Abdominoplasty (tummy tuck)

Abdominoplasty, probably better known as a tummy tuck and mini-abdominoplasty are operations to remove excess skin and fat from the lower abdomen. The majority of patients opting for this procedure will often be women who, following the birth of their child/children, dislike the effects childbirth has had on their body shape and appearance as it can leave stretched abdominal skin with a significant overhang, especially if it contains the scar from a caesarean operation.

Summary

Abdominoplasty is an operation with high patient satisfaction and are good option for people with excess skin after weight loss or childbirth. Certain patients may be suitable for liposculpture without tummy tucks, or indeed may benefit from both procedures, but this would be determined at consultation. We recommend at least two weeks away from work and, of course, this may be increased should you have a very physical occupation.

Procedure Details

Abdominoplasty after significant weight-loss can improve hugely the skin excess. This procedure can be combined with liposuction to the waistline to enhance the cosmetic effect. Usually after the operation there is some relaxation of the abdominal tissues post-operatively which can lead to a fullness above the low abdominal scar. Whether this will occur is difficult to predict or quantify for individual patients. However, it is more often seen when there has been significant weight loss, particularly after bariatric surgery or dieting producing weight loss of several stones. The abdominal scar may need a short vertical as well as a transverse component, and if I feel this is likey in your case, I will discuss it thoroughly with you at the time of your initial consultation.

Abdominoplasty is an operation carried out under general anaesthesia and requires one or two nights post-operative stay in hospital. An elliptical area of skin and underlying fat is removed from hip to hip above the pubic area and below the umbilicus (belly button). The umbilicus is left attached on a stalk. A pocket is made underneath the skin of the upper abdomen as far as the ribs and this skin is then moved downwards to join the lower incision.

Often (mainly post-pregnancy) it is also necessary to tighten the tummy muscles to improve abdominal contour. Having closed the skin edges, the umbilicus is then sewn back in its new position. An mini-abdominoplasty is not quite as extensive as an full abdominoplasty and the umbilicus is commonly left in place. The position of the final position of the scar will depend to some extent on the elasticity of the abdominal skin once relocated. Hidden stitches are used underneath the skin surface which are dissolvable and do not require removal.

A special compression garment is provided routinely to help with healing and decrease post operative swelling. Immediately after the operation, the abdominal skin feels tighter and it is helpful to not to stand up completely straight for the first few days, in order to take tension off the healing incision.

Aftercare

Two drainage tubes are usually removed at 48 hours. A light dressing may be required for one or two weeks and this should be kept dry. The pressure garment should be worn for 4-6 weeks. You may feel mild discomfort after abdominoplasty and this is usually controlled by mild analgesia such as Paracetamol (do not take Aspirin). Some temporary numbness of the lower abdomen skin is usual after this procedure but will gradually return to near normal although the process may take some months. Any bruising is usually very mild and usually settles well within 2 weeks.

Occasionally some sterile fluid collects under the skin (seroma formation) but this always disperses naturally over the first 3-6 weeks. As with all surgery there are risks involved but they are infrequent in occurrence. Blood clotting(Thrombosis/DVT) problems can in theory be a factor and as a precaution you will wear elasticated compression (TED) stockings before, during and after (1 week) the operation and gentle early mobilisation will be encouraged. Wound infection is prevented with antibiotics at the time of the surgery and for one week after.

Patients who smoke or who are diabetic have an increased risk of delayed wound healing and wound problems. Scars are normal after any surgery and are part of the natural healing process. In the early stages, there can be build up of excess scar tissue which is firm, red, raised and itchy. Once the skin strength is restored the scars mature, becoming softer, flatter and more natural skin colour and texture. This process takes on average12-18 months to completion and during this period, daily massage with moisturising cream is advised. Some distortion of the skin, particularly around the hip area often occurs after abdominoplasty and it may occasionally be necessary to carry out a liposuction procedure in order to reduce this should it persist once the initial scarring has subsided.

General Advice

You should arrange for someone to drive you home from hospital. You will experience mild discomfort after your surgery and it is recommended that you take one or two pain relieving tablets (such as Paracetamol) on a regular basis for the first week or so. DO NOT TAKE ASPIRIN OR ANY PRODUCTS CONTAINING ASPIRIN as this may prolong or cause bleeding in the early post operative period. There maybe some bruising following surgery, but this should settle in the first two or three weeks. You will notice the skin of your tummy as well as sometimes and occasionally the skin of your thighs may be numb or tingling. This area of impaired sensation will gradually improve over the coming months. You should therefore take extreme precautions and avoid using any hotwater bottles as this can lead to a full thickness burn to these numb areas without you realising it. Initially mobilisation is slow and we will ask you to walk with a slight stoop to take tension off the suture line/incision. If a lot of skin is removed from your tummy wall it may take at least a week before you can stand up right fully. Sometimes you will find it more comfortable when you lie in bed to have your legs supported on a couple of pillows beneath the knees. You will have been provided with a pressure garment or elasticated dressings to gently compress your abdominal wall. You will be provided with an elasticated corset and you should wear this day and night for the first month.

Exercise

Though you will need rest in the first week post operatively it is very important in this early period that you set yourself a daily walking exercise programme. It is important that you do not just lie in bed for protracted periods to avoid a deep vein thrombosis or pulmonary embolus (DVT or PE).

Bathing

You should avoid getting the wounds or dressings wet for the first week. For your surgery, buried dissolvable stitches have been used. These normally dissolve spontaneously in the first four to eight weeks. Around the tummy button (umbilicus) removable stitches are often used as they give the best scar at this site.

One week post operation

At one week post operatively, you will be seen by the nurse in the dressing clinic who will remove the dressing and inspect your wound. Once the wounds are clean and dry you will be advised when you can recommence bathing. It is very important in the early period after your operation that you move around your home as much as possible, setting yourself a daily walking programme and not staying in bed for protracted periods, however, you should abstain from all exercise from for at least three weeks. For the first week post operatively you should not do household chores.

Two weeks post operation

In the second post operative week you can start light household duties. You may commence very gentle exercises from 2-3 weeks post operatively and are ready to return to gym activities from week six working within the limits of comfort. You may commence driving once you feel confident to undertake an emergency stop, until you feel confident to do this you should refrain from driving.

I would have advised that it is important to stop smoking prior to your operation in order to reduce the risks of complications. Following surgery, the type of job that you do determines when you can return to work. If you mainly confined to deskwork, you may feel able to return to work after three weeks. More physical occupations may require five to six weeks of recuperation before you feel able to return to work. The scar will take time to mature. During those first six weeks the scar will pretty much look after itself. By week three you should commence moisturising and massaging this scar with a good moisturiser and rubbing quite vigorously, the aim being to soften the scar and speed up final scar maturation.

The delicate scar tissue is at greater risk of sunburn if exposed to the sun, therefore, you are advised to avoid sun exposure to any scar tissue for the first six weeks of healing, after this if the area is to be exposed to sunlight you should apply sun protection factor 50 sun block to exposed scar tissue. Though most people experience uneventful post operative recovery, if you develop any of the following you should contact the ward or Mr Armstrong’s nursing team: Temperature greater than 38.5° Severe pain not alleviated by simple painkillers Fresh bleeding from the wound, other than a minor ooze

Before and After Gallery

Patient Journeys

  • Mr Armstrong's care before, during and after the procedure has been exemplary, and, along with his nursing staff,  I was thoroughly well looked after in a most kind, caring and professional manner.

  • Completely natural and totally in-keeping with my physique. I now feel I am as I should be. I would have no hesitation in recommending Mr Armstrong and his team to anyone seeking breast implant surgery.

  • I honestly cannot recommend him enough and have been singing his praises since my operation. I have received nothing but the best quality of care.

  • Thank-you Mr Armstrong, for giving me back breasts of a 39 year old (maybe even slightly younger!) not a 60 year old!

  • I highly recommend Mr Armstrong to anybody considering surgery. He is a highly skilled surgeon with a safe and competent pair of hands. My only regret is that I didn't do it five years earlier.

  • You can really tell that Mr Armstrong is an exceptional surgeon and he genuinely wants to help make people feel good about themselves! Thank you forever more!

  • I am feeling so amazing! I really cannot thank him enough as he has changed my confidence completely. I have had the best recovery process and aftercare.

  • From the minute I walked in to my first consultation I knew Mr Armstrong was more than capable of helping me. He is a lot more thorough than other surgeons I have been to see and really took his time to listen about how I felt and what I desired and he is very understanding.

  • Well done to Anthony and his team for their support and care. So recommended!!

  • I cannot thank Mr Armstrong enough for the difference he has made to the way I feel about myself. I can strongly recommend him to anyone considering a rhinoplasty.

Helpful Statistics

General Anaesthetic

Limited mobility: 2 days

Corset: 4 weeks

Hospital stay: 2-3 nights

Washing: 72 hours

Full recovery: 4-6 weeks

Surgery time: 2-4 hours

Driving: 2 weeks

No smoking 2 weeks before and after any surgery

Off work: 4 weeks

Exercise: 6-8 weeks