Aesthetic surgery of the abdomen is called abdominoplasty and is commonly known as the "tummy tuck". The procedure is designed to remove excess skin and fat from the lower abdomen as well as to address the muscles by tightening them. It can make a dramatic change to the body profile and considerably improve comfort in daily activities.
You may be a good candidate for abdominoplasty if you have one or more of the following conditions:
- Excess fatty tissue concentrated in the abdomen; fat that you can grab with two hands.
- Sagging or loose abdominal skin, which may be as a result of pregnancy or rapid weight loss
- An abdomen that is protruding and out of proportion to the rest of the body
- Weak abdominal muscles following pregnancy
- If there is a central bulge on attempting to raise the head from a lying down position. This indicates muscle separation and requires an abdominoplasty to repair the muscles.
- Stretch marks on the lower abdomen after pregnancy with appearance like dried prune [jelly belly or wobbly belly].
Consultation: Your consultation will involve the taking of a full medical history, which will include information about any previous surgery, your past pregnancies, allergies, your weight history, and any medications you may be taking. You will also be examined both standing and lying down to determine the amount of skin and fat excess, the skin tone and the condition of your abdominal muscles. It is important to rule out whether or not you have a hernia as well. Your plans of future pregnancy and intended weight loss should be discussed with your surgeon so that you may be guided appropriately.
Individual factors and personal preferences will determine the technique used along with the length and site of the scar. Some patients may be better candidates for what is known as a "mini-abdominoplasty" in which the scars are shorter and only the lower abdomen is addressed. Generally, however, the incision lies just above the pubic area and extends laterally toward the pelvic bones. Its extent and design will be based on how much skin is to be removed and what type of bathing suit/ undergarments you prefer to wear. If there is excess skin above the navel, then you will require an incision around the navel to allow the pulling down of this skin. This will not change the position of your navel. It will be possible to tighten the abdominal muscles if required through the lower incision. In women with fatty abdomen it is necessary to combine liposuction of the abdomen with abdominoplasty [see lipoabdominoplasty below] to give a uniform and pleasing aesthetic result. The back can also be addressed in the same operation [extra charges applicable] to do a circumferential treatment.
Lipoabdominoplasty: This is the most modern way of doing the tummy tuck operation and has merit due to better contouring ability, less complications and faster recovery. Dr. Mohan Rangaswamy is a regional pioneer in this technique and uses LABP exclusively. See an article related to this innovation in middle east health.
Surgery: It is usually done under general anesthesia or epidural. A lot of fluid is infused into the abdominal fat; this fluid contains local anesthetic and a drug to reduce bleeding. Liposuction is then performed as per plan to remove maximal amounts of fat. After this the lower skin cut is made, the skin flap is raised up selectively to reach the navel. A cut is made around the navel to isolate it. After this surgery is continued to free up the upper skin and expose the muscles. The muscles are tightened if needed. The upper skin flap is pulled down over the lower edge of the cut [like shirt over pants] and excess skin is removed. The wound is closed by stitching the edges together; in effect the skin above the navel is now reaching the pubis! All lower abdominal skin with the stretch marks is removed and discarded. The navel remains as it was attached to the muscle; it will be now be brought out through a new hole. Drains may be inserted to evacuate fluid from the spaces under the skin flap. Dr. Mohan does not use drains and has seen no increase in the rate of collections [see refinements below]. In fact his rate of seroma is close to zero.
Post-Surgery: The hospital stay is usually one to three days depending on the procedure done and your own speed of recovery. Most are discharged the following day.
The day after surgery, you will be encouraged to walk. You will not be able to stand absolutely straight but should bend forwards at the hip level. You should sleep for the first few days with a pillow under your knees in order to relax the area of surgery. It is best if you do not sit for long periods of time. Straining, bending and lifting too should be avoided. You will have to wear a support garment around the abdomen for three weeks. Sutures are generally dissolvable. You should expect some bruising and swelling which will take between two and three weeks to settle down. There may also be some numbness over portions of the abdomen which may persist for several months. The incisions will be quite red initially but will fade in the next few months after surgery.
You may return to a non-strenuous work a week or two after surgery, and exercise may be started after six weeks. You may experience mild periodic discomfort, sharp brief needle like pains and swellings from time to time over the first few months but such feelings are normal. In some individuals, the incision lines are more noticeable but are fortunately concealed by most bathing suits and undergarments.
Complications: The operation is generally safe and specific details of the potential complications are best discussed during your office visit to your plastic surgeon. The technique used by Dr. Mohan Rangaswamy has been shown to be particularly safe; his complication rates are much below published rates. Some of the aspects which will be discussed with you include seroma, hematoma, infection, chest infections, atelectasis of lungs and deep vein thrombosis. In addition (especially when the operation has been extensive and also in smokers), tissue loss along the lower incision may take place and delay healing, this is extremely rare in our practice.
Results: Every year, many thousands of people successfully undergo abdominoplasty. It will give you a firmer and flatter abdomen which will make you more comfortable in your clothing and may make you feel more confident about your appearance. The result should last many years unless you have significant weight fluctuations or become pregnant. A second procedure is also possible if over the years you again become dissatisfied with the appearance of your abdomen.
Refinements: The author Dr. Mohan Rangaswamy is one of the few surgeons who have been systematically combining extensive liposuction with abdominoplasty in the same operation with increased safety and superior contouring for many years.. The author has been doing this from 1996. It is now called lipoabdominoplasty. Drains are usually not used. Recovery is quicker than in traditional technique. Refer to an interview on this topic in the section ‘in the media’.