Surgery for excess skin removal after multiple pregnancies or weight loss.

Abdominoplasty, also commonly referred to as Tummy Tuck, is a major surgical procedure that removes excess skin and fat from the middle and lower abdomen and tightens the abdominal wall. Sometimes after multiple pregnancies or weight loss, abdominal muscles weaken, and skin in the area becomes loose. If the patient is realistic in expectations and prepared for the consequences of a permanent scar and a lengthy recovery period, then abdominoplasty may be just the answer.

Loss of skin elasticity in older patients, which frequently occurs with slight obesity, can also be improved by abdominoplasty.

If the patient has scarring from previous abdominal surgery, the surgeon may recommend against abdominoplasty or may caution the patient that the scars could be unusually prominent.

For patients who are planning to lose a lot of weight, abdominoplasty is best after the weight is stabilized. The skin and flesh are then sculpted to the new form. This surgery is for sculpture, not weight loss. One of the major fat storage areas of the body is the apron of fat around the intestines (omentum). This fat is located behind the abdominal wall and is not treatable with either liposuction or abdominoplasty. Weight loss is better done with controlled diet and improved eating and exercise habits, or possibly obesity surgery on the morbidly obese. If the patient maintains a positive caloric balance after abdominoplasty, then the patient will regain weight.

Patients who smoke should plan to stop smoking at least one to two weeks before surgery and not to resume for at least two weeks after surgery. Overexposure to the sun before surgery should be avoided, especially to the abdomen.

THE OPERATION

In a typical Tummy Tuck, the scars can extend from hip to hip and another one around the belly button. An incision above the pubic region and extending towards the hips places the scar where it can be hidden by most clothing. In the standard operation the dissection continues up to the ribs. The vertical muscles in the abdomen are tightened by pulling them close together and stitching them into their new position. This provides a firmer abdominal wall and narrows the waistline. Because sagging skin will then be pulled down over the abdomen before it is removed, it is necessary to release the navel from its surrounding skin and bring it out through a new skin opening. The skin around the belly button (navel) is divided so the redundant tissue of the upper abdomen can be pulled down. This hole will frequently be pulled far enough down to be removed by excess tissue. When less tissue needs to be removed, this now may become a short vertical component of the lower scar. Finally, the incisions will be stitched, dressings will be applied, and a temporary tube may be inserted to drain excess fluid from the surgical site. Resulting scars across the pubic area and around the navel are permanent and lighten in color over time. In some instances, when loose skin and muscle weakness are limited to the area below the navel, a modified or partial Abdominoplasty (or mini-tummy tuck) may be recommended, but there may be distortion and an unnatural shape to the navel. This may be performed on an outpatient basis and usually leaves a shorter scar and no scarring around the navel.

Complete abdominoplasty usually takes two to five hours, depending on the extent of work required. Partial abdominoplasty (mini tummy tuck) may take only an hour or two of operating room time. An extended body lift (back and front at the same operation) can take 4 to 10 hours of surgery. Some surgeons may select general anesthesia, and other surgeons may use local anesthesia combined with a sedative.

CONVALESCENCE

For the first few days after surgery, the abdomen will probably be swollen and the patient will likely feel some pain and discomfort which can be controlled by medication. Depending on the extent of the surgery, the patient may be released within a few hours or may have to remain hospitalized for two to three days. The doctor will give instructions for showering and changing the dressings. And though the patient may not be able to stand straight at first, it is important to start walking as soon as possible.

Surface stitches are usually removed in five to seven days, and deeper sutures, with ends that protrude through the skin, will come out in two to three weeks. The dressing on the incision may be replaced by a support garment.

AFTER THE CONVALESCENCE

It may take you weeks or months for the patient to feel fully recovered. If the patient starts out in top physical condition with strong abdominal muscles, recovery from abdominoplasty will be much faster. Some people return to work after two weeks, while others take three or four weeks to rest and recuperate. Exercise will help heal better. Even people who have never exercised before should begin an exercise program to reduce swelling, lower the chance of blood clots, and tone muscles. Vigorous exercise, however, should be avoided until the patient can do it comfortably. Patients usually need to wait 4 to 6 weeks or more, to fully resume more strenuous activity.

The scars may actually appear to worsen during the first three to six months as they heal, but this is normal. It might take nine months to a year, and sometimes more, before the scars flatten out and lighten in color. While they'll never disappear completely, abdominal scars will not show under most clothing, even under bathing suits.

Abdominoplasty, whether partial or complete, produces excellent results for patients with weakened abdominal muscles or excess skin. In most cases, the results are long lasting, if the patient follows a balanced diet and exercises regularly.

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