What is it?
Abdominoplasty means removal of excess skin and fatty tissue from the anterior abdominal walls. It is also called an apronectomy. The end result is to improve the shape of the anterior abdominal wall and to decrease the bulging that can occur between the umbilicus and the pubic bone area.
You will be given a general anaesthetic and be completely asleep during the surgery. The operation takes from about one hour to an hour and a half to perform.
Excess fat on the anterior abdominal wall may be caused by being generally overweight or having been pregnant with the skin stretching over the abdominal wall which has lost its elasticity and does not return to its pre-pregnancy state. Weakness of the anterior abdominal wall muscles can be related to excess weight gain, pregnancy, or general abdominal wall weakness.
If the problem is related to simple accumulation of fat in limited areas, liposuction can be performed. This can be successful if there are good underlying abdominal wall muscles and if the skin elasticity is normal.
If however the skin has lost its elasticity, removal of the fat can result in the overlying skin becoming wrinkly and indented. The exact type of operation that would be performed, the amount of skin that would be removed and the potential use of liposuction during the surgery would be discussed with each individual, prior to the operation.
The surgery is likely to be of most benefit and last longer if you have finished having your family. It is probably unwise to go through this major surgical operation if you have any chance of having children in the future. Pregnancy is likely to undo all the work that has been done, and would therefore be something that most surgeons would be reluctant to undertake this procedure unless there were very firm assurances that you did not wish to become pregnant in the future.
Before the Operation
It would be important for your surgeon to assess your general medical condition prior to the operation. It may be necessary to have advice from other doctors depending on your weight, blood pressure and general overall health. In general it is important to avoid smoking as this can decrease the blood supply to the skin that is going to be stretched tight over your stomach and can cause areas of the skin to become damaged or partially dead, and may even require skin grafting should healing not occur. It is important to be at the ideal weight as weight loss subsequent to the abdominoplasty type procedure can interfere with the final results.
After the Operation
If it has been necessary to tighten up your stomach, you will find that on return to the ward you will be nursed with your knees and hips bent. This may be with you lying on the left or right side or if lying on your back, with some pillows underneath your knees. This is to take the pressure off the muscle to help with post-operative pain and discomfort. It is also likely that there will be drains and you will be required to wear anti-embolism stockings. The nurses will make regular post-operative checks of temperature, blood pressure and pulse rate. It is likely that there will be an intravenous drip in place, in order to provide fluids until you feel like eating and drinking again. It is likely there will be a firm bandage around your stomach, which may have Velcro fastenings that can be loosened if it becomes too uncomfortable.
This supports the surgery that has been done and decreases swelling.
You may experience some pain and discomfort after surgery for which you may need painkilling injections or tablets. When lying in bed, it is very important to continue to move your feet and legs (up and down) to promote circulation and prevent clot formation in the veins of the legs. It is also important to take regular deep breaths to expand your lungs following the surgery. Occasionally it is uncomfortable to do this, particularly if the stomach has been tightened significantly. You will be asked to mobilise gently over the next few days with assistance from the nurses and physiotherapists, as required. If the muscle has been tightened it will be a gradual process of straightening up. This means that for some weeks following surgery you may walk with a stooped-over gait. Assistance will be given with hygiene until you are able to manage independently. The drains will be removed when they are no longer draining significant amounts. You will need to wear a firm dressing or corset around your stomach in order to continue to give it support on going home.
You may stay in hospital for two or three days depending on the extent of the surgery. It is important to maintain a good healthy diet and to avoid becoming constipated as straining can make the stomach uncomfortable.
After – At Home
An abdominoplasty is a major surgical procedure and you may feel tired on returning home. It is likely that you will be able to be self-caring but you should avoid doing any heavy lifting, straining, bending or lifting. You will be given advice as to how to get up from a sitting position and as to how to roll rather than sit straight up out of bed. The wounds can be cleaned when they are sealed, usually from about a week. The firm corset should be worn all the time in order to try and reduce the swelling and improve the discomfort. If the stomach muscle needed to be tightened up, you will still walk with a stoop, which may take a few weeks to straighten up altogether. It is important not to try and straighten up immediately as this can tear some of the sutures that have been used to hold the muscles together and can lead to subsequent problems with further weakness of the anterior abdominal wall.
You can return to driving when you are comfortable enough to do an emergency stop and do not feel any discomfort when moving your feet around when sitting in a car. A safety belt should always be worn.
As with any major surgical procedure, bleeding can occur during and after the surgery. Drains are placed to prevent significant bleeding accumulating under the skin following surgery and it is most unusual to have to return to theatre for excess bleeding. However, there are sometimes small amounts of fluids that can collect underneath the skin and these may need to be removed at a later date either by surgery or by needle aspiration.
There is a large amount of undermining of the skin on the anterior abdominal wall in order to allow it to move into a new position and reshape the tummy. This interferes with the skin’s blood supply and can cause some areas of the skin to become ischaemic (significant decrease in blood supply) and subsequently not heal properly. Should this be the case occasionally skin grafting is required. The position of the scar is discussed with the surgeon prior to surgery and on most occasions, heals leaves a good scar. However, reactions can occur to the suture materials used and the scars can become red, raised and lumpy above the surrounding skin. The design of the scar is such to try and hide it under normal underwear/swimwear.
The shape of the anterior abdominal wall is changed and this may cause other areas of the body to become more prominent, particularly aspects of the hips and the flanks. It is not always possible to address this at the time of surgery and irregularities in the skin may become obvious when the swelling has diminished. At the time of surgery liposuction may be used around the flanks in order to try and improve the overall appearance when looking at the tummy from the front.
The most serious complication that can occur during an abdominoplasty procedure is the formation of clots in the veins in the legs. These can then travel to the heart and lungs and cause severe difficulty with breathing. The surgeon will arrange to try and prevent this occurring both by using anti-clot stockings and pumps that are placed on the legs during surgery to improve blood flow. Frequently blood-thinning agents are also given so that clot formation is decreased.
The altered sensation of the skin over the anterior abdominal wall may be uncomfortable as time progresses. You are also likely to feel uncomfortable and have a feeling of tightness on the skin, particularly for a few weeks following surgery. If the muscle tightening has been required to improve your shape, it may be necessary to avoid physical activity such as swimming and gym work for up to three months following surgery. You would need to discuss this with your surgeon. There may be some irregularities in the skin of the anterior abdominal wall following the surgery and it can take some time for these to settle. Very occasionally the umbilicus can become red and inflamed.
Abdominoplasty type procedures can produce very satisfactory results for trimming the anterior abdominal wall and decreasing the lower abdominal bulge. Although it may address these problems it can make other areas such as the hips and flanks more obvious. These other areas may be improved by continued weight loss. In some circumstances however, it may be necessary to perform further surgery at the flanks to improve the position. Very occasionally, when there is a lot of excess tissue around the back, a similar type operation as performed on the anterior skin of the stomach can be performed on the back. This will leave a scar directly across the back from side to side.