Abdominoplasty Washington DC
An abdominoplasty, or “tummy tuck”, addresses excess skin +/- excess fat with diminished muscle tone which often occurs after significant weight loss or pregnancy. When evaluating a patient’s abdomen, there are 3 separate components – skin, fat, and muscles. The elasticity of the skin determines how well it will contract in response to removal of fat underneath. A patient with good skin tone may not require an abdominoplasty, but may be a better candidate for liposuction or VASER ultrasonic liposuction. In contrast, a patient with significant stretch marks and loose or hanging skin will have poor skin retraction after removal of fat and require excision of the excess skin.
Muscle tone can be improved by exercise, but if the muscles have been stretched apart, there may be a separation between the muscles which will not improve with working out. This is known as a diastasis, and can only be corrected with surgery to narrow the bridge between the rectus abdominis (6-pack) muscles.
A mini-abdominoplasty is ideal for people who have a small amount of excess skin or muscle laxity below the umbilicus (belly button). The scar is limited, but the muscles can be tightened, and a small amount of skin can be removed.
If a patient has a significant excess of skin +/- excess fat, a full abdominoplasty may be necessary to achieve the most dramatic improvement in body contour. The scar will extend from hip to hip, and there will be a scar around the umbilicus. On occasion, there may be a small vertical scar in the lower abdomen from the previous site of the belly button. All of these scars fade and soften over the course of a year.
If there is a hernia present, this may be addressed at the same time. Small hernias may be repaired by the plastic surgeon, but large hernias may require working in conjunction with a general surgeon. An abdominoplasty may also be performed simultaneously with other abdominal surgeries, such as a hysterectomy.
Typically, the surgery is performed on an outpatient basis with general anesthesia. If combined with other procedures, an overnight stay in the hospital may be recommended, but this is determined on a case by case basis. The patient is first marked in an upright position prior to entering the operating room. At the end of the case, 2 temporary drains are placed underneath the skin to prevent fluid accumulation in the abdomen. The patient is then placed in an abdominal binder which provides compression to the surgical site as well as back support.
Recovery from Abdominoplasty (Tummy Tuck)
The patient will awake in a flexed position as this takes tension off of the incision. This slightly flexed position is encouraged for the first 2 weeks while standing and walking. When sleeping, the patient may be more comfortable with pillows beneath the head and knees. For the initial 24 hrs after surgery, it is normal for there to be drainage staining the dressing on the outside. The patient is seen in the next few days for a postoperative visit, and the drains remain until there is minimal output. The patient is asked to limit his/her activity for a period of 2 weeks from the day of the surgery. At that time, he/she will gradually start resuming his/her normal level of activity with the expectation that he/she will be back to normal at approximately 4 weeks.
Abdominoplasty (Tummy Tuck) Risks and complications
Risks and complications are uncommon, but may occur. They include, but are not limited to: infection, bleeding, unfavorable scarring, delayed wound healing, sensory changes of the overlying skin, malposition of the umbilicus, waviness, fluid collection beneath the skin (seroma), and need for revision in the future. Swelling is normal after surgery and minimized by wearing a compression garment for several weeks.