General Surgery - Abdominoplasty (Tummy tuck)

What is abdominoplasty surgery?

Abdominoplasty surgery, commonly known as a tummy tuck, is an operation to remove extra skin and fat from the tummy, and sometimes to tighten the tummy muscles.

Why have a tummy tuck?

People have this surgery to take away extra skin and fat, or get a flatter tummy, often after pregnancy or gaining and losing weight. It can help rejoin the muscles of the abdominal wall if they have been pulled apart in the middle (known as ‘divarication of the recti’). Ideally, your weight will be optimal before the surgery.

A tummy tuck is not best suited for people who are overweight or carried out in order to lose weight. For the right person, a tummy tuck can make a big difference to their confidence and quality of life.

How is the surgery performed?

1.    The standard tummy tuck

This is the most common type of tummy tuck. A cut is made across the body from one hip to the other and around the belly button (umbilicus). The extra skin and fat are removed from just above the pubic hair up to the belly button. The muscles above and below the belly button are tightened. The skin is then sewn together to give a scar around the belly button and a long scar across the lower tummy.

2.    The mini tummy tuck

Here, a smaller amount of skin and fat is removed from the lower tummy, though there will still be a long horizontal scar above the pubic hair. Sometimes the muscles will also be tightened. No scar is left around the tummy button, which may be stretched to become a different shape. A mini tummy tuck will give less of an effect than a full tummy tuck.

3.    The fleur-de-lys tummy tuck

For patients with lots of extra skin on the lower and upper tummy, a fleur-de-lys tummy tuck might be appropriate. Here, as well as the long horizontal cut of the standard tummy tuck, there is a vertical cut too, so the scar looks like an anchor.

How can I help my operation be a success?

Be as healthy as possible. It is important to keep your weight steady with a good diet and regular exercise. Your GP can give you advice on this. If you smoke, you must stop at least six weeks before the operation to help reduce the risk of complications, such as wound breakdown. Do not worry about removing hair near to where cuts will be made but do have a bath or shower during the 24 hours before your operation to make sure that the area is as clean as possible.

What should I expect in terms of treatment, procedures and outcomes?

The surgical procedures described on this page are all best performed when a patient is fit and healthy. No special diet or exercise programme is required prior to an abdominoplasty, but you should be close to your ideal weight.

You will be admitted on the day of surgery, and your length of stay depends on which procedure is done.

With a full abdominoplasty you will have some dressings on your tummy and sometimes some drains (plastic tubes attached to suction bottles). The drains, if placed, will usually be removed before you go home. You will be given instructions about your dressings and stitches when you go home. Most surgeons will use mostly dissolving stitches, but some stitches might need to be removed.

Post-operative pain in these procedures is easily controlled. Patients will usually wake from surgery with an abdominal binder in place, we recommend continuous wear of this for a full 8 weeks post operatively. Patients will be mobile from day one, usually in a bent over posture to minimise pull on the scar(s). Patients should be back to full exercise within 6 weeks.
 
Patients are recommended to take at least four weeks off work immediately after the operation, to ensure they recuperate fully. Patients will also be advised that they cannot drive until they can make a safe emergency stop. These timings are approximate and depend on what exactly is done; also, some people recover quicker than others.

All abdominoplasties result in some scarring although the nature of the scars will depend on the technique that has been used.
Scars tend to be quite red and raised in the first six weeks, changing over the next six months or so and then fading to white. Most patients will form good quality scars over time, but occasionally and unpredictably, some patients will get red lumpy scars that do not improve.

What complications can occur?

Whilst these operations are generally regarded to be highly successful, there are various negatives and complications that patients need to consider.

A full abdominoplasty is a major operation, and you must be prepared for the process and recovery period. Most patients are delighted with the physical and cosmetic improvements that abdominoplasty brings. However, it is impossible to guarantee that every patient will be completely satisfied with the result.

There will be minor asymmetries in respect of the scars, and possibly residual bulges. Occasionally patients will bleed immediately after the operation and need to go back to the operating room for this to be dealt with. Wound healing problems can occur.

Most wound problems are minor and can be managed with simple dressings. However, more major wound problems can arise such as infections, skin loss, wound separation and delayed healing. Wound problems, if they occur, can delay your recovery and result in worse scarring. In some patients, fluid will collect in the abdomen in the region of the operation. If this occurs and needs to be removed using a needle, this can be done in the outpatient clinic.

All patients can expect alteration in the feeling of the lower abdomen which can be permanent and sometimes altered feeling can also extend to the front of the thighs. This operation carries a risk of blood clots in the legs and possibly the lungs.
Various precautions are taken to limit this risk, but if a blood clot occurs, treatment with blood thinning medication will be needed for several months. Blood clots in the lungs can be serious.