Abdominoplasty (Tummy Tuck)

INTRODUCTION

  • Weight gain and post-child often result in excessive abdominal skin, fats and skin striae. Liposuction is useful in removing excessive fats in young patients with good skin elasticity. However for older patients with poor skin elasticity, liposuction may result in excessive unsightly loose skin.
  • Abdominoplasty (Tummy Tuck) is a definitive way to remove excessive skin and fat from the abdomen. It is particularly helpful in removing post childbirth abdominal skin excess with stretch marks (striae).
  • The rectus abdominis muscle (the 6 pack muscle) can be overstretched during pregnancy leaving a gap between them (divarication of recti). This gives the abdomen a very full appearance even if there is little excess fat.
  • During this procedure, any abdominal muscle separation (divarication of recti) will also be tightened (plication of divarication of recti), resulting in a flatter abdomen and more hour glass waistline.
  • To further improve the result liposuction of the abdomen can be done during the same surgery.
  • Occasionally abdominoplasty can also be combined with abdominal hernia repair. Abdominal hernia is a result of bulging of abdominal contents through the weakness of the abdominal wall.
  • Abdominoplasty is a procedure that can radically contour the abdomen at the expense of having a reasonably well hidden scar. There are many patients who cannot accept having an abdominal scar and who are willing to live with less than acceptable abdominal contour.

TYPES OF ABDOMINOPLASTY:

Conventional AbdominoplastyMini AbdominoplastyFleur De LisBelt Abdominoplasty
Diagram
Abdominoplasty - Conventional Tummy TuckAbdominoplasty – Conventional Tummy Tuck
Abdominoplasty - Mini Tummy TuckAbdominoplasty – Mini Tummy Tuck
Abdominoplasty - Fleur De Lis Abdominoplasty – Fleur de Lis
Abdominoplasty - Belt Abdominoplasty – Belt
PurposeRemoval of massive abdominal skin and fat; and plication of divarication of recti.Removal of minimal to moderate abdominal skin and fat just below the umbilicus.Removal of the massive upper and lateral abdominal skin and fat. ie. removal of vertical and horizontal abdominal excessRemoval of massive abdominal, hip and back excessive skin and fat.
IncisionAbove pubic hairline, slightly extended to the hip bones.Short incision above pubic hairline.Above pubic hairline, slightly extended to the hip bones and vertical extension upwards.Circumferential incision from front to back.
Umbilical RepositioningUmbilicus repositioned as the abdominal skin pulled downwards. Small scar around the umbilicus.Umbilicus left intact as abdominal skin pulled down. It may be separated from underlying attachment.Similar to Conventional AbdominoplastySimilar to Conventional Abdominoplasty
Associated ProcedureLiposuction of the love handles and upper abdomen for further enhancement of the abdominal shape.Similar to Conventional AbdominoplastySimilar to Conventional AbdominoplastyLiposuction and buttock lift

CONCURRENT PROCEDURES

Abdominoplasty can be combined can be combined with the following :

  • Liposuction and fat grafting to breasts and face
    • Fat can be harvested using a syringe from the abdomen before abdominoplasty. The harvested fat can then be injected into the breast for volume enhancement into the face for rejuvenation.
  • Mommy make-over – abdominoplasty combined with breast augmentation
    • It is common for women after childbirth to experience both deflation in breast volume and lax abdominal skin with stretch marks. Mommy makeover which is a combination of breast augmentation (lift and implant) with abdominoplasty (tummy tuck) is a common request. This combination treatment provides significant rejuvenation effects to the entire torso.
  • Abdominal Hernia Repair
  • Buttock Lift
    • Can be done with Belt Abdominoplasty
  • Thigh Lift
    • Can be done with Belt Abdominoplasty

SUITABLE CANDIDATES

Patients who has :

  • Excessive abdominal fat and poor skin elasticity.
  • Excessive abdominal skin striae (usually post childbirth).
  • Abdominal muscle laxity (divarification of recti) usually post childbirth.
  • Concomitant abdominal herniation
  • Completed family planning. Female patients who intent to become pregnant in future may decide to defer this procedure.

ANAESTHESIA

  • General anaesthesia

DESCRIPTION OF PROCEDURE

  • Pre-operative marking to determine incision and amount of skin to be removed with agreement of patient.General anaesthesia
  • Liposuction of the love handles and upper abdomen for further enhancement of the abdominal shape (if necessary).
  • Excision of the excess skin and fat according to markings.
  • Plication of the divarication of recti (tightening of the abdominal muscles by suturing) if necessary.
  • Insertion of wound drains (plastic tubings) near the pubic hairline for evacuation of residual blood to prevent blood clot accumulation.
  • Closure of the abdominal fat and skin in layers and skin dressing. Patient is rest in a Jack-Knife position (abdomen is flexed)
  • Surgical duration : 4-5 hours

 

POST OPERATIVE CARE

  • After the procedure patient may opt to stay in the hospital ward or hotel room with a private nurse for recuperation.
    • Usually goes home by 3rd or 4th day after surgery.
  • In the first and second day after surgery patient rest in a jack knife position to relieved abdominal wound tension.
  • Patient may be able to ambulate with support from second to third day onwards.
  • Removal of drains usually by second or third day when the drainage decreases to an acceptable level.
  • Abdominal binder : Wear round the clock for about 3 months to provide support and to reshape the abdomen.
  • Medication: Analgesics (pain killers), Antibiotics and medications to reduce swelling and bruising.
  • Suture removal : 1-2 weeks
  • Bruising and swelling,: May last for about 2 weeks.
  • Return to exercise : Light exercise permitted at about 4 weeks: heavy exercise at about 3 months.

 

FINANCIAL COUNSELLING

  • Abdominoplasty for cosmetic purpose is not insurance claimable.
  • There are very few insurance claimable procedures that can be done together with abdominoplasty.

 

RISK AND CAUTION

  • Infection
  • Bleeding
  • Bruising – usually resolved by 2 weeks
  • Swelling – usually resolved by 2 – 4 weeks
  • Wound dehiscence – may occur in patients who have a tendency of poor wound healing eg. Diabetes, Smokers, Patient on chronic consumption of corticosteroids, and patient with vascular disease.
  • Numbness – over the abdomen within expectation and can last for 6 – 12 months
  • Undesirable scar can be address by injection or simple scar revision.