Tummy tuck (abdominoplasty)

Please adhere to all the information in the General Advice Section. In particular take very seriously the advice on smoking. Do not smoke in the six weeks prior to and after surgery and indeed if you are a smoker it is imperative that you make your surgeon aware. The risks of skin loss and other complications are greatly increased if you smoke.

Do not use moisturising cream or bath oil on the day of your surgery.

On the day of surgery, you will again meet your consultant surgeon and the consultant anaesthetist who will care for your during your 2 ½ hour operation. Immediately before your anaesthetic, key points are marked on your abdomen as a guide to the surgeon.

The abdominal skin is incised across the lower abdomen just above the pubic hair and it is then carefully lifted off the underlying muscle wall leaving the umbilicus or “belly button” safely attached in its original position. This gives your surgeon access to the muscles and the muscle sheath allowing them to be tightened and tucked. Any significant bleeding points are cauterised but as a precaution, surgical drainage tubes will be inserted to cope with any small vessel oozing.

Liposuction can be used in conjunction with certain patterns of abdominoplasty.

The skin may now be pulled back down under some tension and neatly re-draped. The overlapping excess is now trimmed and closure is commenced. Before this is complete, the umbilicus is re-located and a new opening fashioned to bring it back to the surface. The old opening is usually removed with the excess skin.

The closure is a very important part of this procedure and all layers of the skin and underlying tissue need to be individually repaired. We like the length of the final scar to be as short as possible but we have to balance length with the need to fit the skin neatly. At the ends of the scar, little peaks, affectionately called “dog-ears” require tailoring. Small ones can be allowed to settle but larger ones need trimming by lengthening the scar.

Very occasionally, a bladder catheter may need to be inserted during your surgery to ensure that you do not have difficulty and discomfort passing urine in the first few hours in recovery. It will be removed at the earliest opportunity.

After your operation you will remain in hospital for one or two nights and initially you are positioned with your hips flexed and knees bent to take tension off the wound. Very soon you will be encouraged to get out of bed, straighten up and walk and discouraged from sitting hunched. Naturally, your tummy will feel tight but it is important to mobilise as soon as possible. Before you go home, your drains will have been removed and you will have been fitted with an abdominal support supplied by BPS. Very occasionally a drain has to remain in place when you go home if it is collecting a lot of fluid. If this is the case, don’t be concerned, BPS will give you clear instructions and you will not come to any harm.

You will return to have your wound dressed at one week and your sutures may be removed at this time. If absorbable sutures have been used you will only require a dressing.

Bathing and showering will be restricted in the first one to two weeks but may be resumed when the wounds are soundly healed.

To allow the wounds, both internal and external to knit together strongly, physical activity is restricted for 6 weeks. You should avoid much housework, especially vacuuming, dog walking, lifting and gardening. More strenuous activities such as heavy lifting and gym workouts should wait until 3 months have passed.

Once the scar line has healed and is no longer being taped, commence twice-daily massage with the cream or oil supplied or recommended by BPS. This helps the scars to mature and fade more quickly. Additional supplies may be obtained through BPS or your chemist.

Depending upon your occupation, you may return to work after two weeks but remember all the above restrictions on physical activity and avoid prolonged sitting.

You will have a long transverse scar across your lower abdomen extending out towards the hips. The length of the scar will depend upon the extent of skin resection required. The time taken for the scar will mature and fade varies between individuals. Occasionally, some individuals form rather red, raised and itchy scars which will take longer to settle. There will also be a scar around the umbilicus or “belly button”.

At the outer extremities of the scar, the skin may be peaked into small dog-ears. Small ones will settle over a few weeks and months but occasionally, it is necessary to intervene surgically and to trim these under local anaesthetic. We try to avoid this but sometimes they are only evident when standing. There may be additional costs implications for this procedure.

There will be some bruising and swelling but this should settle over the first 3 weeks. The skin of the lower abdomen will inevitably be numb in some areas and other areas will feel a little strange as the skin has been drawn down from the upper abdomen bringing its sensation with it. This will re-educate over the next few months and the numb areas will usually recover but may take a longer time.

The lower abdomen is a favourite resource for breast reconstruction following cancer but after an abdominoplasty, and in the unfortunate need to have such an operation, one of several other good methods of reconstruction can be used.

You can expect a much improved profile and a firmer muscles. Self esteem will improve. Clothing will fit better and choice will be extended. Sweat rashes in skin folds will disappear.

You cannot, however, expect to lose much weight as a result of this surgery. Fat is bulky and light. Your waist size will not change immediately following surgery but you may be encouraged to further weight loss and more activities.

A Tummy Tuck or Abdominoplasty is quite a major procedure and while most patients will sail through this surgery, there are significant possible complications. Your BPS surgeons are aware of these risks and work hard to eliminate them. You must heed the advice on smoking and the use of aspirin-like drugs mentioned in General Advice and Preparing for Surgery.

Skin loss due to impaired blood supply to the wound edges can result in delayed healing and increased scarring. The implication that smoking does contribute to this complication cannot be overemphasised. Smoke causes spasm in the small blood vessels which the skin depends upon for survival. Skin loss in non-smokers will be uncommon.

Despite careful cauterisation of the bleeding points and the prophylactic use of surgical drains, blood and serum can sometimes accumulate in the extensive space beneath the skin. As this increases the risk of infection, aspiration of this fluid will need to be performed and occasionally a fresh drain may need to be inserted under local anaesthetic.

Our ultimate concern would be an infection and while it is uncommon, you will possibly receive antibiotics at the time of surgery to help minimise this risk.

Symmetry of the scars and the central position of the umbilicus or “belly button” is our intention. It will not surprise patients with large mobile skin redundancy and loose muscle wall that perfect symmetry and centralisation are not always achieved.