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Abdominoplasty (Tummy Tuck)

1. OVERVIEW

An abdominoplasty (or “tummy tuck”) is a cosmetic surgical procedure that can be used to treat excess abdominal skin and fat resulting from significant fluctuations in weight, childbirth, and/or aging. During the procedure, excess abdominal skin and fat is removed, and, in most cases, plication (tightening) of weakened or separated abdominal muscles is performed in order to create a flat and well-toned abdomen. The procedure is often complemented with liposuction in order to contour the flanks and upper abdomen.

A complete abdominoplasty will leave a horizontally-oriented scar across the lower abdomen (just above the pubic hairline), as well as a small scar around the navel. Please refer to “THE PROCEDURE – Incisions” section for further details.

2. IDEAL CANDIDATES

In general, ideal abdominoplasty candidates are healthy individuals with excess abdominal skin and fat who are bothered by the appearance of their abdomen. A candidate’s weight should be stable for at least 6 months prior to surgery for optimal aesthetic results. Therefore, candidates planning to lose more weight are encouraged to do so before undergoing an abdominoplasty procedure. Candidates should ideally be non-smokers to minimize the risk of complications.

3. THE PROCEDURE

An abdominoplasty consists of surgically excising excess skin and fat from the middle and lower regions of the abdomen. If necessary, liposuction can also be performed in order to remove excess fat from the upper abdomen and flanks. Lastly, plication (tightening) of weakened or separated abdominal muscles may be necessary to optimize the overall results of the procedure.

The duration of an abdominoplasty is quite variable, and may range from 2-4 hours for a complete abdominoplasty procedure (i.e. surgical excision, plication, and liposuction).

3.1. ANESTHESIA

  • An abdominoplasty is most commonly performed under general anesthesia.

3.2. INCISIONS

  • A complete abdominoplasty requires a horizontally-oriented incision to be made just above the pubic hairline. The length of the incision will be determined by the amount of excess skin that needs to be excised.
  • A second incision around the navel may be necessary to remove excess skin from the upper abdomen. See “Umbilical transposition” below.

3.3. UMBILICAL TRANSPOSITION

  • When skin and fat need to be removed from the upper abdomen (i.e. above the navel), a new opening for the belly button has to be created. The belly button is brought out through this new opening and sutured into position. This is a standard part of an abdominoplasty procedure, and will leave a small scar around the navel which is usually quite inconspicuous.

4. PREOPERATIVE CONSULTATION

During your consultation, Dr. Lee will discuss the various treatment options and help you determine which procedure is right for you. He will perform a thorough medical evaluation during your preoperative consultation to ensure that you are medically fit for surgery. He will also revise your medication list, as certain medications may need to be temporarily stopped before your surgery.

Since smoking is known to be associated with poor/delayed wound healing, wound dehiscence, wound infections, and increased scarring postoperatively, smokers will be asked to stop smoking 4 weeks prior to surgery, and for at least 2 weeks postoperatively1.

Patients will also be scheduled for routine pre-operative blood testing and an electrocardiogram before surgery. Dr. Lee may make additional recommendations based on the results of your tests.

4.1. COMBINED PROCEDURES

Patients who are also bothered by excess sagging skin in other areas of their body could consider combining their abdominoplasty with a breast lift or another body contouring procedure (liposuction). Combined procedures offer patients the advantage of treating multiple areas of their body in one operative setting with a shorter overall recovery period

See also MOMMY MAKEOVERS

  • A “mommy makeover” is a combination of cosmetic surgical procedures to address changes in a woman’s body following childbirth. The most common procedures that are combined include:
  • Breast lift (mastopexy) or breast lift with implants (mastopexy-augmentation)
  • Abdominoplasty
  • Liposuction (usually of the abdomen and lower body)

5. RECOVERY

The operation is most often performed on an outpatient basis; however, some patients may require an overnight stay at our facility for postoperative monitoring and/or pain control.

Drain(s) (usually two) will be placed during your abdominoplasty procedure to prevent fluid from accumulating beneath the skin of your abdomen. Drain(s) will be removed in our clinic (or at a CLSC) once discharge is less than 30 mL for 24 hours, generally by post-operative day 5-7. An oral antibiotic will be prescribed postoperatively, to minimize the risk of infection while drains are in place.

Dressings will be applied to your incisions and changed approximately 5-7 days after surgery. An elastic bandage (abdominal binder) will also be wrapped around your abdomen to minimize postoperative swelling, and to provide abdominal support during your recovery. The abdominal binder is generally worn for 4-6 weeks after surgery.

Recovery times will vary according to the extent of your abdominoplasty (i.e. extent of resection, need for plication and/or liposuction). In order to minimize the final appearance of scars, patients are advised to maintain a relaxed position, with approximately 30° of flexion at their hips when lying down or walking for 2-3 weeks postoperatively. Though sporting activities should be avoided for 6-8 weeks post-operatively, patients are encouraged to walk as soon as possible following surgery.

6. RISKS AND COMPLICATIONS

Pain and swelling are expected in the days to weeks following surgery. Postoperative pain control is usually well-managed with oral medication (which will be prescribed).

As with any surgery, there are risks associated with abdominoplasty. Smoking, diabetes, peripheral artery disease (poor circulation), as well as heart, lung, or liver disease may increase your risk of perioperative and/or post-operative complications.

Risks/complications include:

  • Risks associated with anesthesia
  • Bleeding (hematoma)
  • Infection
  • Unfavorable/suboptimal scarring
  • Fluid accumulation (seroma)
  • Poor wound healing
  • Persistent postoperative pain
  • Partial wound dehiscence
  • Skin discoloration and/or prolonged swelling
  • Recurrent abdominal skin laxity (excess skin) and/or abdominal obesity
  • Necrosis of fat cells under the skin
  • Deep vein thrombosis
  • Cardiac and pulmonary complications
  • Possible need for revision surgery

Post-operative scarring

Scars form as the body’s natural response heal tissues. As with any scar, the extent of post-surgical scarring depends on a number of modifiable factors (i.e. avoidance of UV light exposure, tension-free wound closure, appropriate wound care, etc.) and non-modifiable factors (i.e. patient age, comorbidities, skin type, genetics, etc.). While it is not possible to perform scar-free surgery, Dr. Lee makes every effort to minimize the appearance of your post-surgical scars through careful pre-operative planning, the use of meticulous surgical technique, and by ensuring appropriate wound care and follow-up post-operatively.

It is not unusual for scars to appear red and be slightly raised/firm for the first 4-6 weeks following surgery. Scars will flatten and become more pale over time, and can take up to 12 months before achieving their final appearance.

Dr. Lee will thoroughly discuss all the risks/complications associated with the procedure and answer any questions you might have prior to obtaining your consent for surgery.

Office of Dr. James Lee:

  • 2540 Daniel Johnson, Suite 905 Laval, QC,
  • Tel: 1(514) 664-2076

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