Tummy tuck (Abdominoplasty)

There are several types of abdominoplasty, also known as a "tummy tuck", ranging from a minor removal of hanging skin (a mini-tuck) to a major abdominoplasty where a new umbilicus is made and the entire abdomen is tightened.

When women have had children, the lining of the abdominal muscles, the so-called fascia, can rip and the abdomen can develop a bulge. This is a type of hernia, and other types of hernia may develop as well. The patient can often feel a layer of fat on the lower abdomen. The layer below that is called the fascia. Liposuction (including Dr Kremer's signature e-lipo) alone removes excess fat, but cannot tighten the fascia or remove hanging skin; for that, you need an abdominoplasty - London surgeon Dr Kremer is here to provide it.

Abdominoplasty is an operation performed to remove excess fatty tissue and skin folds in the mid and lower abdominal region and to tighten up the abdominal wall. Diet and exercise alone cannot provide correction, since this condition is often accompanied by separation and stretching of the abdominal muscles and weakening of the abdominal wall. Abdominoplasty is not directed toward weight reduction. It is designed to remove only as much excess skin and fatty tissue as is practical and safe. Stretch marks, where possible, will be removed along with the excess skin. However, stretch marks on the remaining abdominal skin cannot be removed. Photographs are as important to the plastic surgeon in the proper care of his patients as X-rays are to the physicians in other medical specialties. Therefore, photographs are taken before and after the surgery and become a permanent part of the patient's confidential medical record.Abdominoplasty is considered major surgery and is usually performed in our outpatient surgical facility.

The anaesthesia

Abdominoplasty surgery is performed under a "light" general anaesthetic (patient is asleep). This technique provides excellent operating conditions while affording maximal patient comfort and safety. The anaesthetic is administered by a Board certified anaesthesiologist (M.D.) who remains in attendance throughout the operation. All of the required monitoring, anaesthesia delivery and emergency equipment are present at all times. Further information, including any questions you may have, will be explained and discussed fully by our anaesthesiologist prior to your surgery.

Pre-operative preparations for abdominoplasty surgery

Referral

A physical examination and routine lab work will need to be performed by your own primary physician. If you do not have a primary doctor, we can refer you to local doctors in our area. We do not provide these services at our London surgery. We require that we receive the pre-op paperwork 1-2 weeks prior to the tummy tuck surgery.

Health and medication

You must be in good health to undergo any elective cosmetic surgery. It is very important that our office is aware of any medical conditions and all medication you are taking.  Do not take aspirin or aspirin-containing products for 2 weeks before and after surgery.

Smoking

It is imperative that you do not smoke 2 weeks before and after surgery. This would impede your healing greatly. Talk to us about options.

Travel

It is required that someone drive you home upon your discharge. You will also need to arrange for transportation to and from our office for your post-operative appointments until your doctor gives you permission to drive.

Diet

An adequate diet with vitamin supplements, especially Vitamin C, is recommended. You should be in the best nutritional state possible prior to surgery. If you will be preparing your own meals at home after surgery, have on hand easy to prepare foods.

The abdominoplasty surgical procedure

The tummy tuck procedure takes approximately 3 hours to complete and will be carried out at our surgery in London. Abdominoplasty surgery usually involves two incisions. One incision extends along the lower abdomen just above the pubic hairline. The other is a circular incision around the navel, as the operation frequently requires repositioning the navel to a higher, more natural level. The abdominalskin and fatty tissue are raised away from the underlying abdominal structures. When necessary, repair of the abdominal wall and muscles is done at this time. The tissue is then stretched in a downward direction and the excess tissue is removed. Small rubber drains may be inserted in the wound to remove blood and serum that may accumulate. The incision is closed either with suture material, special tapes or metal clips. A large pressure dressing is applied followed by a supportive abdominal binder. An I.V. is routinely placed in the hand or arm prior to surgery for fluid maintenance and remains in place usually until the next morning.A urinary catheter may be inserted at the time of surgery and will be removed usually straight after surgery, sometimes in 24 hours if staying in aftercare.

Possible complications

Complications are rare but when they do occur, they usually respond promptly to proper treatment without unfavourably affecting the final result.

Bleeding can sometimes occur after the operation, it may accumulate in the operative area and may require opening the wound to remove the blood and prevent further bleeding.

Infection occurs rarely and usually responds to antibiotics.

Tissue loss is very rare. Should this happen, a reconstructive operation can be performed with satisfactory results at a later date.

Keloids/Hypertrophic scars may occur and for those prone to keloids, (overgrowth of scar tissue at the incision site) steroid injections can be administered to breakdown and flatten scars.

What to expect after an abdominoplasty operation

Activity: Post-operatively the patient is encouraged to walk soon after surgery, with frequent periods of resting.

Pain: There is a minimal to moderate amount of pain associated with abdominoplasty surgery. Medication is available to control any discomfort experienced while in an after-care facility or at home. Coughing, laughing, sneezing or other any-thing that exerts the abdominal muscles will produce discomfort post-operatively.

Splinting (using counter pressure with a pillow) is best to reduce discomfort. A feeling of tightness in the lower abdominal area will be experienced after surgery, necessitating a somewhat stooped posture. This is temporary and usually lasts 7-10 days.A large abdominal binder or garment will be applied immediately after surgery. Sometimes drains are placed in the lower pubic area, and are removed 5-10 days after surgery. This binder should be used for two weeks after surgery, and then a department store girdle may be purchased and worn for an additional several weeks.  

Scars left by this procedure are generally predictable and although they fade with time, they are permanent. Occasionally, a scar revision procedure is necessary to attain the best cosmetic result. These procedures are minor and can be carried out in our London office under local anaesthesia. A pouching of the tissue immediately above the incision line may be apparent after surgery. This is usually temporary and gradually smooths out over a period of months. There are several options for scars i.e. topical gels, laser treatments, steroid injections, all of which are offered when appropriate for the patients. We will discuss these options with you. It is not unusual for a patient to experience a period of the "blues" during the convalescence. This is temporary. It's helpful to remember that it is impossible to judge the final result of your surgery until all of the swelling has subsided and the operative area has smoothed out.

Post abdominoplasty care

Avoid lying on your abdomen for two weeks. The optimal sleep position is to be elevated on your back with two pillows. Place a pillow under each arm and a pillow under your knees to keep your abdomen flexed. If applicable, empty drains twice a day, morning and night. Call the London office if you are experiencing excessive drainage. On your third post-op day you may remove your dressing, discard any sponge padding (leave steri-strips alone) and sponge bathe only until drains have been removed. Once drains have been removed, a quick shower is fine. It is normal to experience oozing from the drainage site after the drain has been removed. Take your temperature occasionally and call the office for any fever over 100 degrees.

Resumption of physical activities after a tummy tuck

General rules of thumb: follow the two, four, six rule. In the first week, take it easy! Patients who are too vigorous frequently develop complications.

At two weeks, take long walks on a flat surface. No other kind of workouts. Any activity that would raise your blood pressure would compromise the healing incisions and newly developing blood supply.
At four weeks, begin light exercise such as aerobics, but no weight training.Start light. For example, if you normally do 30 minutes on a treadmill, begin with 15 minutes, then increase as your body gets used to things.
At six weeks, resume all previous activities with clearance from Dr Kremer. Avoid sun exposure to incision site for months following surgery, as this may result in a hyper-pigmented scar.