When Should I Consider an Abdominoplasty, or “Tummy Tuck?”
- Loose or sagging abdominal skin; abdominal stretch marks
- Loose, stretched abdominal wall; Relaxation of the abdominal muscles related to pregnancy, excessive weight loss, previous surgeries)
- Separated and weakness of the abdominal wall muscles (Referred to as a diastasis related to excessive stretching during pregnancy or with excessive weight loss
- A desire for a smoother, flatter abdomen
- Removal of stretch marks and improvement with overhanging skin
- Improved abdominal contour; desire for an “hour glass” waistline
- Ability to fit better in clothing and comfortable in a swimsuit
The Gillian Institute feels it is important to maintain and achieve a natural, feminine abdominal contour.
An hour glass figure is achieved with emphasis on the feminine curves of the body following an abdominoplasty procedure. The abdominoplasty or tummy tuck will remove stretch marks, improve excess skin or overhanging skin by tightening the skin, improve looseness of the abdominal wall or stretching of the abdominal muscle by tightening the abdominal wall, with incorporating liposuction for contouring purposes.
It is important to realize that no amount of weight loss, weight lifting, or exercise programs will improve the appearance of excess or loose skin or separated or relaxed abdominal rectus muscles. Typically, weight loss and exercise will make the appearance of loose skin less desirable and more noticeable. Liposuction alone for a patient who is a better candidate for a tummy tuck will not achieve an optimal result. Liposuction alone will not tighten the abdominal muscles and will only make stretched, loose skin overhang more after surgery. If you have only an extra layer of fatty tissue but no loose skin and you are not concerned with improving stretch marks or tightening the abdominal muscles; then you may achieve a very nice result with liposuction alone.
The tummy tuck or abdominoplasty procedure allows our doctors to tighten the abdominal wall by using permanent sutures to bring the underlying tissue and muscle together. The abdominal skin is released and pulled downward, and the excess skin is removed. A small new opening is made in the abdominal skin to bring the navel or belly button through the skin. Liposuction may also be performed for contouring purposes to the pubic area and along the waistline in surgery during the tummy tuck procedure. The incision is well concealed along the pubic area and will extend laterally; but will be hidden even in a bathing suit. We perform mini tummy tucks, standard tummy tucks, skin excision only tummy tucks and extended tummy tucks based on the amount of excess skin and/or stretch marks to be removed, the degree of abdominal wall looseness or separation of muscles and the patients’ desired improvements. Our doctors will recommend a specific approach at the consultation.
The tummy tuck procedure is permanent and typically a tummy tuck with muscle wall tightening is only recommended if future pregnancies are not desired. The Gillian Institute’s technique for the abdominal contouring is aggressive in terms of muscle wall tightening. The use of permanent sutures to tighten the abdominal wall will result in the “hour glass figure” following surgery. Our plastic surgeons will use interrupted and running sutures to tighten the rectus muscles (located vertically) and this will also pull the oblique muscles (located on the side of the abdomen) inward also. This tightening will correlate to the achenes and need for pain medication and muscle relaxants following surgery.
Patients will be encouraged to ambulate every 2-3 hours directly after surgery but will prefer a more bent position with walking and resting at a 45 degree angle for the first 3-5 days. To ensure fluid collections (referred to as a seroma) do not occur, a drain or two drains are placed under the abdominal skin to allow any fluid that accumulates an exit out of the body through a drain system using suction. The drain(s) are very patient friendly and are easy to manage follow surgery. We also perform a special suturing technique in surgery that uses sutures in a mattress placement to decrease the risk of fluid collections. This mattress technique allows the drains to be removed in the office sooner (within 3-5 days), and to advance the abdominal skin with closure of the incision to remove more loose skin and stretch marks compared to the process without this technique.
We also spend additional time on the appearance of the belly button. Our philosophy desires a natural, depressed belly button outcome; allowing other people not to detect a tummy tuck has been performed by the appearance of the belly button and belly button opening. The belly button is not flat and should not appear as if it was “stuck on,” an indication of a tummy tuck procedure. The belly button stalk is the original but a new opening is made for the location of the belly button stalk. Our surgeons like to allow some fullness on both sides of the belly button and to place sutures to pull the belly button more downward, indication a natural depressed belly button appearance. If a hernia is also present, we are able to repair the hernia as well.
Our technique does require more time in surgery compared to more common tummy tuck techniques; but she feels her technique warrants the additional time in surgery for the ultimate, permanent result. If a patient is not concerned with tightening the abdominal muscles or if future pregnancies may be a possibility, and the primary goal is to remove the excess skin and any stretch marks to the abdomen; a skin only tummy tuck can be performed. A skin only tummy tuck will offer patients less recovery period and post operative restrictions based on no muscle work is performed in surgery. If the patient’s lower abdominal area is the main concern and the patient does not want to re-position the belly button; a mini-abdominoplasty or endoscopic abdominoplasty may be recommended.
In some cases, staging with liposuction either before or after the tummy tuck procedure may be recommended to give the best results possible with the fewest risk of complications. If a patient is not at their ideal body weight or if the patient has a significant history of smoking; liposuction of the abdomen first can minimize the thickness and fullness to improve the contour with the second staged tummy tuck and to increase blood flow with re vascularization to decrease risks of healing with the second stage tummy tuck procedure.
The results from the tummy tuck or abdominoplasty are permanent and long lasting. We recommend maintaining your preoperative weight, because if you gain weight in the future, the liposity will be added to your figure, just not typically the abdomen. If you were to get pregnant in the future, your abdominal wall will re-stretch without problems as well as the skin envelope but you may undo a significant portion of our contouring results. If this occurs, patients will tend to return after all pregnancies are completed, and have us re-tighten the abdominal muscles, and skin envelope again. This is not ideal but can be done if it occurs, which is not common.
Patients are required to stop smoking and use of all tobacco products a minimum of 6 months prior to surgery to decrease the risk of complications related to healing and decreased blood flow to the abdominal tissue and skin resulting in skin necrosis and incision separation. Smoking has been shown to decrease blood flow by 30% to the incision and abdominal tissue resulting in complications related to healing, which will significantly increase the recovery period. Ideally, the longer the smoking has ceased the better in terms of reducing the risk of complications. We would also recommend you are within 15-20 lbs of your ideal body weight to optimize the final result and to decrease the risk of complications related to healing.
Planning the Surgery:
Time Off Work: 14 days recovery period for most tummy tuck procedures; 7-10 day recovery period for skin only tummy tuck (with out muscle work) procedures. You will be required to Limit twisting/bending movements for the first 2 weeks and lifting restrictions of less than 10lbs for the first 4-6 weeks.
Caregiver: You will need someone to take care of you for the first 48 hours after surgery. You will need a driver for the first week. You will be required to return to the office the day after surgery for a post-operative appointment.
The Day of Surgery: The procedure is usually performed under general anesthesia and the procedure will last approximately 3-5 hours depending on the type of approach. This procedure is outpatient but you are able to stay overnight at JKS Surgery if desired.
After Surgery: This procedure is one of the more uncomfortable plastic surgery procedures due to the extensive muscle work performed in surgery. Patients can stay overnight at the surgery center and may opt to stay 1-2 days in a nearby hotel. Light dressing are placed after surgery and skin glue adhesive with steri-strips are placed along the incision for the first two weeks. A scar treatment for the incision is started at two weeks after surgery to improve the scarring. Light activity is possible within 14 days and will become more comfortable over 2-3 weeks after surgery. Patients will have a drain(s) placed to the abdomen and will not be allowed to shower until the drain is removed in the office. The drain site is located in the pubic area. Patients should refrain from vigorous activities for at least 6-8 weeks. Topifoam compression pads are placed under the compression device for the first 1-2 weeks to reduce abdominal swelling and encourage skin contraction. The compression device is recommended for the first 6 weeks to reduce swelling and provide support. The majority of swelling will be resolved by 6-8 weeks. Post-operative external ultrasound is also recommend to reduce swelling, areas of firmness, and encourage the lymphatic system to positively respond to the swelling and healing process.
Note:It is important to address any concerns with The Gillian Institute at the time of your consultation. There is some risk, as with any surgical procedure. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual. To reduce post-operative complications, our doctors recommend you be within certain weight requirements and absolutely no tobacco use. The Gillian Institute can explain the procedure and potential complications to you in detail, and she can assist you in determining if an abdominoplasty is right for you.