Tummy Tuck (Abdominoplasty)

Directly before a planned surgical procedure you should be in the best possible overall health. Please reduce your nicotine and alcohol consumption to a minimum. Take your medication regularly; discuss how to take it in detail with your surgeon. Any hormonal medication (the contraceptive pill, hormone replacement medication) is temporarily discontinued if necessary. In all cases you should refrain from taking aspirin or similar medication for at least ten days before the procedure. It is advisable to plan around seven to ten free days in the period after the operation, as your physical mobility will be limited during this time.

The surgery can be performed on an outpatient basis.

Anaesthetic

Tummy tucks are usually performed under general anaesthetic so that you remain asleep for the entire operation. You will be examined by an anaesthetist before the operation to assess your suitability for anaesthesia.

The anaesthetist is present throughout the operation to manage the anaesthetic. An alternative to general anaesthetic is available in the form of local anaesthetic injections for pain relief. With a local anaesthetic you also receive a sedative (either as a tablet or as an intravenous injection in the arm) to induce a kind of twilight sleep.

You are awake but relaxed and not sensitive to pain. However, you may feel a pulling sensation during the operation, or a similar feeling.

A tummy tuck usually takes between 1.5 to 3 hours, depending on the extent of the procedure. The individual extent of your abdominal wall tightening procedure depends on your anatomical prerequisites, your personal wishes, and the recommendations of your surgeon. In principle the operation proceeds as follows:

To begin with, a long incision is made in the skin from one hip bone to the other, just above the pubic area. Another circular incision is made to free the navel from the surrounding tissue. For partial abdominal wall tightening the incision is significantly smaller, and the incision around the navel may not be required. However, this can lead to the navel becoming puckered in the direction in which the tissue is tightened.

A large area of skin from the abdominal wall is then lifted up to the ribs to expose the abdominal musculature. The straight abdominal muscles are brought together in the middle, tightened and fixed in the new position. This achieves a firmer abdominal wall and a narrowing of the waist.

The raised area of skin is then pulled back down. Excess skin is removed. A new hole is created for the concealed navel, and it is sutured into place. In the initial post-operative phase (12 to 24 hours), blood and wound secretions drain away through thin drainage tubes. To finish the procedure, the incisions are closed up and a dressing is applied. For partial abdominal wall tightening, only the skin between the navel and the incision line is tightened. This area of skin is pulled downwards in order to remove excess skin before being sutured into place.

In the first few days after abdominal wall tightening you will feel pain in the wound area. This will limit your usual mobility. You will usually be provided with pain relief medication.

The drainage tubes inserted during the operation will usually be removed on the first day after the operation. The dressing will be removed within the next few days. In the first few days after the operation, you should allow yourself to rest as much as possible in order to minimise swelling.

Any swelling, bruising and possible numbness of the skin should usually subside within a few weeks of the operation. Immediately after the operation, while you are still on the operating table, a pre-measured compression bandage and/or compression stockings will be fitted.

The sutures are removed eight to ten days after the operation. At first the scar is red and firm. Over the course of several months the scar will become paler and will blend with the surrounding area. You may begin to treat the scar with suitable ointments and creams from the third week after the operation.

You should avoid exposing the scar to sunlight for the first 6 months (by wearing suitable clothing or applying a plaster). You can resume your normal daily life again after a few days, depending on the level of physical effort required.

However, you should plan to rest for the first week after the operation. Exercise can be resumed after 3 months in consultation with your doctor. You should reduce your nicotine and alcohol consumption to a minimum after the operation, and avoid saunas and steam rooms for a few months.

It is possible to shower with the adhesive dressing in place.

With a correct indication for surgery and realistic expectations, most patients are very content and happy with the achieved result. The improvement in external appearance can mean the start of a new phase of life for most patients, with raised self-confidence and increased self-esteem.

In principle, a tummy tuck can be repeated. Regular checkups with your plastic surgeon can help to recognise and treat any complications that may arise.

If problems occur, they must be assessed on an individual basis in order to clarify which corrective measures are to be taken.

• Post-operative infection, secondary bleeding with haematoma formation, loss of sensation in the skin.
• Loss of sensation in the scar area. This usually improves within a few weeks/months, but can last longer (in rare cases).
• Formation of skin folds in the area of the lateral incisions.
• Swelling and discolouration from haematoma. This usually subsides of its own accord. Keeping the area cool can assist with this.
• Secondary bleeding and haematoma may occur, even several days after the operation. For the most part, this requires no further treatment. An operation to stop the bleeding is only required in extreme cases.
• The edges of the wound may come apart under mechanical stress, e.g. when combing hair. This can have an undesirable effect on scar formation and in very rare cases can even require a scar correction procedure.
• In very rare cases, local anaesthetic or the additional injection of haemostatic medication during anaesthesia can cause undesirable side effects such as allergic reactions, or reactions to the anaesthetic (swelling, itching, severe circulatory reactions and shock), additional side effects in the central nervous system (restlessness, cramp, respiratory disorders), raised or lowered in blood pressure, cardiac arrhythmia and slowing of heartbeat.
• Rare inflammatory reaction of the wound, especially with embedded sutures. This can extend treatment duration.
• Scars: the operation cannot be performed without leaving scars. However, they are positioned in skin folds to ensure that they are as inconspicuous as possible and can be easily concealed. The natural redness of fresh sutures disappears after 2-3 weeks, but in rare cases it can last for several months. Small skin cysts may form in the scar area, but these can be treated quickly and easily.
• Problems during scar formation: depending on the constitution of the patient, bulging, painful scars that itch may occur (keloid scar tissue). Keloid scarring usually subsides through conservative treatment without the need for further operations.
• Excessive scarring of the skin and musculature really only occurs after years of nicotine misuse, or if there is severe internal bleeding with no inflammation. Scar deformations following complications such as these must often be corrected with a follow-up procedure.
• In some cases the cosmetic result may be unsatisfactory. This can be corrected with a further operation if necessary.
• Straining can lead to the tearing of the sutures within the muscle or skin, which can require a follow-up operation.
• An umbilical hernia may be discovered during the operation. If so, this must be repaired surgically.
• Upright mobility after the operation is restricted and can interfere with daily life until the 4th week.
• The scars will appear red for a few weeks, but they become paler after a few months.