Procedures | Abdominoplasty
Abdominal contour problems may be the product of one or more of three possible factors: excess subcutaneous fat, excess skin, or abdominal wall laxity. When excess subcutaneous fat alone is the cause of the abdominal protrusion, liposuction works wonderfully. However, many patients, particularly women who have had previous pregnancies, have more complex reasons that cannot be fixed by liposuction alone. Due to stretching to accommodate an expanding uterus, the abdominal wall gets lax and the skin expands in surface area. After the pregnancy is completed, often the abdominal wall remains lax and the skin excessive. This combination of problems is also seen in patients who have large weight fluctuations. All the crunches in the world won't fix these problems.
Abdominoplasty gives the surgeon the ability to address any situation contributing to a protuberan abdomen. Excess skin and fat is removed and the abdominal wall is tightened. It is done at the expense of an incision along the bottom of the abdominal wall.
- How long is the scar?
- Will there be drains after and abdominoplasty?
- How long does it take for scars to fade after an abdominoplasty?
- What are the risks of abdominoplasty?
- Will I spend a night at the surgery center after abdominoplasty?
- What is recovery like after abdominoplaty?
- Are there different types of abdominoplasty?
An abdominoplasty requires an incision along the lower abdomen, in the "bikini line", to allow the necessary corrections. After the incision is made, the skin drape is elevated off the abdominal muscles exposing them for later repair. The umbilical stalk (navel) remains attached to the abdominal wall.
The abdominal muscles are tightened to flatten the abdomen and narrow the waist. No muscles are cut but the tightening results in abdominal soreness common for several days after an abdominoplasty. The abdominal recontouring is performed when the patient's trunk is flexed to obtain the flattest abdomen possible.
After muscle repair, the excess skin is amputated and the umbilicus is reconstructed. Generally this is a generous amount of skin-extending from above the umbilicus to the pubic region. Any stretch marks or scars in this area are thus removed with the skin redraping. The incision, which extends for several inches in each direction from the midline, is then closed meticulously. It is the intent that the scar, although long, will be narrow and flat.
The length of the scar is proportional to the amount of skin removed. The skin is removed by a "cut as you go" or freehand method. That is, the length of the resulting scar across the lower abdomen is only as long as is necessary. Every effort is made to limit the length of the scar and plastic surgeons have techniques that help them somewhat.
Drains are almost always placed, brought out through small puncture sites in the pubic region. They remain in place for several days and are removed in the office.
The main drawback of the technique is the resulting incision across the lower abdomen. In all patients, this incision will begin somewhat red and thick. Over the course of months to even a couple of years, the scar will fade and flatten. Almost always, after wound healing is complete, the scars are narrow and flat.
To aid in the healing process, pressure, moisturizers, steroid cream, injections, or silicone sheeting may be used to generate a more favorable scar. The choice of adjunctive treatment is made in the office and is individual for each patient. Most of the time, though, the healing process yields a good result with only the passing of time.
The risks of the procedure are small although blood loss, infection, and wound problems are occasionally seen. The most common complication is a seroma, or a collection of fluid beneath the skin that can be aspirated in the office.
The most dangerous complication is pulmonary embolus, or a blood clot that forms in the legs or pelvis and later breaks off and gets stuck in the lung. Tightening of the abdominal wall increases intrabdominal pressure. This increases the risk for pulmonary embolism. Special precautions are taken to minimize the risks including hydration, leg pumps, and early ambulation of the patient.
Most of our patients spend the night after abdominoplasty with a private duty nurse. Our primary focus is prevention of pulmonary embolus by encouraged movement and occasionally intermittent compressive stockings during sleep. The patients are also generally sore and the nurse can assist with pain management.
Abdominoplasty patients begin walking on the first post-operative day but with significant limitations. Most patients will remain at home for at least a few days. Walking is permitted (actually encouraged) immediately with no particular limits on amount. After 5 days or so, recovery has proceeded so that driving and other more aggressive activities are undertaken.
Most patients will be fit enough to return to work, provided it requires no heavy lifting, in about 2 to 3 weeks. Light athletic activity may begin in about 3 to 6 weeks depending upon the way the patient feels and the extent of the abdominal surgery. Abdominal exercises, however, are avoided for several months. Specific activity levels will, of course, be individually set for each patient.
Some patients' problems stand in gray zone where liposuction alone is inadequate treatment and formal abdominoplasty is over treatment. For these individuals, modifications of the abdominoplasty are available which will maximize results and minimize extent of surgery. I will point out, though, that these are very uncommon situations.
One example is the mini-abdominoplasty, which limits the length of the lower abdominal incision as well the fascia repair. Patients get the full benefit of liposuction since it is always a part of the procedure and the advantages of an abdominoplasty in the lower half of the abdomen. Patients with surplus skin of significant amount are not candidates. Where there is only as modest surplus of skin and it is below the umbilicus, the mini-abdominoplasty allows the surgeon to suction surplus fat, tighten the abdominal wall of the of the lower abdomen, and remove a small amount of redundant skin through a limited lower abdominal incision.
Endoscopic abdominoplasty can allow major restoration of the abdominal musculature through relatively small lower abdominal incisions. As with the mini-abdominoplasty, patients with generous excess of skin are not candidates since a large incision would be required for the adequate removal of the skin. The endoscopic abdominoplasty can be performed through a small horizontal incision above the pubis. Repair of the fascia can be accomplished through this limited incision taking advantage of fiberoptic lighting and imaging. Regrettably, there are very few patients that are good candidates for this type of abdominoplasty.