Tummy Tuck

During a traditional tummy tuck (abdominoplasty) a modified horizontal incision is placed just within or atop the pubic area, as shown above (think of the incision as a modified, extended C-section pattern, centered just above the pubic mound and reaching toward the hips). Fatty, flaccid rolls of stretch-marked abdominal skin are surgically removed in the process (i.e., cut out in a precise, geometric way [More recent advances in the geometric design of these incisions have improved results.]): The resulting edges are closed with a surgeon-tailor’s hand. The length of the incision depends largely on the amount of skin slated for removed. The patten of the tummy tuck (abdominoplasty) incision will vary somewhat according to the structure of a person’s abdomen and the style of bathing suit or undergarments which that person prefers. If there is loose skin above the navel, Dr. Minoli may make a second incision around the navel so that the redundant skin in the upper abdomen can be pulled down. (In the diagram above, the skin in the darkly shaded area is surgically separated from the deeper abdominal wall muscles: This surgical-separation maneuver allows excess tummy-tissue to be removed more easily. Interestingly, the actual core-position of the navel itself remains unchanged while everything else changes around it.)

To tighten the abdominal wall, Dr. Minoli uses sutures to bring the underlying fascial tissues and 6-pack mucles back together with corset-like stitching. The navel is usually repositioned in the process. (One again: Interestingly, the actual core-position of the navel itself remains unchanged while everything else changes around it.)

VARIATIONS OF TUMMY TUCK (ABDOMINOPLASTY) PROCEDURES

• There are many variations both to the design of the incisions and the technique itself. In some instances, it may be possible to avoid an incision around the navel. When the amount of loose skin is minimal and the excess fat deposits are located below the navel, a short horizontal incision is all that is needed: This procedure is called a partial or mini-tummy-tuck (partial or mini-abdominoplasty).
• Sometimes liposuction may be used in conjunction with tummy tuck (abdominoplasty) surgery.
• Endoscopic abdominoplasty is yet another technique for minimizing scars and can be a useful technique in patients who have a mild excess of fat and a modest laxity of muscles.

Dr. Minoli will discuss the particular methods that may be right for reshaping your abdomen. These considerations are based on individual factors and upon realistic goals that you and he set.

Any one or combination of the following may indicate that you are a candidate for tummy tuck (abdominoplasty) surgery:

• You have excess, flaccid, sagging abdominal wall skin
• You have a protruding abdomen – out of proportion to the rest of your body
• Your abdominal wall muscles that have separated and weakened
• Your excess fat deposits are concentrated within your abdominal wall

Your consultation likely will include a discussion about your overall goals. What do you wish to achieve through tummy tuck (abdominoplasty) surgery? You should come to a consultation with Dr. Minoli prepared to discuss your medical history – including any conditions you may have such as diabetes, high blood pressure or heart disease. If you plan to become pregnant in the near future, you should discuss this too. Dr. Minoli will want to know about your current medications and your previous surgeries & medical treatments. Complete information is important for proper decision-making. You will be asked if you had prior surgery of the abdomen. Your current weight, diet & exercise regimen will also be amongst the considered factors.

Dr. Minoli will examine your abdomen while you are standing as well as lying down. Your skin tone and the degree of laxity will be assessed … as well as the amount of excess fat in your abdomen and the condition of your abdominal muscles. Pre-existing scars will also be evaluated. (Scarring from previous abdominal surgery may limit the results of your tummy tuck [abdominoplasty] surgery.)

Not everyone will achieve the same results. Dr. Minoli will take into consideration your unique features. During the consultation, you will be asked to point out the exact areas you would like improved. This will help Dr. Minoli understand the reality of your expectations.

Tummy tuck (abdominoplasty) surgery is typically a cosmetic procedure and, as such, is not covered by most insurance companies. However, in some instances a patient may have a hernia (and not merely the more common abdominal-muscle spread): As such, a hernia repair would be needed: Insurance reimbursement may be available. For example, if a patient has a condition which is not cosmetic in nature tummy tuck (abdominoplasty) surgery may be needed (most likely in the form of a panniculectomy). Many factors determine your eligibility for coverage, including the specific terms of your insurance policy. Dr. Minoli & his staff will discuss these matters with you.

The subject of risks and potential complications of surgery is best discussed on a personal basis between you and Dr. Minoli & his staff. Fortunately, significant complications from tummy tuck (abdominoplasty) surgery are uncommon – this takes into consideration thousands of procedures worldwide.

Every year, many thousands of people have tummy tuck (abdominoplasty) surgery and experience no major problems while being pleased with the overall results. As benefits are considered, so too are specific risks: These include the possibility of bleeding, infection, bruising, prolonged discoloration, swelling, numbness, reactions to anesthesia, painful or unattractive scarring, contour irregularities, fluid collections, tissue loss, need for further surgery, and unsatisfactory overall results.

Further considerations which pertain to tummy tuck (abdominoplasty) surgery include the following:

• Following surgery, the body produces a serum-fluid under the abdominal skin. Sometimes it can accumulate to such a degree that it needs to be removed. This process is a fairly simple office procedure involving aspiration with a needle & syringe; but the condition may require more than one postoperative visit.
• Tissue loss can occur along the edges of the wound. This condition can delay healing & recovery. It is more common when the tummy tuck (abdominoplasty) surgery is extensive. Of course, the condition also occurs more commonly in diabetics and smokers, so these circumstances need special considerations.

Minor irregularities can sometimes arise (e.g., in certain instances when incisions have not healed in an ideal way), but office-based postoperative treatments are usually available to help minimize these problems if they occur. You can help to lessen certain risks by following the professional advice given by Dr. Minoli and his staff.

We want to make your surgical experience as easy and comfortable for you as possible. If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin, certain anti-inflammatory drugs, and an array of supplements (e.g., fish oil, flaxseed oil, garlic supplements, green tea & Vitamin E) can cause increased bleeding, so you should avoid taking these medications & supplements well in advance of surgery. Dr. Minoli and his staff will advise you and provide additional preoperative instructions during the preoperative consultation phase.

During your preoperative visit you will be instructed in the use of Lovenox® – a mild anti-coagulant injection which offers protective benefits against dangerous blood-clotting (including deep vein thromboses & pulmonary emboli). Lovenox® is an injectable prescription medication that is self-administered once-a-day, beginning a few days before surgery & continuing several days thereafter. (During your preoperative consultation you will be instructed in the art of giving yourself subcutaneous shots along your lower belly skin (e.g., in the same manner that a diabetic self-administers daily insulin shots).

Tummy tuck (abdominoplasty) surgery is usually performed on an outpatient basis. (When combined simultaneously with certain gynecological procedures it may be performed on an inpatient basis in a hospital setting.) In any event you will need to stay in a nearby hotel overnight under nursing supervision. (Dr. Minoli & his staff will help guide you during your preoperative counseling session.)

Your tummy tuck (abdominoplasty) surgery may be performed in a hospital or a free-standing ambulatory facility. Medications are administered for your comfort during the surgical procedure Dr. Minoli and your anesthesiologist will determine with you what type of anesthesia will be used – intravenous sedation, or general anesthesia. For your safety during the operation, various monitors are used to check your blood pressure, pulse and circulating oxygen.

When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. There may be some discomfort, but this can be controlled by medication which you may continue taking at home. Surgical dressings & bandages may be placed over the treatment area (i.e., a circumferential wrap around your waist). After a few hours of recovery room monitoring, you likely will be permitted to go to a nearby hotel for your overnight stay under nursing supervision. (When tummy tuck [abdominoplasty] surgery is performed in conjunction with another medically necessary procedure [e.g., a hysterectomy] a short hospitalization may be required. Dr. Minoli & his staff will help guide you in these preparations.)

You will be returning to Dr. Minoli’s office at regular intervals so that your postoperative progress can be properly evaluated. During the first few postoperative days your lower abdomen may be tender, but this usually subsides later in the 1st week or so.

In the early stages of recovery (the first 2 or 3 days especially) you may need personal assistance, perhaps even for meals and bathroom visits. This is one of the reasons that overnight nursing care is so helpful just following surgery. Washings must be done in a gentle manner during this early period; and in fact, specific instructions are given to each patient.

In most instances, small temporary drain tubes may be placed underneath the abdominal incisions. The drains can help prevent the accumulation of postsurgical fluids in the belly. These drains are usually removed with the 1st week after surgery; but a full shower or bath is not permissible until the drain is gone.

The day after surgery, you will be encouraged to get out of bed for short walks to promote blood circulation. Although you may not be able to stand up completely straight, it is best if you do not sit for long periods during the first several days. Straining, bending and lifting must be avoided, since these activities may cause increased swelling or even bleeding. You may be instructed to sleep on your back in an elevated position with a pillow under your knees.

As the 1st postoperative week progresses you will likely be gaining a bit more independence. Nonetheless, specific recommendations will be of aid in the early stages of healing. Sutures usually dissolve, but if they persist beyond the 1st week they are removed. Drains and their associated sutures are typically removed within the 1st week. Bruising and swelling, common during the first few postoperative days, subside during the 2nd week. By the 2nd week walking will be easier, and by the 3rd week driving privileges will likely resume. Of course, Dr. Minoli will help guide you through these milestones.

It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

Straining, bending and lifting should be avoided during the early postoperative period. Depending on the extent of your tummy tuck (abdominoplasty) surgery and your general physical condition…you may be able to return to non-strenuous work anywhere from 1 to 3 weeks after surgery. Sexual activity should be avoided for a minimum of 3 weeks. And vigorous activities should be restricted for at least 3 weeks.

In many instances, you can resume most of your normal activities, including some form form of mild exercise, after a few weeks. You may continue to experience mild periodic discomfort and swelling during this time, but such feelings are normal. Severe pain should be reported. In general, the timing of your recovery depends largely on the extent of your surgery and your individual healing capacity.

Bruising & swelling, common during the 1st week, begin to subside noticeably during the 2nd week. In a broader sense: It takes about 6 weeks after surgery to pass social scrutiny … & 6 months or more before residual lumps & bumps soften & dissipate. Incisions will initially be red or pink in color: They will remain this way for many months following surgery – and may even appear to worsen before they fade, but eventually incisional scars fade. There may also be numbness in some areas; it may take months before feeling returns. Of course, Dr. Minoli will help guide you through these milestones.

During the early stages of healing you will notice puffiness and discoloration which may be more pronounced in some areas rather than others. Do not be alarmed by any unevenness or temporary asymmetry caused by this variance in swelling and bruising; it is perfectly normal. Generally, the greatest swelling occurs 24 to 72 hours after surgery, but it may take several weeks, or even months, before all puffiness resolves; yet, this should not be apparent to others.

You should be up and gently about during the first few days following surgery; but without strain. Your dressings will be removed temporarily in the days following surgery so that Dr. Minoli can examine the treated areas. Depending on the tummy tuck (abdominoplasty) technique, you may be instructed to wear a supportive garment for several weeks. Any suture removal usually occurs within 10 days; but often, these are dissolvable. Drains and their associated sutures are typically removed within the 1st week; but a full shower or bath is not permissible until the drains are gone.

It is important to realize that recovery time varies greatly among individuals. Please remember that the relationship with our staff does not end when you leave the operating room. Since the healing process is gradual, you should expect to wait up to one year to see the final results of your tummy tuck (abdominoplasty) surgery. You are likely, however, to begin enjoying the appearance of your lower torso within a few weeks after surgery. Occasionally, a touchup may be desired to further improve results: Any additional procedure typically would be far less extensive than the original operation … and is usually performed under local anesthesia in an office setting. If you have any questions or concerns during your recovery, or need additional information at a later time, please contact us.

The results of your tummy tuck (abdominoplasty) surgery may be dramatic or subtle, depending on how you looked before surgery as well as the specific goals that you and Dr. Minoli establish. Since the healing process is gradual, you should expect to wait at least several weeks before being able to appreciate your “new look.” Modest changes may continue to occur over several months to a year.

When healing is accomplished, tummy tuck (abdominoplasty) surgery will have enhanced your body contour by making your abdomen firmer and flatter. You may find it easier to wear certain clothing styles. It may take some time to adjust to your new body image, but you are likely to feel a boost in self-confidence as you progress in your healing. Still, it is important to remember that various healing factors may prolong the final result. Fluid retention and prolonged swelling are typical in the months following surgery. The healing process is gradual, so you should expect to wait a while before fully enjoying the outcome. Nevertheless, the results of your surgery should be long-lasting, as long as you maintain your postoperative weight. (Even if you gain a few extra pounds you likely will find the weight is more evenly distributed.)

Scars will fade over time; but no matter what, incisions create scars – and scars are permanent. Most incisions heal nicely; but some scars are more noticeable. Fortunately, tummy tuck (abdominoplasty) surgery scars are usually concealed by natural body creases or actual clothing. Occasionally, a touch-up revision may be desired to further improve a contour or a scar. The additional treatment can usually be performed under local anesthesia in Dr. Minoli’s office. You will return to Dr. Minoli’s office for follow-up care at prescribed intervals, at which time your progress will be evaluated. This postoperative period typically spans the first year following surgery, and certainly beyond if needed. Please remember that the relationship with Dr. Minoli and his staff does not end when you leave the operating room, but continues. If you have questions or concerns during recovery Dr. Minoli and his staff will be available to respond.

(Dear reader, please note: Aging, gravity & weight-fluctuation can take their toll. If your body changes even after surgery, secondary procedures are still available.)