Abdominoplasty: The Facts

Abdominoplasty, also known as a "tummy-tuck," is an elective cosmetic surgical procedure. It is major invasive surgery, which removes excess skin and fat from the middle and lower abdomen. It also tightens the muscles of the abdominal wall.

The procedure can dramatically reduce the appearance of a protruding abdomen. However, it also produces a permanent large scar, which can extend from hip to hip, depending upon the extent of the procedure. If you are considering abdominoplasty, this article will give you a basic understanding of when it can help, whom it can help, how it is performed, and results you can expect.

IS THIS PROCEDURE RIGHT FOR ME?

The best candidates for abdominoplasty are emotionally stable men and women who are in relatively good shape, close to their ideal body weight, and who have good overall skin elasticity, 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 have lost elasticity in the muscles and skin of the abdomen due to multiple pregnancies. Loss of skin elasticity in older patients because of weight loss can also be improved. Abdominoplasty is not a "one size fits all" procedure; it is unique for each patient. Much depends upon the joint decisions made by the patient and his or her surgeon.

Patients who plan to lose a lot of weight should postpone surgery until after they have achieved their desired weight. Young women who plan future pregnancies should also wait, since vertical muscles in the abdomen, which are tightened during surgery, can separate during pregnancy.

If you have heavy scarring from previous abdominal surgeries, your doctor may advise against an abdominoplasty because of the possibility of unusually prominent scars.

COST CONSIDERATIONS

An abdominoplasty is an expensive surgery. The average cost ranges from $5,000 to $9,000. In addition to the cost of abdominoplasty, a liposuction might require an additional $2,700, or more.

According to the American Academy of Cosmetic Surgery's 2005 Procedural Census, 32.4% of all member surgeons have performed abdominoplasties. The "tummy-tuck" lies near the middle of popular plastic surgery procedures; since liposuction is number one that would make the abdominoplasty procedure near the top in popularity when it is combined with liposuction.

WHAT RISKS ARE INVOLVED?

When performed by a qualified plastic surgeon, one trained in body contouring, the results are normally more than satisfactory. However, as with all surgical procedures, there are some risks associated with abdominoplasty. There are also specific complications associated with the procedure. These include: infection, blood clots, and poor healing, which can result in heavy scarring. Infection can be treated with antibiotics and drainage. The risk of blood clots can be minimized by moving around as soon after surgery as is possible. Poor healing and scarring may require additional surgery.

Smoking can increase the risk of complications and hinder healing. By following your surgeon's instructions carefully before and after surgery, you can significantly reduce your risk of complications.

FINDING THE RIGHT SURGEON

Before electing to have abdominoplasty you must find a qualified surgeon. One who is board certified. Be wary of any doctor who identifies him or herself as simply "board certified." All certification boards are not the same; you need to understand exactly what the "board certification" means.

In the United States there are several plastic surgery certifications: the American Society of Plastic Surgeons (ASPS); the American Board of Plastic Surgery (ABPS); and the American Society for Aesthetic Plastic Surgery (ASAPS). Claims of board certification can be verified by the American Board of Medical Specialties. Be sure that the doctor is board certified specifically in the area of abdominoplasty plastic surgery.

In Canada make certain that the surgeon is certified by the Royal College of Physicians and Surgeons of Canada.

To find a plastic surgeon that performs this procedure in your area, visit the online referral service of the American Society of Plastic Surgeons (ASPS). It is the largest plastic surgery organization in the world, and is the foremost authority on cosmetic and reconstructive plastic surgery.

All ASPS physicians are certified by the American Board of Plastic Surgery (ABPS) or the Royal College of Physicians and Surgeons of Canada.

THE CONSULTATION PROCESS

Many plastic surgeons do not charge for the initial consultation. The surgeon will evaluate your medical history and ask about your health habits. Be as honest and upfront as possible in answering each question.

Be specific about what you want done, and what you hope to achieve. If your plastic surgeon fully understands your expectation, he or she will be able to determine whether or not your goals are realistic.

Tell the surgeon if you smoke, or have health or medical conditions or complications. The surgeon will ask you about you family medical history, especially your parents and siblings. He or she may want to run some tests to rule out certain diseases.

Ask questions and request specific, not vague, answers. If you have any concerns, share them. Discuss with the surgeon what procedure is right for you, and ask exactly what that procedure will entail.

TYPES OF ABDOMINOPLASTIES

There are two different types of abdominoplasties: the "mini-abdominoplasty," and the more invasive type, "abdominoplasty." Both these surgeries may involve liposuction. In both surgeries skin and fat are cut away from the abdomen.

In a mini-abdominoplasty an incision is made just above the pubic area; fat and excess skin is removed from the middle and lower abdomen. The navel is pulled lower to compensate for the stretching and removing of skin. Minimal or no abdominal tightening will be required. Recovery time is usually very quick.

A full abdominoplasty requires a much larger incision. Skin is separated from the abdominal wall, all the way up to the ribs. Muscles are sewn together to tighten them, and a significant amount of skin is removed, requiring the patient to be bent over for 10 to 14 days. Usually within 2 to 3 weeks the patient is able to resume normal activity, except for lifting. There should be no lifting or pushing, putting strain on the stomach muscles, for up to 2 months.

THE SURGERY ITSELF

Complete abdominoplasty usually takes 2 to 5 hours, depending upon the extent of the work needed. 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.

The surgeon will separate the skin from the abdominal wall, lifting a large skin flap to expose the abdominal muscles. The muscles are sewn together to firm the abdominal wall and narrow the waistline. The skin flap will be stretched, and excess skin removed. A new opening will be cut for the navel, which will be stitched in place. Incisions will be stitched closed, and dressings will be applied. A temporary tube may be inserted to drain off excess fluid.

Partial abdominoplasty may take just over an hour or two. The incision is much shorter, and although it may be pulled into an unnatural shape once the skin is tightened and stitched, the navel usually does not require relocation. Both types of surgeries may require liposuction.

Surgeries for both types of procedures can be performed using either general or local anesthesia. When local anesthesia is used, you will be relaxed and pain free, but may feel some tugging or pulling. Depending upon your doctor, your surgery will be performed in either a hospital or an outpatient surgical center.

AFTER SURGERY

After the surgery you may be swollen and in pain, which can be controlled by medication. Depending upon the type of surgery performed, you may be released within a few hours, or remain hospitalized for up to 3 days. Your doctor will give you instructions in your post-operative care.

Although you might not be able to stand up straight, you should start walking as soon as possible to reduce the risk of blood clots. Surface stitches will be removed within a week; deeper sutures protruding through the skin will be removed in 2 - 3 weeks. The dressing on your incision may be replaced by a support garment.

It may take weeks, even months, to fully recover from surgery. The better your physical condition is prior to surgery, the shorter the expected recovery time. Some people return to work within a couple of weeks; other people can take up to a month to recover enough to return to work.

A low-impact exercise program, such as yoga, will help you heal faster, reduce swelling, tone the muscles, and lower your chances of blood clots. Getting plenty of rest and eating a healthy diet will also help you to heal faster.

A word about scarring: your scars may appear to worsen during the first three to six months. This is normal, and will be only temporary. Expect it to take several months or up to a full year for the scars to flatten, and lighten in color. While scars will not be noticeable under clothing, even when wearing a bathing suit, they will always be visible on the skin.

SUMMARY

In most cases the results of abdominoplasty are long lasting as long as you maintain a healthy lifestyle. Eat wisely, and get proper exercise. If you are realistic in your expectations and are prepared for a permanent scar and lengthy recovery time, chances are you will be very happy with the end result.

If you have large deposits of body fat in the stomach region that you want removed, or loose abdominal skin that won't respond to diet or exercise, abdominoplasty may just be the right choice for you. But you, and only you, should make that decision.

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