Abdominoplasty (Tummy Tuck)
Abdominoplasty (tummy tuck) helps flatten the abdomen by removing excess fat and skin, and tightening muscles. The best candidates for abdominoplasty are in good physical condition, with pockets of fat or loose skin that have not responded well to diet and exercise. Abdominoplasty can also be appropriate for slightly obese people whose skin has lost some of its elasticity, and for women with skin and muscles stretched from pregnancy. Anyone planning on losing a significant amount of weight, and women planning on having (more) children, should wait before undergoing abdominoplasty.
The Abdominoplasty Procedure
Abdominoplasty takes approximately 2 to 5 hours to perform; the patient is placed under general anesthesia. Two incisions are made: one from hipbone to hipbone close to the pubic area, and another around the navel. Skin is separated from the abdominal muscles, which are then pulled together and stitched into place for a firmer abdomen and narrower waist. The skin flap is then stretched down over the newly tightened muscles, excess skin is removed, and the navel is reattached where it looks natural. The incisions are then closed, and sterile surgical dressings are applied over the sutured areas.
Recovery After Abdominoplasty
After surgery, a temporary tube may be inserted to drain excess fluid from the surgical site. An overnight hospital stay may be necessary. Recovery time ranges from 2 weeks to 2 months. Abdominoplasty leaves a scar spanning the lower abdomen from hip to hip, although it is low enough to be concealed by a bikini. Maintaining weight with a balanced diet and regular exercise provides long-lasting results.
Risks Of Abdominoplasty
In addition to the usual risks associated with surgery and anesthesia, risks associated with abdominoplasty include the following:
- Poor aesthetic result
- Unsightly scarring
- Loose skin
- Numbness in skin sensation
- Need for revisional surgery
Patients who have had previous abdominal surgery may find that their old scars look more raised, have stretched or are more noticeable in general. Undergoing a scar revision may minimize their prominence.
A panniculectomy is performed to remove a panniculus, which is an “apron” of excess skin and fat hanging from the lower abdomen. Panniculectomy is different from abdominoplasty, which, in addition to removing excess skin and fat, tightens the abdominal muscles. Abdominoplasty is considered a cosmetic procedure; panniculectomy is not, because a panniculus can cause medical problems and interfere with everyday activities. Candidates for panniculectomy have typically lost a large amount of weight through gastric- or intestinal-bypass surgery, or changes in nutrition and fitness habits; or are normal-weight women who have excess skin post-pregnancy.
A panniculus is graded on a scale from one to five. A grade one panniculus extends to the pubic hair but does not cover the genitals; a grade five extends to the knees or lower.
The Panniculectomy Procedure
During panniculectomy, which is performed under general anesthesia in a hospital or outpatient surgery center, the surgeon typically makes two incisions: one that runs vertically from the lower portion of the sternum to the pubic bone, and one that runs horizontally across the pubic area. Excess fat and skin are removed through the horizontal incision; skin and fat from above the belly button are pulled down and sutured in place; and the belly button is shifted to a normal position. Drains are usually inserted to prevent fluid from accumulating. Panniculectomy takes from 2 to 5 hours to complete; exactly how many hours depends on how much skin and fat need to be removed, and whether it is combined with other procedures.
Recovery From Panniculectomy
The amount of time required to recover from panniculectomy is significant. Immediately after surgery, pain, swelling and bruising are present, and pain medication is prescribed. Most patients are hospitalized for up to a week, and typically do not return to work for 4 to 6 weeks. Patients are encouraged to walk postsurgery, but must avoid other activities until sufficient healing has occurred, usually after 6 to 8 weeks.
Risks Of Panniculectomy
In addition to the risks associated with surgery and anesthesia, those related to panniculectomy include the following:
- Seroma (fluid accumulation under the skin)
- Skin separation
- Reduced sensation in the treatment area
- Unsightly scarring
- Discolored skin
- Loose skin
- Blood clots
Because panniculectomy is not considered a cosmetic procedure, it may be covered by insurance.