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Tummy Tuck

Tummy tuck is a major surgical procedure that involves the removal of skin and fat from the lower 2/3 of the abdominal wall and allows tightening of the abdominal muscles.

Aim of the tummy tuck

Tummy tucks allows drastic reduction of the size of a prominent belly and may significantly improve the shape of the body. The procedure does not aim at reducing body weight and in no case must it be considering as a slimming method.

Ideal tummy tuck candidates

The ideal candidates for tummy tuck are women and men who have good health but are concerned about the size and shape of their abdominal wall, excess fat and loose skin that can no longer be treated with diet and exercise.

Tummy tuck is also advisable for patients who have undergone gastroenterical surgery for obesity treatment (bariatric surgery) and due to significant weight loss have developed abdominal lipodystrophy.

Women who have been through multiple pregnancies are also good candidates for this procedure. These women experience muscle and skin laxity that cannot be corrected with exercise.

Patients who are planning to follow a diet scheme must first complete the diet and then undergo a tummy tuck. Also, women who are planning to become pregnant in the future should postpone the tummy tuck, since the abdominal muscles on which the tummy tuck is performed will become flaccid again during pregnancy.

Patients who have been previously submitted to specific surgical procedures on the abdomen that have left scars on specific areas, may not be eligible for a tummy tuck.

It must be noted that this operation may be combined with other surgical procedures such as liposuction and breast reduction or augmentation.

BENEFITS

Tummy tuck may significantly improve the appearance of the outer abdominal wall and therefore the patient’s spirit and self-esteem. However, the patient must know that his/her expectations must be realistic.

PRE-OPERATIVE ADVICE – PRE-OPERATIVE CHECK-UP FOR TUMMY TUCK

During the initial consultation, the plastic surgeon will perform a clinical examination of the patient and will provide him/her with detailed information regarding the procedure (indications, contra-indications, risks, benefits, complications, post-operative course). Pictures will also be taken.

Further to usual pre-operative tests (full blood count, complete urinalysis, electrolytes, urea, creatinine, blood sugar, ECG and chest X-ray), an abdominal CT scan and examination by a general surgeon may also be required in specific cases where an abdominal hernia is suspected. Patients who smoke should ideally refrain from smoking for two months before the surgery in order to achieve optimum results.

Prior to the tummy tuck you shall be given a handout with specific advice on the diet you should follow, medication and vitamins that you must avoid or take, smoking and sunbathing habits before and after surgery. In case you catch a cold, (runny nose, cough) or infection, surgery may be postponed for a few days.

SHORT DESCRIPTION OF THE TUMMY TUCK PROCEDURE

The tummy tuck is performed in a general hospital, preferably under general anaesthesia. Before anaesthesia, the doctor will ask the patient first to stand up and then to lie down so that he may draw the incision line, which generally looks like the caesarean section incision and is a horizontal line above the pubic hair extending laterally (see figure). The incision line is made so that it may be concealed under swimwear. The abdominal wall is then prepared and lifted towards the lower ribcage. The rectus abdominis muscles are then sutured to correct their separation and enhance the strength of the abdominal wall.

The prepared skin and fat is lifted downwards and excess skin and fat is removed. The navel is not cut but repositioned on the abdominal wall and pulled downwards through a round incision. Then incisions are closed with a combination of absorbable and non-absorbable sutures. Before suturing a supplementary liposuction may be performed on the side of the abdomen for a better aesthetic result. One or two tube drains are placed and removed within a few days.

POST-OPERATIVE COURSE/ HOSPITAL STAY

After surgery you will be taken to your room. Patients are advised to stay at the hospital for one or two days; however most patients are discharged the day after surgery.

The afternoon following the surgery you shall be put on a liquid diet and eventually on a normal diet if you are not feeling sick. Post-operative pain is average and usually treated with analgesic injections. It usually only lasts for a few days. With the help of a nurse, the patient gets out of bed on the same day to avoid blood clots in the legs. The patient wears special anti-embolism stockings while at the hospital. After surgery, the patient wears a special compression garment for approximately four to six weeks.

The patient is discharged if able to follow a regular diet, walk with or without help, is self-supported and if feeling good in general. The first visit at the doctor follows one week after surgery.

POST-OPERATIVE OUT-OF-HOSPITAL PROGRESS

During the first days the patient will experience oedema (swelling) and bruising which will, however, gradually disappear (most of the oedema subsides within two to three weeks). Pain will become lighter and can be treated with painkillers. Gauzes must remain intact for two days. They are then removed and the patient may take a bath as usual (if drains are left in position for more than two days then bathing is only allowed after the drains are removed).

The patient must walk around and must not spend much time in bed in order to avoid blood clots. The patient must wear the compression garment for at least four weeks. Work out and lifting weight (suitcases etc) is allowed after four weeks. However, fast walking is allowed with moderation. Driving is allowed two weeks after surgery. The patient is usually able to return to work at least one week after surgery (depending on the nature of work). Scars will improve with time and their final form will appear after approximately nine months. However, scars will never disappear completely.

POSSIBLE COMPLICATIONS OF A TUMMY TUCK

As in any surgical procedure, even if all rules are followed, a tummy tuck may have complications of which the patient must be informed. These are rare and may include:

  1. Wound infection, treated with antibiotics and possible removal of purulent tissues. Lower limb vein thrombosis, that usually develops in patients who do not move a lot after surgery and are obese.
  2. Heavy smokers may develop problems during wound healing. This is why candidate patients are advised to quit smoking two months before surgery.
  3. Diabetic patients may also face healing difficulties.
  4. The final appearance of the scars cannot be estimated. Bad scars (hypertrophy, keloids, pigmented scars, atrophic scars, wide scars) are rare but if they occur they may be treated with surgical or non-surgical methods
  5. Fluid concentration. This fluid is usually self-absorbed but in some cases the use of syringes may be necessary.