Also known as the tummy tuck, abdominoplasty involves surgically tightening loose or separated abdominal muscles following pregnancy and removing excess abdominal skin, which is usually a co-existing problem. Many patients with this condition also have an umbilical hernia (a hernia of the belly button), which causes a bulge in the umbilicus. If present, the hernia is repaired at the same time. The goal of this procedure is to reverse the damaging effects of pregnancy on the tummy and restore it to its pre pregnancy state so that it becomes flatter and smoother.
Occasionally, there may be a significant degree of abdominal skin laxity but without significant damage to the muscles. In this situation, the excess skin is removed without surgically repairing the muscles.
An incision is made along the line of a typical C-section scar in the lower abdomen, extending laterally by a variable length according to how much skin needs to be removed. The skin and underlying layer of fat are dissected of the abdominal muscle up to the rib margins. The separated rectus abdominis muscles are carefully repaired in the midline with multiple strong sutures. If an umbilical hernia is present, it is repaired concurrently. Bleeding is meticulously controlled.
Excess skin is then removed. If the amount of excess skin to be removed reaches the level of the umbilicus or above, the umbilicus is first preserved by making an incisions around its margins and deepening these incisions so that the umbilical stalk is effectively preserved. The excess skin is then removed, and the upper skin flap is pulled downwards to meet the lower skin flap for wound closure. An opening is then created in the midline of the upper skin flap exactly where the previously preserved umbilical stalk is located, and the umbilicus is then brought out through this opening and sutured to it margins. The wounds are accurately closed after inserting one or two surgical drains.
The procedure takes three to four hours under general anesthesia and is completed as an inpatient procedure in hospital.
If there is only loose and excess skin without muscle separation, then muscle repair is not required and only the excess skin needs to be removed. In this case, the operation is completed as a two hour day surgery procedure without the need for hospitalization.
A full abdominoplasty with muscle repair and skin removal usually requires around four days of hospitalization. For the first one and a half days, complete rest in bed is required so as to protect the repair from unwanted tension. A urinary catheter, inserted at the start of the operation, is kept in the bladder during this period of immobilization. Pain is managed effectively by a continuous infusion of intravenous pain killers. After this period, the catheter is removed, and mobilization is begun with nursing assistance. Gradual ambulation continues until the patient is able to walk freely and comfortably. Pain management is switched to oral pain medication. An abdominal binder is worn continuously to provide support and protect the repair.
By the fourth postoperative day, the patient is usually ready to be discharged from hospital. The drain is usually kept and the patient goes home with it. It is typically removed around one week after the surgery when the drainage is low enough. The stitches are normally removed at two weeks post surgery. Normal daily activities can be resumed one to two weeks after surgery. After a few weeks, the abdominal binder can be replaced with a corset-like compression garment, which is worn until six to eight weeks post surgery.
Exercise may be resumed around this time.
Abdominoplasty is a safe procedure, with minimal blood loss and a low risk of infection. It is common to experience numbness over the abdomen for several weeks to months due to temporary damage to sensory nerves, but this usually recovers by three to six months. Unfavorable scarring occurs occasionally even with good surgical technique. Recurrent skin laxity can occur if the skin’s elasticity is poor to start off with.