Abdominoplasty, or a tummy tuck, is a surgery to remove excess skin and fat tissue present in the central and lower abdomen in order to have a flat abdomen.
Why undergo this surgery?
The reason why someone decides to undergo this kind of surgery is aesthetic, namely the need to have a more toned abdomen, proportionate to the rest of the body. A tummy tuck can be useful in many cases, e.g. in case of a significant weight loss – due to a diet or bariatric surgery – or after a pregnancy, which caused a relaxation of the abdominal wall, and therefore reduced skin elasticity. Furthermore, the cutaneous resection of the lower abdominal wall allows for the improvement of cutaneous imperfections quite common in these kinds of patients, such as scars and stretch marks. The purpose of this surgery is to eliminate excess fat and skin as well as reinforce the abdominal wall using specific muscle suturing techniques,which give tone to the muscles. Nonetheless, the purpose of the surgery is not to lose weight and should not be considered as an alternative to a healthy lifestyle.
How is the surgery performed?
The surgery is done with general anaesthesia and can last up to 2-3 hours. The surgery techniques used for standard abdominoplasty foresee a transverse incision above the pubis, between the two iliac crests. We then proceed with the over-fascial disconnection of the abdominal wall until the xiphoid process of the sternum and periumbilical incision with isolation of the navel. If necessary, in case of diastases of the rectus muscles of the abdomen, the approach is made via suture of the muscle margins along the midline. We then proceed with the downward traction of the abdominal wall, resection of the excess tissue and margin suture. The surgery finishes by repositioning the navel and placing suction drains. Compared to the standard procedure, mini-abdominoplasty foresees a reduced disconnection of the abdominal wall and does not foresee the repositioning of the navel. At the end of the surgery, a compressive dressing is applied. Once removed, the compressive dressing is replaced by a girdle. In some cases, it is possible to add even the liposuction of excess adipose tissue in specific areas.
What happens after the operation?
Normally, two or three days of hospitalization are required. After about 48 hours, the wound is medicated, the bandage and then the drains are removed. At this point, the patient has to wear a girdle for 25-30 days. The stitches are removed after about 15 days after surgery. Absolute rest and limited movement are indicated in the days following the surgery. It is preferable to sleep in a semi-seated position for at least two weeks. Return to work occurs after 7-10 days, whilst one can restart sport activities after about 40 days. Mini-abdominoplasty allows a faster recovery since the surgery is less invasive and the sutures are less extensive.
Patients normally suffer pain, swelling, reddening and bruises in the treated area during the first days following the surgery. Post-surgical issues may be kept under control using normal painkillers, antiemetic or anti-inflammatory drugs.
There will be two scars: one long and transversal “wing-shaped” scar above the pubis - that can be easily hidden with normal underwear - and another periumbilical scar. The most severe cases may foresee a third sub-umbilical vertical suture, perpendicular to the transverse incision.
A good outcome of the surgery depends on many factors: the patient’s initial clinical conditions, his/her healing capacity, a suitable tissue resection and following the doctor’s post-surgical indication – namely avoid inappropriate movements or sun exposure. The desired abdominal profile will be achieved if associated with a correct diet and adequate physical exercise.
What are the possible risks?
The complications linked to the surgery are hematomas and bleeding, infection and delayed healing of the surgical wound, seromas, poor wound healing, change in skin sensitivity, skin necrosis, persistent pain, venous thrombophlebitis and abdominal asymmetry.