Tummy tuck

Tummy tuck or abdominoplasty is a procedure intended for patients with various levels of abdominal skin and subcutis sag. We most frequently encounter this diagnosis in patients who have lost a more appreciable amount of weight and in the case of women who have given birth. The procedure, in terms of which excess skin and subcutis is removed, can also include correction of spreading of the direct abdominal muscles, which is relatively common, especially in women who have given birth.

Who is a suitable candidate for tummy tuck?

Any patient with overhanging abdominal skin and subcutis, who is not excessively overweight and for whom there is no contraindication for the procedure as a result of serious overall illnesses or unsuitable local conditions on the abdomen such as extensive scarring from previous operations is a suitable candidate. If the patient is planning to get pregnant within the next two years, it would also be sensible to defer the operation.

How does consultation take place?

The overall state of health and any possible contraindications to the procedure are ascertained in terms of consultation. After examination of the local finding on the abdomen, it is determined whether the condition is suitable for surgical resolution and which technique will be used in terms of the operation. The patient is familiarised with the procedure and subsequent scope of scarring. The techniques most frequently used include: conventional tummy tuck with an incision in the lower abdomen and around the navel, also mini-abdominoplasty with an incision made only in the lower abdomen and mini-abdominoplasty with movement of the navel, in terms of which the resulting scar is also only on the lower abdomen. All types of tummy tuck procedures can be combined with liposuction (most frequently in the upper abdomen and hips). Elastic underwear, wearing of which is an integral part of post-operative care for most procedures, is also tried during consultation. It is always necessary to inform the doctor of all medicines which the patient uses. This especially relates to medicines which affect coagulation.

Essential pre-operative examination

Apart from standard pre-operative examination, which is performed by a general practitioner approximately seven to ten days before the procedure, no special examination is required.

Hospitalisation

Tummy tuck is mostly performed under general anaesthesia whilst the patient is hospitalised, the length of which does not normally exceed three days after the operation. Photo documentation is created before the operation and the operative plan is marked out on the patient’s body. Prevention of thromboembolic diseases by injection of preparations and equipping the patient with elastic tights goes without saying. The actual operation takes about one and a half hours. After the procedure, the patient spends several hours in a recovery room and after stabilisation, is moved to a standard ward. Elastic underwear is worn from the first day after the operation. Drains are mostly removed the second or third day after the operation. If there are no complications and the patient feels subjectively well, he or she may be released then.

Post-operative care

Post-operative pain is not usually great and reacts well to regular analgesics. Too much physical activity is not recommended in the period immediately after the operation. Showering is possible after three to five days. Elastic underwear is worn for four to six weeks. After this period, the condition is usually fully stabilised in the majority of cases, and if spreading of the direct abdominal muscles has not been treated, not restrictions are then necessary. If spread abdominal walls were stitched, it is advisable to treat the abdomen gently for a further six weeks. Care for the scars constitutes an important part of the post-operative regime. Once the stitches have been removed, the scars are lubricated and massaged, and silicone patches may be applied to ensure quicker maturation.

Complications

Complications are infrequent in the case of tummy tuck. Early post-operative complications include hematomas or accumulation of blood in the wound. Small amounts of blood are not a problem. Blood which is not channelled away by the drain is spontaneously absorbed and no surgical intervention is required. In the case of larger hematomas, the wound must be checked, the blood removed and the source of the bleeding treated if necessary. If a hematoma occurs once the stitches have been removed, in most cases, the condition can be resolved by merely sucking out the liquid with a needle. The same procedure is followed if a seroma occurs (accumulation of interstitial fluid in the wound). From the list of later complications, we must mention an extended period of healing of the wounds, which may exhibit itself in the wound opening, marginal loss of skin, especially in the central part of the wound. One heightened complication in terms of healing is the creation of more extensive skin necrosis in the lower part of the abdomen or navel. This complication is however very rare. Relatively frequent post-operative conditions especially include changes in sensitivity in the lower part of the abdomen caused by extensive mobilisation of the soft tissue. In the vast majority of cases, these changes are temporary and subside fully over the course of a few weeks or months. In some cases however, the change in sensitivity can be permanent. Later complications include the creation of hypertrophic scars (wide rigid scars that protrude above the level of the skin).