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Abdominoplasty, probably better known as a tummy tuck and the Apronectomy,
also known as a mini-abdominoplasty or mini-tuck are operations
to remove excess skin and fat from the abdomen or tummy.
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The majority of patients opting for this procedure will inevitably be women who, following the birth of their child/children, dislike the effects childbirth has had on their body shape and appearance. Mothers often dislike their stretched abdominal skin, especially if it contains the scar of a Caesarean operation, and no amount of cream or exercise will ever reduce ‘stretch marks'.
You will be asked a general medical history together with details of any previous abdominal surgery. The surgeon will then be able to show you where the scar runs from hip to hip and is designed to be covered by normal pants (the bikini line). There may be a slight variation on these scars depending on the type of clothing the individual may wish to wear after surgery, but please bear in mind the scar cannot follow the fashions.
Abdominoplasty after significant weight-loss can improve on the skin excess but the operation has less than ideal results. For best results , the patient should be within several pounds of their ideal weight. This procedure can be combined with liposuction to the waistline to enhance the cosmetic effect.
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The procedure can dramatically reduce the appearance of a protruding abdomen.
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An incision just above the pubic area is used to remove excess skin and fat from the middle and lower abdomen.
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Abdominoplasty is a major operation carried out under general anaesthesia and requires one but more often two nights post-operative stay in hospital.
A triangular area of skin and underlying fat is removed from hip to hip above the pubic hair and below the umbilicus. The umbilicus is left attached on a stalk.
A pocket is made underneath the skin and fat of the upper abdomen as far as the ribs and this skin is then stretched downwards to join the lower incision. Often (mainly post-pregnancy) it is also necessary to tighten the tummy muscles to improve abdominal contour. Having closed the skin edges, a moon-shaped incision is made at the new site of the umbilicus which is then sewn back in its new position.
An Abdominoplasty is not quite as radical as an abdominoplasty and the umbilicus is commonly left in place.
Drainage tubes are placed under the skin to collect any excess fluid that may accumulate. Hidden stitches are used underneath the skin surface which are dissolvable and do not require removal. A special compression garment may also be required to help with healing.
Immediately after the operation, the abdominal skin feels very tight and indeed it may be difficult to stand up straight for the first few days.
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Skin is separated from the abdominal wall all the way up to the ribs.
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The surgeon draws underlying muscle and tissue together and stitches them, thereby narrowing the waistline and strengthening the abdominal wall.
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The drainage tubes are usually removed at 48 hours and dressings will be re-applied just prior to discharge from hospital. A light dressing may be required for one or two weeks and this should be kept dry. If the pressure garment has been advised, this should be worn for one month.
It is normal to feel moderate discomfort after abdominoplasty and this is usually controlled by mild analgesia such as Paracetamol (do not take Aspirin).
Numbness of the lower abdomen is usual after this procedure but will gradually return to near normal although the process may take many months, or even years to completion.
Bruising may be considerable but this is normal and usually settles well within two to three week, but takes up to six weeks to settle completely. We recommend taking Arnica for one week prior to surgery and two weeks afterwards to lessen the bruising.
Occasionally, fluid continues to collect under the skin and may need to be drained with a needle (seroma formation).
As with all surgery there are risks involved but with Abdominoplasty and apronectomy they are small and infrequent in occurrence. Blood clotting problems can be a factor and as a precaution you will wear TED stockings before, during and after the operation and gentle early mobilisation will be expected although adequate rest is essential.
Wound infection can occasionally occur but is readily treated with antibiotics. Patients who smoke or who are Diabetic have an increased risk of delayed wound healing and wound problems.
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Abdominal skin is drawn down and excess is removed. With complete abdominoplasty, a new opening is cut for the navel. Both incisions are stitched closed.
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After surgery, the patient has a flatter, trimmer abdomen. Scars are permanent, but will fade with time.
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Scars are not a complication but a normal event after any surgery and following these procedures scars usually take many months or even years to settle. In the early stages, there can be build up of excess scar tissue which is hard, red, raised, lumpy and itchy. Once the skin strength is restored the scars mature, becoming softer, flatter and more natural skin colour and texture. This process takes on average 18 months to completion and during this period, daily massage with moisturising cream is advised. Some distortion of the skin, particularly around the hip area often occurs after Abdominoplasty and it may occasionally be necessary to carry out a liposuction procedure in order to reduce this should it persist once the initial scarring has subsided.
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Abdominoplasty and apronectomy are operations with high patient satisfaction and are often the only option left for people with excess skin. Certain patients may be suitable for liposculpture without tummy tucks, or indeed may benefit from both procedures, but this would be determined at consultation.
We recommend at least two weeks away from work and, of course, this may be increased should you have a very physical occupation. Your surgeon will advise you fully.
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