greater degree of skin laxity, excess fat and splaying of the muscles. These patients require a classic tummy tuck. This operation is usually performed under general anaesthesia and usually requires hospitalisation of 2-3 days. An incision is made from hip to hip and around the belly button. A large wedge of skin and fat is excised from above the belly button to just above the pubic hair. Some areas may be treated with liposuction and the muscles above and below the belly button are tightened. Although this operation does leave the biggest scar, it does provide the greatest degree of improvement in shape. Patients still planning pregnancies should wait until completion of their family.
    The best candidates for abdominoplasty are men or women who are in relatively good shape but are bothered by a large fat deposit or loose abdominal skin that won't respond to diet or exercise. The surgery is particularly helpful to women who, through multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where they can return to normal. Loss of skin elasticity in older patients, which frequently occurs with slight obesity, can also be improved
    Patients who intend to lose a lot of weight should postpone the surgery. Also, women who plan future pregnancies should wait, as vertical muscles in the abdomen that are tightened during surgery can separate again during pregnancy. If you have scarring from previous abdominal surgery, your doctor may recommend against abdominoplasty or may caution you that scars could be unusually prominent.
    The Abdominoplasty or "Tummy Tuck" is designed to remove excess abdominal skin and fat, as well as tighten loose abdominal muscles. The perfect candidate is a woman with prior pregnancies which have stretched her abdominal muscles past the point of repair by standard exercise. Poor candidates are those who are obese and simply have too much abdominal fat. Liposuction can be an alternative in these patients.

    Pre-Operative Care

    Pre-operatively patients usually need routine blood tests to be sure they are not anemic or pregnant. Photographs are taken to assess progress.
    Patients should not smoke within three weeks of the operation. Of course, smoking is never a good idea and patients should quit smoking early and permanently.
    No aspirin, ibuprofen, or similar drugs should be taken within two weeks of surgery. These medications can cause serious excess bleeding during, and after, the operation. If you have any questions about drugs you are taking, including over the counter preparations and natural herbs, please call the office.
    Please shower the night before surgery and do not EAT or DRINK anything before your surgery or at least 6 hours before surgery. This prohibition includes coffee and juice in the morning. Oral medications can be taken with a sip of water.
    You should be at the office surgicenter or hospital at least 4 hours prior to your scheduled surgical start time. 

    The Operation

    Complete abdominoplasty usually takes two to five hours, depending on the extent of work required. Partial abdominoplasty may take an hour or two.
    Most commonly, the surgeon will make a long incision from hipbone to hipbone, just above the pubic area. A second incision is made to free the navel from surrounding tissue. With partial abdominoplasty, the incision is much shorter and the navel may not be moved, although it may be pulled into an unnatural shape as the skin is tightened and stitched.
    Next, the surgeon separates the skin from the abdominal wall all the way up to your ribs and lifts a large skin flap to reveal the vertical muscles in your abdomen. These muscles are tightened by pulling them close together and stitching them into their new position. This provides a firmer abdominal wall and narrows the waistline.
    The skin flap is then stretched down and the extra skin is removed. A new hole is cut for your navel, which is then stitched in place. Finally, the incisions will be stitched, dressings will be applied, and a temporary tube may be inserted to drain excess fluid from the surgical site.
    In partial abdominoplasty, the skin is separated only between the incision line and the navel. This skin flap is stretched down, the excess is removed, and the flap is stitched back into place.

    Post-Operative Care

    You will be allowed to eat and drink once you are awake. If you are an in-patient, you will be well looked after in hospital and gentle mobilisation will be started on the first post-operative day.
    If you are to have dartial abdomino plasty surgery as a day case, you will only be allowed home once you are fully awake, able to walk and talk and once you have had something to eat and drink and have passed urine. The person collecting you from the clinic will be given instructions as to how to look after you. You will be given pain killers to take home with you. At home you should rest for the first night. It is a good idea to have some extra pillows to place under your knees as you will find it most comfortable to sleep on your back with your knees up. On the first day after surgery, you should try to get up into a comfortable chair and should be able to walk to the toilet.
    The drains are usually removed after only 3 days when the drainage has diminished to acceptable levels.
    Swelling and bruising take about 3 weeks to settle. To help diminish swelling and bruising the corset or pressure garment should be worn and arnica, a homeopathic preparation, can be begun from about day 2 post-op.
    Mobilisation should be gentle, but begun early. Immediately after surgery you should start with wiggling your toes and ankle and knee movements to help prevent leg clots. Avoid crossing your legs in bed. On the first postoperative day you should mobilise to a chair, walk to the bathroom and a little around your room. Thereafter mobilisation should progress so that gentle exercises can be begun about 3 weeks after surgery. Vigorous exercise should be avoided until you can do this comfortably.
    Depending on the procedure you have, you may be able to begin work after about 3 days (liposuction), a week (mini tummy tuck) or longer, possibly up to three weeks or more for a full tummy tuck.

    SPECIFIC INSTRUCTIONS
    TIGHTNESS:
    Your abdomen will feel tight for a month or longer. If you have had a muscle repair as well (the usual case), you will feel the most tightness down the center of your tummy where your surgeon has actually repaired your muscles. This hurts more than any other part of the procedure.
    HEALING OF SENSORY NERVES:
    Usually, the skin of the abdomen remains partially or completely numb for several months or longer. Tingling, burning, or shooting pains indicate regeneration of the small sensory nerves. This feeling will disappear with time and is not cause for alarm. It may take as long as 2 years for sensation in your abdomen to be restored completely.
    FEELING OF FULLNESS:
    You may pleasantly find that you feel full sooner than normal when you begin to eat regular meals.
    ACTIVITIES:
    If your job keeps you sedentary, you may plan on returning to work in 7-14 days, with the understanding that you will still have discomfort with motion. Please discuss this with your surgeon and the nursing staff. Here again, swelling may indicate too much activity. Do not plan on resuming aerobic or strenuous exercise for about 4 weeks after surgery. Let your body tell you what it can do.

    FAQS
    HOW LONG DOES IT TAKE TO DO A TUMMY TUCK?
    Typically, this surgery takes two to five hours.

    WHAT KIND OF ANESTHESIA IS USED?
    Patients having tummy tucks usually have general anesthesia, but some have local anesthesia with sedation. It can be done as an outpatient or inpatient procedure. Dr. Aguilar will tell you which one is the better choice for you.
    WHAT ARE THE MOST COMMON SIDE EFFECTS?
    You will probably experience pain temporarily, which you can relieve by taking the pain medication prescribed. Expect swelling, bruising, soreness, and stomach-skin numbness. Tiredness may last for several weeks.

    HOW SOON CAN I RETURN TO WORK?
    Most women go back to work two to four weeks after tummy-tuck surgery. But don't rush back to strenuous exercise for six weeks or more. Your scars will fade and flatten for many months--up to two years. Be patient.