ABDOMINOPLASTY (tummy tuck)
INTRODUCTION
Abdominoplasty is a major operation
requiring general anaesthesia and hospital admission usually for two days. The
aim is to flatten the tummy but it is not meant to be a way of losing weight.
The ideal patient has already lost weight and is left with loose folds of skin
that need tidying up. At the same time looseness of the abdominal muscles can
be tightened if necessary.
Patients taking the oral contraceptive
pill are advised to stop such medication for at least one menstrual cycle. This
is to reduce the risk of thrombosis (blood clot) in the leg veins. Remember
to take other contraceptive precautions at this time.
You are very strongly advised to
stop smoking before the operation because of the risk of delayed healing. Nicotine
reduces blood flow to the skin, which can lead to infection and loss of large
areas of skin over the lower part of the tummy. If this happens a skin graft
may be required to heal the raw area and this will produce very ugly scarring.
There is also an increased risk
of healing problems in the overweight patient.
A long, flattened 'W' shaped scar
is produced which stretches from hip to hip but this can be covered by a conventional
bikini. However it is visible if swimwear with high cut sides is worn. There
is also a less conspicuous scar all round the umbilicus (belly button). The
scarring varies in prominence from person to person but at its worst is very
unsightly and at its best clearly visible. Not all stretch marks are removed
by the procedure. If you have stretch marks above the belly button they will
remain, although their position will change. Previous operation scars, depending
on where they are, can make a big difference to the procedure and can necessitate
variations in technique. The most common is the addition of a vertical scar
in the middle above the pubic hair line.
Photographs will be taken of your
abdomen before the operation as part of the clinical record. These photographs
remain confidential and are kept securely.
Your GP will be given full details
of your surgery and progress.
The hospital holds a pre-assessment
clinic (PAC) which is run by the nursing staff. You will be invited to attend
one of these clinics a week or two before the operation. They are intended as
a medical screen to identify problems and carry out any necessary tests before
the day of your surgery.
OPERATION
The operation lasts for approximately
two hours. You will wake up with knees and thighs bent to relieve tension on
the wound. The abdomen will be very tight and uncomfortable for a few days (although
this will be reduced by pain killers, initially by injection and then by tablets).
You will feel very tired and weak for several days. The wounds are covered by
paper tape dressings only so you will be aware of some minor bleeding along
the incisions. Thin plastic tubes (drains) from each end of the wound will empty
internal bleeding into a plastic bottle. These drains are removed (which can
be a little uncomfortable) before you go home. You will be encouraged to get
up out of bed as soon as possible on the day after the operation and walking
is encouraged at this stage to reduce the chance of blood clots forming in the
leg veins. You may bath or shower and this is encouraged. Adhesive paper tape
(micropore) is used to reinforce the wound and this can be safely soaked in
a bath.
DISCHARGE
When you get home take life very
slowly and carefully at first. Avoid any lifting, stretching or strenuous exercise
for three months. You can bathe normally and get the wound wet but try to keep
the adhesive paper tape on the wounds until you are reviewed. About a week after
the operation you will be seen again as an out patient in the clinic when about
half a dozen stitches are removed from around the belly button. The tape will
be removed and the wounds inspected. Micropore tape will again be used to reinforce
the wound and ideally this should be left in place for about a fortnight. The
buried part of the stitches will dissolve. There is likely to be a certain amount
of bruising visible in the skin.
The scars will initially be very
pink but with time (more than six months) they will fade to a paler colour.
However narrow the scar is to start with it will almost certainly stretch and
may also thicken and irritate. Skin scars should be protected from the sun for
at least a year to prevent permanent colour change. Remember that some swim
wear allows ultra violet rays to reach the skin and so a good sunscreen should
be applied when sunbathing.
Before leaving hospital you will
be given an outpatient appointment but if you have any problems, worries or
concerns after discharge from hospital please feel free to telephone me for
advice. I can generally be contacted on 07850 484 672 but if I cannot be reached
immediately a message can be left on my office answerphone (0208 463 0019) and
I will get back to you as soon as possible.
COMPLICATIONS
No operation on the body is without
risk. A few of the more common problems are listed below. This list is intended
to inform rather than frighten and it does not cover every thing that can go
wrong:-
1. Anaesthesia. The small risk of
an anaesthetic applies as in any operation. Smoking and the oral contraceptive
pill increase this risk.
2. DVT. There is a risk of deep vein thrombosis occurring during any operation.
Precautions are taken during the surgery to reduce this risk. You will also
be fitted with tight stockings to wear before, during and after surgery. After
discharge from hospital it is worthwhile wearing the stockings, day and night,
until you are fully mobile.
3. Wound Breakdown. Infection, wound breakdown and skin loss are usually, but
not always associated with smoking or being overweight.
4. Scarring. The scarring can never be invisible although it is of course covered
by normal clothing. However the scar is sometimes very prominent and unsightly.
5. Distortion. The belly button will be a different shape than before the operation.
The pubic hair line can be higher after the operation.
6. Numbness. After the operation the whole abdominal skin will be numb but usually
this improves after six months or so.
7. Haematoma/Seroma. Fluid or blood clot can build up underneath the skin, despite
drains. This can occasionally require removal, sometimes repeatedly, through
a needle or rarely by a second operation.
8. "Dog ears". Small bumps can appear at each end of the scar. Often
these shrink with time but if they persist a small surgical revision is required
which can be done under local anaesthesia.
11/01/05