There are cases when the excess skin in the abdomen cannot be reduced by exercises or diet alone. It might be a result of major weight loss or pregnancy. In other cases, patients may have scars or stretchmarks that they would like to have removed. All these problems will be positively influenced by abdominoplasty.
There are different types of abdominoplasty. In general the main subdivisions are full abdominoplasty, mini or partial abdominoplasty, and liposuction.
A full abdominoplasty is a standard procedure, which is suitable for patients complaining of excess or loose skin.
The patient is put under general anaesthesia and requires two to three days of postoperative hospital stay.
The operation involves a hip-to-hip incision around the umbilicus. A second incision is placed to free the umbilicus from the skin around it. Excision of the excess skin and fat, above and below the navel, is performed. The muscles and the skin in the area are tightened using sutures. Since the procedure involves moving the umbilicus, there might be a need for the placement of surgical drains, which will stay in place for several days. The surgery leaves a circular scar situated around the navel and a long scar in the lower part of the abdomen. Even though the more extensive scarring might be seen as a downside of the procedure, it remains the most efficient solution for improvement of the abdominal shape.
It is not a recommended procedure for women who are planning to have more children in the future. It should be performed after their last pregnancy.
MINI- OR PARTIAL-ABDOMINOPLASTY
This is a procedure for patients who have a smaller amount of excess fat or skin situated in the area below the navel. The umbilicus will not be moved, and the procedure takes less time, but general anaesthesia is still needed.
The surgery requires a smaller incision – a short, horizontal incision on the lower abdomen. A segment of skin and fat is excised from the lower abdomen. The scar is about the same length as that from a C-section or about half of the hip-to-hip distance. The procedure might also involve tightening of the muscles. The navel area will have no scarring, but it might be stretched a little and change its shape. The mini-abdominoplasty yields limited results and the outcome might not be as good as that from a full abdominoplasty.
Liposuction, also known as lipoplasty, is a minimally scarring procedure, which can be performed simultaneously with abdominoplasty. It is a suitable procedure for patients with higher skin elasticity, usually such of younger age, where there is only need of improving the body contour by removing localized fat excess.
The procedure usually requires a general anaesthetic and often a postoperative hospital stay is not needed. Small incisions are made, and the excess fat is removed through small stainless steel tubes. The incisions are closed at the end of the procedure. The results from a liposuction may vary in the different individuals, although some tightening and shrinking of the skin are to be expected. On its own, liposuction does not have results as good as abdominoplasty.
On the first consultation, the patients will be questioned about the problems related to their abdomen that bother them and what their expectations of the procedure are.
The general fitness of the individual will also be part of the initial examination. The ideal candidate for the procedure is an individual in good general health, with a normal weight. The procedure is not recommended for overweight patients and should not be treated as a means to lose weight. Other information will also be needed, such as past medical history, any concomitant diseases, any medications the person is currently taking, smoking and drinking habits, etc.
Based on all this, the surgeon will decide whether the patient is eligible for any form of abdominoplasty and if so, discuss the procedure options and which one would be recommended based on the individual characteristics of the patient. A description of the procedure itself, possible outcome, risks and complications will be mentioned as well.
The patient is usually admitted to the hospital on the day of the surgery. Postoperative hospital stay depends on the type of procedure performed. On discharge, the patient is instructed on how to care for the dressings and stitches if there is a need for stitch removal afterwards. Any drains are to be removed beforehand. There might be postoperative pain and swelling, but they can be controlled without any problems. In the majority of cases, the patients will be able to move around right away and resume regular daily activity after approximately six weeks. The surgeon might also provide advice on a position for sitting or lying down that will ease the pain. The recommendation is for the patient to take at least four weeks off from work. However, the recovery period varies from person to person and depends on the exact procedure.
Scarring is also individual for each case. Initially, the scar is prominent and red ,but this will fade to white with time. Still, there are individuals whose scars might remain red and uneven.
There is a generally high success rate in this type of surgery, and even though most patients are satisfied with the results, as with other significant operations, there is a risk of complications. The chance of complication occurrence increases with the presence of concomitant diseases such as – diabetes, poor circulation, or heart, lung or liver diseases.
The complications, although rare, might include infection and bleeding immediately after the surgery, which would require a second trip to the operating room to manage it. Delayed or insufficient healing is another major problem, which can lead to skin loss or worse scarring. Poor wound healing might require a second surgery. Fluid accumulation in the surgery area is possible. This is removed with a needle in an outpatient setting. There is also a relatively permanent change in the feeling of the lower abdomen. Blood clots are another possible complication, and various measures are taken to prevent this. Should a blood clot occur, certain blood-thinning medications might be used to manage the condition.