Abdominoplasty
What is Abdominoplasty (Tummy tuck surgery)?
Abdominoplasty or tummy tuck is a surgical procedure in which the pannus or the hanging excess skin in the lower part of the abdomen is removed and the loosened fascia in the abdomen is tightened. This surgery flattens the abdomen by removing extra fat and skin and tightening muscles in the abdominal wall.
Abdominoplasty /Tummy tuck surgery is generally done by a qualified plastic surgeon. Ensure he is a board-certified and registered practitioner before undergoing the treatment.
During pregnancy, there is a physiological expansion of the abdominal skin. But after child delivery, the skin in the lower abdomen will not shrink completely or go back to its original shape and texture. The belly button is widened and the skin is lax with a lot of stretch marks called striae (due to dermal damage) which is a form of scarring on the skin with an off-color hue. This excess bag of skin interferes with the person’s physique and is also a constant problem for wearing certain dresses and maintaining local hygiene. Sometimes this condition may be associated with divarication of the Recti where there is abnormal fullness in the upper abdomen due to excess separation of the rectus muscle (present in the middle of the abdomen) and fascia in the abdomen. This excess skin can also occur in patients who have undergone Bariatric (weight loss surgery) and lost significant weight.
Tummy tuck reshapes your body by removing the overabundance of fat & skin in the stomach area and approximation of the relaxed fascia and separated muscle, restoring the physique which influences you to feel sound and young. The excess skin and fat in the lower abdomen are removed to give a near-flat belly. The procedure is generally combined with Liposuction in certain areas of the abdomen and sides of the body to maintain the shape of the abdomen and harmony with the overall physique. The belly button (Umbilicus) will also be reshaped and repositioned appropriately to give a youthful look. The entire scar will be on the waistline which will be hidden in the innerwear.
Types of Abdominoplasty
Complete abdominoplasty: The surgeon will make a skin incision below the abdomen along the waistline from one hip bone to the other hip bone. The abdominal skin is elevated up to the lower part of the rib cage. Then the skin is redraped and the extra skin is removed. The fascia is tightened if there is laxity. The surgery will involve moving your belly button to an appropriate position. Liposuction might be combined with the procedure called Lipoabdominoplasty.
Partial or mini abdominoplasty: Mini-abdominoplasties are often done on people whose fat deposits are located below the navel. During this procedure, the surgeon most likely will not move/reposition the belly button. This procedure is usually simpler and takes a shorter time.
Primary Abdominoplasty/ Panniculectomy:
This is a procedure in which the extra hanging abdominal skin is excised along with the caesarian section. This procedure is done only for patients with high BMI / excess lower abdominal skin so that hygiene is good and reduces the chances of infection. The procedure will be executed only if the cesarean section is uneventful and the mother and child are stable.
Frequently Asked Questions
Patients may lose a few kilograms from the procedure depending on the amount of excess skin removed in the lower abdomen. But tummy tucks should not be done primarily for weight reduction. Also in patients with weight loss programs / after bariatric surgery, abdominoplasty is done when a patient is already at/close to his or her ideal weight. A tummy tuck is not considered a weight loss procedure, but rather a contouring procedure.
No, Tummy tuck is done for men too. It’s most commonly done for women as the physiology of pregnancy leaves excess abdominal skin. In men, it’s generally done after significant weight loss and after bariatric surgery.
The scar size and location will depend on the type of abdominoplasty needed. For a traditional tummy tuck, the scar will be from hip to hip and most doctors will do their best to ensure that the scar is along the waistline and hidden under the inner garment. You will also have a scar around your belly button because it’s actually relocated during the procedure.
For patients undergoing a mini tummy tuck, the incision leaves a scar a little longer than a C-section scar in the waistline.
For patients who are interested in a tummy tuck after significant weight loss or weight loss surgery, there is horizontal and vertical skin excess that extends up the midline of the abdomen. Hence removal of the excess skin in both axes results in an upside-down T scar across the abdomen
If you’re a woman who plans to get pregnant, then you may want to postpone a tummy tuck until you’re done having children. During surgery, your vertical muscles are tightened, and future pregnancies can separate those muscles. Also, the skin will get stretched, leaving excess in the lower abdomen again, though it may be less than in the previous pregnancy.
Tummy tuck surgery should not be done on a patient on a weight reduction regimen. It’s better to do the surgery, once body weight is stabilized for a minimum of 3-6 months.
Also, Patients who underwent bariatric surgery, cannot undergo tummy tuck surgery immediately. They have to wait for a minimum of 6 months after the bariatric surgery and stable weight for a minimum of 3 months.
Tummy tuck should not be considered an alternative or an aid to weight loss. A stable weight is important for the abdominoplasty procedure. If you lose additional weight after surgery, then your abdominal skin will again become saggy.
A person with a BMI of more than 40 is generally not considered for abdominoplasty as the chances of complications are higher and the desired result will not be achieved. A BMI of less than 30 is generally considered ideal and patients with a BMI of 30 – 40 are considered as a relative contraindication but surgery can be considered after proper assessment on a case-to-case basis.
Yes, the hernia repair and abdominoplasty can be done as a combined procedure. The patient may have a hernia due to congenital abdominal weakness or after previous surgery (incisional hernia). In both cases, the abdominoplasty procedure can be combined. An ultrasound / CT scan is done to assess the hernia size, location, and contents before surgery. The hernia will be repaired using the native abdominal tissue or synthetic mesh depending on the need and the surgeon’s choice.
Yes, it is done in the majority of cases. Since the abdominoplasty removes only the lower abdominal skin, there could be excess/irregular fat deposits in the upper abdomen and on the sides. When skin from the upper abdomen gets pulled down, it can lead to an unnatural bulge on the hips or a lack of definition. In order to get the best results, we use liposuction to help them reshape and contour the area.
There are many benefits of abdominoplasty that extend beyond the cosmetic appearance. Removing excess skin and tightening lax muscles can provide both physical and mental benefits
Patients generally feel a lot more confident in their clothes after a tummy tuck.
Some studies have suggested that tummy tucks may help with urinary incontinence
An integral part of a tummy tuck is repairing the rectus diastasis, which is a space between the rectus muscles that naturally occurs after childbirth or a large amount of weight loss. For patients with significant diastasis, repairing this can help improve their core stability and can also help with back pain and bloating.
Removing the excess lower abdominal skin helps to maintain better hygiene and avoid intertrigo in the waist and genital area.
Tummy tuck can be done as a daycare procedure, especially in cases of mini-abdominoplasty
In patients undergoing total abdominoplasty, one or 2 days of admission is required for monitoring and pain relief.
The following are the common complications, but the majority can be avoided if adequate care is taken
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- Seroma – a collection of fluid in the abdomen
- Bleeding or hematoma
- Infection
- Contour irregularity
- Unsightly scar
- Abdominal Skin Necrosis (Skin Death)
These are the general guidelines and the specific orders will be given by the surgeon depending on the type of procedure done and the wound healing.
Ambulation/walking is generally started on the same day/next day of surgery
Walking with bending forward to avoid tension in the abdomen and to relax the abdominal muscles
Have the legs bent/have a pillow under your knees while lying down / sleeping. This will reduce the tension in the abdominal muscles.
Not to lift weights for a minimum of 4 – 6 weeks
High fiber diet and adequate water intake. This will avoid constipation, which will strain the sutures and the muscle approximation
Bathing is generally advised after first dressing, as per the surgeon’s discretion
Surgical scar care started after the wound healing. scar reducing cream and scar massage is advised.
Compression garment – 4 – 6 weeks
The cost of abdominoplasty/tummy tuck varies from Rs. 70000 to Rs. 300000, depending on the complexity of the Procedure
- Type of abdominoplasty
- Type of Anesthesia
- Needed for liposuction
- Associated Hernia
- Needed for synthetic mesh
- Duration of Stay in Hospital
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