Abdominoplasty (Tummy Tuck)
Abdominoplasty is a surgical procedure that aims to remove excess fat and skin from the lower abdomen and contour the waistline. Abdominoplasties can be purely cosmetic or they may have a functional element, such as repairing separation of the rectus (‘six-pack’) muscles or removing functionally debilitating skin after weight loss. Liposuction is often used concurrently to improve the result.
After pregnancy, there can be a separation of the rectus muscles in the midline called rectus divarication. This is often associated with reduced core strength and pelvic floor dysfunction (manifesting with issues such as bladder dysfunction). If present, rectus divarification can be repaired at the time of abdominoplasty.
Abdominoplasty is used to improve the contour of the abdomen as well as correct abdominal anomalies caused by pregnancy or significant weight loss. There are a different types of abdominoplasties which vary in the length and type of scar, whether any rectus divarification is repaired and whether the umbilicus is repositioned. In some cases, patients develop a large distressing apron of fat and skin which interferes with mobility. Removal of this is a functional operation aimed at improving quality of life and movement to aid further weight loss. This is referred to as an ‘apronectomy’ and is not the same as an abdominoplasty. The goals of abdominoplasty are to:
Create a more aesthetically pleasing abdomen.
Address any divarification of the rectus muscles if present. Patient with separation of the rectus muscles often have functional impairment with reduced core strength and pelvic floor dysfunction
Remove excess skin which can break down in the folds leading the rashes and infections.
A thorough history and physical examination is important to ensure that the correct surgical plan is implemented. Abdominoplasty is personalised procedure. During your consultation, Mr. Bunker will evaluate your condition, overall health, and provide recommendations for a tailored treatment plan that best suits your specific goals. Abdominoplasty is not a substitute for weight loss but may benefit patients who:
Are physically healthy and at a stable weight
Have realistic expectations about what surgery can achieve
Do not smoke (or quit at least 3 months ago)
Are bothered by the feeling of a large abdomen
Suffer skin irritation in abdominal skin folds
Have rectus divarification (this can sometimes be noted as a midline bulge when you attempt to do a sit-up)
Abdominoplasty may not be suitable for people who:
Have not achieved a stable weight
Are planning future pregnancies
Are still significantly overweight (though these patients may benefit from an apronectomy)
Patients with significant medical comorbidities or who are prone to bleeding or poor wound healing
All surgery has risks. There are general risks which apply to all operations as well as specific risks for individual procedures. General risks and complications of surgery may include:
Bleeding
Infection that may require treatment with antibiotics or further surgery in some cases
Allergic reaction (to sutures, dressings or antiseptic solutions)
The formation of a large blood clot (haematoma) or fluid (seroma) beneath the skin that may require drainage
Pain, bruising and swelling around the operated sites
Keloids and hypertrophic scars that are raised, red and thickened scars over the healed incisions. These may be itchy, annoying and unsightly but are not a threat to health
Poor or slow healing
Wound breakdown
Short-term nausea following general anaesthesia and other risks related to anaesthesia
Specific risks and complications associated with abdominoplasty surgery include:
Bruising and swelling which usually resolve in the first few weeks, often associated with any concurrent liposuction.
Issues with blood supply to the abdominal skin leading to wound breakdown at the incision or loss of the umbilicus
Asymmetry or contour irregularities
Collections of fluid (seromas) under the skin of the abdomen which may require repeat drainage (usually done in the rooms).
Numbness at the lower end of the abdomen which can be permanent.
Tightness in the abdomen which can take some weeks to resolve.
Injury to the internal organs.
Due to the recent cosmetic surgery reforms, all patients in Australia undergoing cosmetic surgery are required to undertake a Body Dysmorphic Disorder Questionnaire.
You will be asked to complete a full medical history. You must list all medications you take including dietary supplements such as fish oil which increase your risk of bleeding.
Check with your surgeon about your medications as some may need to be stopped. Any additional tests required preoperatively will be arranged by Mr. Bunker or your anaesthetist.
If you decide to have abdominoplasty, you will need to sign a consent form. Make sure you read the consent form carefully before signing. If you have any questions, please ask them prior to surgery.
Purchase some ‘high’ tights which go as far up your abdomen as possible to wear after the surgery.
Avoid any strenuous activity or exercise in the week before your surgery
Make sure you arrange for a relative or friend to drive you to and from the hospital or clinic and that you have arranged appropriate help at home including someone to stay with you for the first 24 hours. Think about the setup at home where you will recover – you may want extra pillows, fluids and a toilet nearby and it is useful to have a telephone within reach.
Consider work arrangements. Most patients will remain off work 4 - 6 weeks after abdominoplasty. A medical certificate can be supplied to your pre-operatively if required.
Take Vitamin C supplements 1 gram daily starting at least 2 weeks before your surgery, unless you are allergic or unable to tolerate.
You will receive detailed preoperative and postoperative instructions. Follow them carefully.
You can usually drink fluids and eat a light meal two or three hours after surgery. Postoperatively you will have a catheter to assist with passing urine and drains to remove excess fluid. The catheter is removed whilst you are in hospital but the drains usually need to stay longer, sometimes for a number of weeks.
Initially you may feel ‘tight’ in the abdomen and need to mobilise carefully in a slightly bent forward position. This usually resolves quickly. It is important you ask for help with getting out of bed and mobilising to the bathroom initially, as you do not want to strain any necessary muscle repairs.
You can usually shower (with assistance) the day after your surgery.
Arrange for a relative or friend to drive you home when you are cleared for discharge. Someone should also stay with you for at least the first day after the operation and preferably for a few days.
You will receive medications for home (usually pain relief and antibiotics) as well as detailed postoperative instructions which include how to care for your surgical sites, signs which warrant concern, contact information and follow-up instructions.
Some bruising and swelling is normal and may take up to a few weeks to disappear.
You will usually have a garment to wear after abdominoplasty – this should stay on as much as possible.
Avoid heavy lifting, strenuous exercise, swimming and sports for 6 weeks after surgery.
If you experience any of the following symptoms, notify us immediately:
Heavy bleeding from the incisions or into the drains
Fever (>38°C) or chills
Worsening redness around the incision sites or a foul odour from the wounds
Issues with the dressings (becoming wet or dirty)
Some visible scars are inevitable, however Mr. Bunker will aim to make these are inconspicuous as possible. Usually an abdominoplasty requires a long scar low on the abdomen hidden under your underwear as well as another small scar around the umbilicus. For weight loss patients there may also be a vertical scar on the abdomen to deal with the additional excess skin.
Cost is always a consideration in elective surgery and may include:
Surgical fee
Hospital or surgical facility costs
Anaesthesia fees
Prescriptions for medication
Postsurgery garments
Medical tests
A quote for the surgical fee is provided to you prior to surgery. This also contains instructions on how to obtain quotes for associated fees as listed above. If you have any questions please contact the Practice Manager.
General anaesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness. When you are under general anaesthesia you are ‘asleep’.
Necrosis: Death of tissue usually as a result of impaired blood supply.
Rectus divarification: Separation of the rectus muscles in the midline.
Liposuction: The surgical removal of fat using a suction cannula
Based on information provided by:
