Tummy Tuck

A Tummy Tuck is an operation designed to improve the appearance of the abdomen.  It tightens and flattens the abdomen, taking away the stigmata of pregnancy and weight loss. Say good bye to that unwanted excess skin and fat in your abdomen with a abdominoplasty! What is an abdominoplasty? This is also known as a tummy tuck.  If you have loose excess skin in your lower abdomen from pregnancy or weight loss, you might be interested in a Tummy Tuck.  If you have noticed a bulge in your abdominal wall that disappears when you lie on your back, you might benefit from a tummy tuck.

Before and After Photos

About

During pregnancy, the abdominal wall stretches all it’s components to accommodate the growing baby.  Similarly, with other conditions leading to weight gain, the abdomen stretches to accommodate the additional fat deposited inside the abdominal cavity, also known as visceral fat.  Both situations lead to stretching the abdominal wall including the connective tissue between the rectus muscles.  Similar to a balloon that is inflated, the longer it remains stretched, the less likely it is to return to it’s preinflation state.  Thus it is common for this stretched connective tissue not return to it’s pre-pregnancy or pre-weight gain state.  The muscles can be brought together, resulting in abdominal wall tightening and flattening.  The skin may be permanently stretched out, so this excess skin can be removed. 

The tummy tuck is designed to minimize the deformities commonly seen after pregnancy or weight loss.

The stretching out of the connective tissue, or fascia, between the muscles, or rectus abdominis muscles, is referred to as a diastasis of the muscles, or diastasis recti.  This diastasis is a stretching out of the fascia in contrast to a hernia that has a hole in the fascia.  This diastasis recti is treated by pulling the connective tissue together, moving the rectus muscles back toward the midline and restoring their original orientation straight up-and-down in contrast to the stretched and bowed out parentheses configuration.

The excess skin is removed from the lower abdomen.  Depending on the degree of excess, the removed skin may include tissue only below the umbilicus or belly button (mini-tummy tuck) or may even involve removal of skin above the umbilicus (full-tummy tuck).  In either case, more is removed in the middle with less and less removed towards the sides. The upper skin is released and pulled down to meet the lower incision so the ultimate scar can reside on the lower abdomen, extending to the flank when there is more excess tissue.  If a full abdominoplasty or tummy tuck is performed, with the upper incision being above the umbilicus, when the skin is pulled down, it covers the umbilical stalk.  To prevent it from being buried, an incision needs to be made in the skin to allow for it to be inset into the newly redraped skin.  Thus, there will also be a scar around the belly button.

Benefits

The best results are obtained when you are happy with your weight.  Are you happy with your weight?  Are your muscles still lax, even after exercise? 

This procedure will remove any excess skin laxity as well as tighten the muscles underneath, leading to a flatter abdomen with skin tightening. It will also remove any stretch marks in the area of skin that is removed.  There are no topical creams that will remove these stretch marks and exercise will not tighten up this stretched out skin.  Exercise can certainly tone the muscles, but it will not eliminate the diastasis between them.  These are only addressed with surgery.

If you are happy with your weight and exercise is not tightening or flattening your abdomen as you hoped, you may be a good candidate for a Tummy Tuck.

While exercise is good for muscle tone and overall conditioning, it will not tighten the overlying skin.  In fact, if you are aggressively exercising and losing weight, this will often result in more skin laxity noted in the abdomen.  The abdominal wall is made up of several components: the skin, the subcutaneous fat, and the underlying muscles. Exercise affects the subcutaneous fat component, with it decreasing in amount with exercise and weight loss.  This fat provides both support and volume, so exercise that decreases this will decrease the volume and support of the skin.  If the skin has stretch marks from weight gain or pregnancy, then the skin has been torn at it’s deepest level and will not shrink back as well, leaving lax skin.  This can only be improved with surgery.  Exercise will improve the muscle tone, but will not help the connective tissue between the muscles.  This can only be improved with surgery.  Thus, exercise will improve your muscle tone, but it can worsen skin laxity and will not address any muscle separation or diastasis.

Is There a Specific Age that Benefits Most from a Tummy Tuck?

While any age patient can benefit from an abdominoplasty or tummy tuck, the best results are seen in patients with the best quality skin and muscle tone.  If there are stretch marks that will be left after either the breast or abdominal surgeries, this tissue will relax or age faster.  Thus, the better the quality of the remaining skin envelope of the abdomen and breasts, the better the long-term quality of the result.

Pregnancy

The tummy tuck is best performed after a patient is done with having children.  Additional pregnancies after a tummy tuck will certainly affect the appearance of the operated abdomen.  Pregnancy will again lead to changes in the abdomen, with stretching of the skin and soft tissues.  Whether they will return to their prepregnancy state after returning to prepregnancy weight is unpredictable.  Some may notice little or no change, however others may note dramatic changes.  Thus, to spare the additional time and expense of a second surgery, it is best to wait until one is done with having children.

Tummy Tuck Addresses …

Deformity	Intervention	Benefit
Skin Excess	Skin Excision	Skin Tightening
Stretch Marks	Skin Excision	Remove Stretch Marks in Area Excised
Muscle Laxity	Muscle Plication	Muscle Tightening and Flattening

Personal Consultation

If you are interested in a tummy tuck with Dr. Smith, he will be pleased to meet with you to discuss your pregnancy and weight history as well as seek to understand your goals and desires.  He will want to know about your weight history and personal history of pregnancies and any surgeries you may have had on your abdomen.  He will conduct a physical exam, focusing in on both your abdomen, but will also look at your backside as well as this may impact your results and influence your options.  He will then discuss your various options and recommend a treatment tailored to you and your goals and desires.

Preparation

Doing all these will give you the best chance to have a great, uncomplicated surgical experience with the longest lasting best result possible for you.

Procedure

This procedure is done under general anesthesia.  Before going to sleep, leg squeezers or sequential compression devices (SCDs) are placed on the calves to help decrease the chance of a blood clot or deep venous thrombosis (DVT).  Patients will also get a dose of antibiotics given in their IV to decrease the chance of a postoperative infection.

Incisions are made across the lower abdomen and the skin and fat are removed from the lower abdomen, sparing the umbilical stalk or belly button.  The upper abdominal skin is then elevated to the level of the lower portion of the sternum or breast bone.  The muscles are now clearly visible and the diastasis or separation between the rectus muscles is repaired by plicating or pulling in the muscles toward the midline.  This tightens and flattens the abdominal wall.  A pain catheter is placed to deliver local anesthetic across the plicated muscles and drains are placed to evacuate tissue fluid (serum) from the raw tissue surfaces.  The skin is then pulled down and closed to the lower incision and the umbilical stalk is matured through this redraped skin.  This results in scars that run across the lower abdomen from hip to hip and a scar around the umbilicus or naval.

Rapid Recovery

Once awoken from surgery, your will go to the Recovery Room for observation.  Once you have met all milestones to leave, you may go home or to the floor for a 23-hour observation period.  If you go home, Dr. Smith likes to see you the next day to make sure all is well.

Pain Management

Narcotics:  You will be prescribed oral narcotics for moderate to severe postoperative pain.  You are also encouraged to take non-narcotic medications to help decrease the amount of narcotic consumed.  Narcotics have more undesirable side effects that can be avoided with the use of non-narcotic pain medications.

Pain Pump:  The pain pump will deliver a continuous flow of local anesthetic through a catheter placed through your abdominal wall at a prescribed rate determined by Dr. Smith.  This is designed to take the edge off of your early post-surgical pain and decrease your need for narcotic pain medications.  It will be removed at the 1-week postoperative visit when the bulb is empty.  The tape is removed, sutures are cut and the catheter is pulled out.  This is wiped down and then covered with a small dressing.

Nausea Prevention

Medicine for nausea will be provided.  Take if you need it.  The pain pump will hopefully decrease the amount of narcotic you need, and thus decreasing any nausea associated with your narcotic pain medication.  Take your medicines with a little food.  This will also help decrease nausea associated with your medications.

Itching and Sleep

Some patients may experience itching associated with taking narcotics. If this is the case, Benadryl has been prescribed for you to help with this.  If severe itching is noted, please contact Dr. Smith to evaluate you for a possible allergic reaction.  Some patients will benefit from a gentle sleep aid in the early postoperative period.  Benadryl can also be helpful to you in this regard.

DVT Prevention

While in bed, the SCDs should be worn.  You are encouraged to be out of bed and walking at least once an hour.  Both the SCDs and this ambulation will help decrease the chance of a blood clot or DVT.  This can be a life-threatening complication.  In some patients with enough risk factors for blood clots, some patients may get a blood thinner to minimize the chance of such a clot.  This needs to be balanced with the risk of increased bleeding.

Antibiotics

You will receive a single dose of antibiotic in your IV before your surgery.  You will not receive any additional antibiotics after surgery unless there is evidence of a postoperative infection.

Nutrition

You are encouraged to advance to a normal diet, eating a good well-balanced diet, emphasizing your protein intake.  Your nutritional requirements go up with the stress of surgery and you need the appropriate nutritional building blocks to heal.  You are encouraged to consume 1.5 – 2.0 grams of protein for each kilo they weigh.  For instance, if you weigh 60 kgs, then you should eat 90 – 120 g of protein each day.  When patients are not appropriately healing their wounds, it is commonly traced to inadequate nutrition, specifically protein.

Drain Care

You need to record your 24-hour drain output for each individual drain.  The bulbs must be collapsed at all times to create the suction necessary to facilitate good flow of fluid out into the bulbs.  To more easily calculate 24-hour drain outputs, it is best to empty the drains at least once at the same time everyday.  The drain may be emptied more frequently to ensure the bulb is always collapse create sufficient suction.  Once the drain output has slowed to less than 30 cc in a 24-hour period, the drain is removed.  Drain sites typically take a day or two to seal up.  Once both drains are removed and both drain sites have sealed, the patient may shower.

Showers

While you have drains in your abdomen, Dr. Smith prefers you sponge bathe.  Once the drains are out and the sites have sealed, then you are allowed to shower, but no soaking in the tub for 4-6 weeks, assuming normal healing.

Compressive Garments

Once the final drain is removed, most patients will benefit from wearing a lightly compressive garment.  This helps stabilize the tissues and decreases the chance of fluid accumulation in between the tissue layers.

Incision Management

The incisions are closed in multiple layers of dissolvable sutures and/or staples.  The incisions are sealed with a skin tape and glue combination.  This typically stays in place for a month.  When showering, these should be patted dry.  If the tape begins to lift, the lifted areas may be trimmed leaving the adherent tape in place.  If there is moisture that is accumulating underneath the tape, this portion of tape should be removed to prevent maceration or incision break down due to moisture.  Any tape and glue that is still in place at the one-month postoperative visit will be removed by Dr. Smith. 

Lifting

You should not lift anything greater than 10 pounds for 4-6 weeks assuming normal healing.  After all is sufficiently healed, Dr. Smith will allow you to gradually increase your activities to normal.

Tobacco and Nicotine

If you smoke, you must refrain from doing so for a minimum of 1 month after surgery, assuming normal healing.  If you are having some healing issues, this may be pushed back even longer. Ultimately, if you have already stopped this long, with 2 months before surgery, strongly consider staying away from this permanently.  This will pay long term health benefits in the long run.