Introduction: Abdominoplasty (tummy tuck)
Abdominoplasty (tummy tuck) is a procedure performed on both women and men to remove excess skin and fat from the lower abdomen to provide a more aesthetic body contour. Part of the procedure includes tightening the abdominal muscles to reduce the width of the waist. Also, a new belly button is created. While liposuction is also used to improve body contour, no skin is removed. For patients who have excess fat and skin, as well as lax abdominal muscles, an abdominoplasty will provide a more satisfying result. The primary disadvantage of the procedure is the length of the scar, which extends across the lower abdomen, and in some cases, to the back. Overall, however, patients who would like to get rid of the excess tissue in their lower abdomen, are much happier with a scar than with their hanging skin.

Who is a candidate for abdominoplasty?
The procedure is performed on men and women who have excess skin and fat in the lower abdomen, and/or laxity of their abdominal muscles. It is often performed on patients who have lost a considerable amount of weight and now have a "pannus" hanging from their belly. Patients need to be generally health and off any nicotine products for at least 2 to 4 weeks. The procedure is also a good way to get rid of stretch marks along the lower abdomen, if there is excess skin to remove.

Is there anyone who should not have an abdominoplasty?
An abdominoplasty is considered major surgery. It is also usually an elective cosmetic procedure. Patients should be relatively healthy and cannot smoke for 2 to 4 weeks before surgery. Patients who do not fit these minimum criteria are not good candidates. Furthermore, anyone who has had clots in the veins of their legs (DVT's) in the past is at increased risk of developing these clots again. Patients who only have excess fat may be better off with liposuction. Finally, this is not a treatment for obesity or weight loss. Obese patients are not good candidates.

What are the potential risks with this type of surgery?
Risks include asymmetry, dehiscence (opening) of the incision site, necrosis (death) of the belly button, unattractive appearance, deep vein thrombosis (clots), fluid collection (seroma), wide scar, skin necrosis, and infection.

What are the different techniques used for abdominoplasty?
For smaller patients with only a small amount of excess tissue, a "mini-abdominoplasty" can be performed. The operation is essentially the same except that the incision is shorter. A long transverse incision is made, the skin and fatty tissue are elevated off of the abdominal wall, the excess tissue is excised, the abdominal wall is tightened with sutures, and the incision is closed. A new opening for the belly button is made and the belly button sewn in place.

What type of anesthesia is used?
General anesthesia is almost always used.

Where is the incision made?
An incision is made around the belly button, and across the lower aspect of the abdomen.

How long is the incision? Will it be noticeable?
The scar is very long, usually extending across most of the lower abdomen. The scar is noticeable but is covered with clothing. The incision can be designed so that the scar is well hidden in most bikinis.

How long does the surgery take?
The surgery generally takes 2 to 4 hours

When will I see the final results?
Most of the swelling and bruising will be gone after 1 month at which time you will have a pretty good idea of what the final result is.

Are drains placed?
Yes. Generally at least 2 drains are placed into the wound. These come out in the pubic region. The fluid collects into a container. The drains may stain in for 1 to 4 weeks depending on the amount of drainage.

Why do some people have incisions extending to the back?
If there is a significant amount of excess tissue around the entire abdomen, the only way to remove this is to extend the incision onto the back. A longer scar results, but this is preferable over leaving the excess behind. This should be discussed with Dr Wigoda before the surgery.

What happens after Abdominoplasty?
The surgery can be performed as an outpatient procedure. Pain is controlled with medication as well as with a pain pump that the patient goes homewith. You will get out of bed the day after surgery and with assistance, begin to walk very slowly. You will need to walk with your waist flexed so as not to pull on the incision site. Over the next 1 to 2 weeks you will begin to straighten out as you walk.

How much bruising, swelling, and pain is there?
There is a moderate amount of bruising and swelling. The pain can be somewhat higher than for other cosmetic procedures but is tolerable with good pain medication. The new pain pump has reduced the amount of pain significantly. It usually remains in place for 4 to 5 days.

Will I have to change any bandages?
You will have bandages over the incision sites that will need to be changed by Dr Wigoda during the first week.

Will there be stitches that have to come out?
There are stitches that will be removed after 7 to 10 days.

How long do the results last?
Assuming your weight is kept relatively stable, the results are permanent. Obviously your body will go through normal changes with age.

If I get pregnant after a tummy tuck, will there be any danger?
No. It is OK to get pregnant from a safety standpoint. However, your abdominal muscles may once again become lax. You may also find that you have excess skin once again and can also develop stretch marks. If you plan on getting pregnant, it is probably best to wait until you are finished having children before having the surgery.

What are the potential risks with this type of surgery?
Risks include asymmetry, dehiscence (opening) of the incision site, necrosis (death) of the belly button, unattractive appearance, deep vein thrombosis (clots), fluid collection (seroma), wide scar, skin necrosis, and infection.

What happens if the belly button dies? How does that happen?
The belly button can die if it does not get enough blood supply. If this occurs, the necrotic tissue must be removed and the open would allowed to heal. A new belly button will then have to be reconstructed. Unfortunately, it is unlikely to look as good as the real thing. Luckily, this is a rare complication.

What happens if the skin dies? Where is this likely to happen?
The skin can die as well if it loses its blood supply. This happens most commonly at the center of the incision, below the belly button. If this occurs, the open wound is allowed to heal. This will take weeks to months. A wide scar will result which can be revised once it is completely healed. This is more likely to happen in smokers.

What happens if a fluid collection develops after the drains are removed?
This is not all that unusual. The fluid will need to be drained using a syringe and needle. Sometimes, this has to be done 2 or 3 times before it disappears. This is done in the office with local anesthesia. There is minimal discomfort with this procedure.

What happens before I have the surgery?
You will first have a consultation with Dr. Wigoda to discuss your particular case. Once you have decided to proceed with the surgery and have scheduled a date, you will return for a second visit at which time Dr. Wigoda will review the surgery with you, photos will be taken, consent forms will be signed, and further instructions and prescriptions will be provided. Full payment is made prior to surgery (or financing is arranged). You will have lab tests drawn and an electrocardiogram done by your primary care physician (or we will recommend where to do this) one to two weeks prior to the surgery.

What happens on the day of surgery?
You will arrive at the office surgery center. You will not have eaten or drank anything since midnight the night before. You will be checked in and your vital signs will be taken. You will put on a gown. An intravenous line will be started. Dr Wigoda will mark your abdomen with a marker. You may be given a sedative in your I.V. to help you relax before you are taken back to the operating room.

What happens after surgery?
Bandages and dressings will be placed. You will recover for 1 to 2 hours in the recovery room. You will then be driven home by a friend or family member. Your activities will be limited for the first few days. It is advisable that you not drive for at least 5 to 7 days after surgery. As the pain and swelling decreases you will be able to resume normal activities. Dr Wigoda will allow you to resume light exercise after 4 to 6 weeks.

How much bruising, swelling, and pain is there?
After surgery, it is expected that the abdomen will have a moderate amount of swelling. Most of the swelling will resolve over 2 to 4 weeks. The amount of pain post-operatively is very patient dependent. It is unusual to have significant pain with use of the pain pump. The vast majority of patients report the pain as tolerable. Some patients have reported difficulty getting comfortable when going to sleep for the first 1 to 2 weeks. For the most part, all of the pain and discomfort resolves completely with time, generally 2 to 4 weeks.

When can I get back to work? When can I drive a car?:
For sedentary work with minimal physical activity you can expect to go back after 7 to 10 days. For moderate activity, it will take about 10-14 days to be comfortable. For manual type labor with heavy lifting, you will need to wait 3 or more weeks. It will take 10 or more days to be able to drive safely, depending on your pain tolerance and how much pain medication you are taking (if any).

When can I resume sexual relations?
You may want to wait at least one to two weeks until your incisions are well on their way toward healing. Early sexual activity may prolong your soreness and discomfort.

When will I see the final results?
It will take 3 to 4 weeks for most of the swelling to resolve and probably 3 months for all if it to resolve. After this you should have a reasonably good idea of what the final look will be.

Please take a moment to contact Dr. Wigoda with any question you may have