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Surgery of the Abdomen
Abdominoplasty
If you're considering abdominoplasty...
Abdominoplasty, known more commonly as a "tummy tuck," is a major
sugical procedure to remove excess skin and fat from the middle and lower
abdomen and to tighten the muscles of the abdominal wall. The procedure can
dramatically reduce the appearance of a protruding abdomen. But bear in mind, it
does produce a permanent scar, which, depending on the extent of the original
problem and the surgery required to correct it, can extend from hip to hip.
If you're considering abdominoplasty, this will give you a basic understanding
of the procedure-when it can help, how it's performed, and what results you can
expect. It can't answer all of your questions, since a lot depends on the
individual patient and the surgeon. Please ask your surgeon about anything you
don't understand.
The best candidates for abdominoplasty
The best candidates for abdominoplasty are men or women who are in relatively
good shape but are bothered by a large fat deposit or loose abdominal skin that
won't respond to diet or exercise. The surgery is particularly helpful to women
who, through multiple pregnancies, have stretched their abdominal muscles and
skin beyond the point where they can return to normal. Loss of skin elasticity
in older patients, which frequently occurs with slight obesity, can also be
improved.
Patients who intend to lose a lot of weight should postpone the surgery. Also,
women who plan future pregnancies should wait, as vertical muscles in the
abdomen that are tightened during surgery can separate again during pregnancy.
If you have scarring from previous abdominal surgery, your doctor may recommend
against abdominoplasty or may caution you that scars could be unusually
prominent.
Abdominoplasty can enhance your appearance and your self-confidence, but it
won't necessarily change your looks to match your ideal, or cause other people
to treat you differently. Before you decide to have surgery, think carefully
about your expectations and discuss them with your surgeon.
All surgery carries some uncertainty and risk
Thousands of abdominoplasties are performed successfully each year. When done by
a qualified plastic surgeon who is trained in body contouring, the results are
generally quite positive. Nevertheless, there are always risks associated with
surgery and specific complications associated with this procedure.
Post-operative complications such as infection and blood clots are rare, but can
occur. Infection can be treated with drainage and antibiotics, but will prolong
your hospital stay. You can minimize the risk of blood clots by moving around as
soon after the surgery as possible.
Poor healing, which results in conspicuous scars, may necessitate a second
operation. Smokers should be advised to stop, as smoking may increase the risk
of complications and delay healing.
You can reduce your risk of complications by closely following your surgeon's
instructions before and after the surgery, especially with regard to when and
how you should resume physical activity.
Planning your surgery
In your initial consultation, your surgeon will evaluate your health, determine
the extent of fat deposits in your abdominal region, and carefully assess your
skin tone. Be sure to tell your surgeon if you smoke, and if you're taking any
medications, vitamins, or other drugs.
Be frank in discussing your expectations with your surgeon. He or she should be
equally frank with you, describing your alternatives and the risks and
limitations of each.
If, for example, your fat deposits are limited to the area below the navel, you
may require a less complex procedure called a partial abdominoplasty, also know
as a mini-tummy tuck, which can often be performed on an outpatient basis. You
may, on the other hand, benefit more from partial or complete abdominoplasty
done in conjunction with liposuction to remove fat deposits from the hips, for a
better body contour. Or maybe liposuction alone would create the best result.
In any case, your surgeon should work with you to recommend the procedure that
is right for you and will come closest to producing the desired body contour.
During the consultation, your surgeon should also explain the anesthesia he or
she will use, the type of facility where the surgery will be performed, and the
costs involved. In most cases, health insurance policies do not cover the cost
of abdominoplasty, but you should check your policy to be sure.
Preparing for your surgery
Your surgeon will give you specific instructions on how to prepare for surgery,
including guidelines on eating and drinking, smoking, and taking or avoiding
certain vitamins, and medications.
If you smoke, plan to quit at least one to two weeks before your surgery and not
to resume for at least two weeks after your surgery. Avoid overexposure to the
sun before surgery, especially to your abdomen, and do not go on a stringent
diet, as both can inhibit your ability to heal. If you develop a cold or
infection of any kind, your surgery will probably be postponed.
Whether your surgery is done on an outpatient or inpatient basis, you should
arrange for someone to drive you home after your surgery, and to help you out
for a day or two after you leave the hospital, if needed.
Where your surgery will be performed
Many surgeons perform both partial and complete abdominoplasties in an
outpatient surgical center or an office-based facility. Others prefer the
hospital, where their patients can stay for several days.
Types of anesthesia
Your doctor may select general anesthesia, so you'll sleep through the
operation.
Other surgeons use local anesthesia, combined with a sedative to make you
drowsy. You'll be awake but relaxed, and your abdominal region will be
insensitive to pain. (However, you may feel some tugging or occasional
discomfort.)
The surgery
Complete abdominoplasty usually takes two to five hours, depending on the extent
of work required. Partial abdominoplasty may take an hour or two.
An incision just above the pubic area is used
to remove excess skin and fat from the middle
and lower abdomen.
Most commonly, the surgeon will make a long incision from hipbone to hipbone,
,just above the pubic area. A second incision is made to free the navel from
surrounding tissue. With partial abdominoplasty, the incision is much shorter
and the navel may not be moved, although it may be pulled into an unnatural
shape as the skin is tightened and stitched.
Skin is separated from the abdominal wall all
the way up to the ribs.
, the surgeon separates the skin from the abdominal wall all the way up to
your ribs and lifts a large skin flap to reveal the vertical muscles in your
abdomen. These muscles are tightened by pulling them close together and
stitching them into their new position. This provides a firmer abdominal wall
and narrows the waistline.
The surgeon draws underlying muscle and tissue
together and stitches them, thereby narrowing
the waistline and strengthening the abdominal
wall.
The skin flap is then stretched down and the extra skin is removed. A new hole
is cut for your navel, which is then stitched in place. 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.
Abdominal skin is drawn down and excess is
removed. With complete abdominoplasty, a
new opening is cut for the navel. Both
incisions are stitched closed.
In partial abdominoplasty, the skin is separated only between the incision line
and the navel. This skin flap is stretched down, the excess is removed, and the
flap is stitched back into place.
After your surgery
For the first few days, your abdomen will probably be swollen and you're likely
to feel some pain and discomfort which can be controlled by medication.
Depending on the extent of the surgery, you may be released within a few hours
or you may have to remain hospitalized for two to three days.
Your doctor will give you instructions for showering and changing your
dressings. And though you may not be able to stand straight at first, you should
start walking as soon as possible.
Surface stitches will be 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 your incision may be replaced by a support garment.
Getting back to normal
It may take you weeks or months to feel like your old self again. If you start
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 you 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 you
can do it comfortably.
Your scars may actually appear to worsen during the first three to six months as
they heal, but this is normal. Expect it to take nine months to a year before
your 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.
Your new look
Abdominoplasty, whether partial or complete, produces excellent results for
patients with weakened abdominal muscles or excess skin. And in most cases, the
results are long lasting, if you follow a balanced diet and exercise regularly.
After surgery, the patient has a flatter,
trimmer abdomen. Scars are permanent, but will
fade with time.
If you're realistic in your expectations and prepared for the consequences of a
permanent scar and a lengthy recovery period, abdominoplasty may be just the
answer for you.
The preceding information was provided by the ASPS
at www.plasticsurgery.org
I hope the preceding information was helpful to you. For
more information you can e-mail me at dek111@pol.net
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