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Tummy tuck (abdominoplasty)

What is a tummy tuck (abdominoplasty)?

A tummy tuck (abdominoplasty) is a plastic surgery operation to remove excess skin and fat from the abdominal area. Abdominoplasty can also have the effect of making the waist narrower as any separated abdominal muscles (common in women who have had children) are pulled back together during the surgery.

Typical tummy tuck patient

Mr Morritt most frequently performs abdominoplasty for patients who are unhappy with the appearance of their tummies after losing weight or following childbirth. Patients are typically concerned about excess skin and fat in the abdominal area producing overhang. Some patients may also have significant bulging of the tummy and find this difficult to conceal without having to resort to wearing baggy clothing.

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Other patients may have developed excess skin and fat in this area as a result of normal ageing or following previous surgery. Many patients will have tried dieting or exercise to improve this area without success as despite their best efforts their tummy skin doesn’t tighten up. Some patients requesting tummy tucks may have scars from caesarean sections or other surgery on the abdomen and are unhappy with their tummy tissue overhanging the scar.

 

Who is not suitable for a tummy tuck?

Mr Morritt generally advises his patients that they should not proceed with abdominoplasty unless they have reached a stable body weight which they can maintain in the long term. Putting on or losing weight following the surgery will adversely affect the cosmetic outcome of a tummy tuck. It is recognised that the risks of abdominoplasty are greater in people who are overweight. Mr Morritt generally recommends that patients have a BMI or 33 or less if they wish to proceed with tummy tuck surgery in order to reduce the risk of complications. The risks of surgery are significantly increased in people who smoke and Mr Morritt therefore does not undertake the surgery in people who are actively smoking.  He recommends stopping smoking (and all nicotine containing products) for a minimum of 6 weeks before and after a tummy tuck to minimise the risks.

 

Patients who have been placed under pressure by others to undergo the procedure or who have unreasonable expectation about what surgery can achieve should not undergo abdominoplasty.

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The risks of surgery are higher in those who have multiple medical problems or take multiple prescribed medications.  Steroid medication increases the risk of wound healing problems with a tummy tuck. Anticoagulant medications (blood thinners) also significantly increase the risk of bleeding from the surgery. People who plan to have more children would be advised to delay an abdominoplasty until they have completed their family. Strong coughing/sneezing can trigger bleeding following abdominoplasty and patients with bad coughs are therefore advised to delay their surgery until they are no longer coughing.

 

Can a tummy tuck be performed with another procedure?

Yes, a tummy tuck can be performed with other procedures such as breast surgery or liposuction.

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Mr Morritt gained expertise in the ‘Mummy makeover’ during his training in Toronto. The ‘Mummy makeover’ is typically performed in women following childbirth. Many of these ladies will have stubborn areas of excess skin and fat in the abdominal wall which is resistant to dieting and exercise. They may also be unhappy about the size and shape of their breasts. Some patients will have liked the increased size of the breast which occurred during pregnancy, while others may feel that their breasts are less firm and more droopy after pregnancy. The ‘Mummy makeover’ combines an abdominoplasty with a breast augmentation or uplift in suitable patients. In other patients, flank liposuction may be combined with abdominoplasty in order to improve the contour of the waist or to remove ‘love handles’.

 

The tummy tuck (abdominoplasty) procedure

Mr Morritt regularly performs tummy tuck surgery on private patients at the Claremont and Thornbury Private hospitals in Sheffield.

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Full abdominoplasty

The full abdominoplasty is used for patients who have a lot of excess skin and fat in the abdominal region. Many of these patients will have separation of the muscles (divarication). The tissue below the belly button is removed, the skin and fat above the belly button are then raised off the underlying muscles. The muscles are brought back together and tightened if necessary and the belly button brought out in a new position. The scar typically goes from one hip to the other.

 

The full abdominoplasty procedure is performed under general anaesthetic and typically involves a two night stay in hospital. Mr Morritt inserts drains at the time of surgery which usually are removed before discharge from hospital. Following the surgery you will be able to eat and drink as soon as the effects from the anaesthetic wear off. You will be encouraged to mobilise. It is normal to have some abdominal discomfort  and Mr Morritt will prescribe you some regular painkillers.

 

You will be seen in clinic 1 week following the surgery to check that the wounds are healing properly. Patients must wear an abdominal support garment for 6 weeks following the surgery in order to support the wounds while they are healing and should avoid any straining or strenuous exercise for 6 weeks following surgery. Mr Morritt recommends scar massage once the wounds have healed.

 

Mini-abdominoplasty

A ‘mini-abdominoplasty’ as the name suggests is a smaller version of an abdominoplasty. It is used to target excess skin and fat between the patients’ belly button and the top of their bikini line. It is a smaller procedure than abdominoplasty so results in less scarring and the recovery following surgery is quicker. Some patients may be unhappy with the appearances of their caesarian section scars and the bulging which sometimes occurs above these scars and this can be often be improved with mini-abdominoplasty. The belly button is not touched with this procedure and the muscles are generally not tightened. The mini abdominoplasty is often combined with liposuction.

 

Fleur-de-lys abdominoplasty

This procedure is the most extensive type of tummy tuck and is generally performed most frequently in patients who have lost large amounts of weight e.g. after gastric banding. In contrast to the full abdominoplasty which generally mainly tightens the tummy in a head to toe direction, the fleur-de-lys abdominoplasty also tightens the tummy in a side to side direction. This results in an additional vertical scar that runs up the middle of the tummy.

 

Risks of tummy tuck surgery

Tummy tuck is a frequently performed and very popular procedure and the vast majority of patients are very happy with their results.  Mr Morritt and his team take patient safety very seriously and have introduced a number of steps to make cosmetic surgery safer. Patients should be aware however that some minor complications do occur frequently following abdominoplasty.

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Numbness – this may take a number of months to improve. Permanent numbness can frequently occur in the area between the pubic hair and belly button.

Bruising and swelling – surgery is effectively an ‘injury’ to the body and the body therefore reacts in the same as it would to an injury by producing bruising and swelling. This will settle as the wounds heal.

Asymmetry – It is very common for there to be slight differences between the left and right sides of the abdomen following the surgery which is called asymmetry (and many of these differences are actually present before the surgery). These difference may be more visible after surgery as the skin is pulled tight.

 

Less common problems include:

Wound infection – this may require treatment with antibiotics.

Bleeding – this is usually minor but may in some cases require a return to theatre. Bleeding is more common is patients with high blood pressure or those on blood thinners. Strong coughing after surgery or lifting heavy things may trigger bleeding.

Wound healing problems – this includes delayed healing and skin loss. Wound healing problems following tummy tuck surgery are much commoner in smokers. Mr Morritt therefore recommends that patients having abdominoplasty stop smoking completely for 4 weeks before and 4 weeks after surgery.

Seroma formation – it is common for the body to produce ‘seroma’ following any operation like this. A seroma is a collection of serous fluid which is a naturally occurring fluid in the body and looks like the fluid in a blister. In some cases, it may be necessary to drain this fluid with a needle following the surgery.  Very rarely the serous can continue to accumulate months after the surgery and further surgery may be necessary to stop this happening.

Poor scarring – despite intensive research around the World towards producing scarless wound healing, it is impossible at the moment to produce invisible scars from surgery. Plastic surgeons therefore take care to place scars in areas where they are less likely to be seen. Most patients do ultimately get good scars (pale, flat, thin) once the scars have matured but this may take up to a year.  Rarely, some patients get thick, red, painful or stretched scars which is often related to their genetics and therefore difficult to prevent. These patients may have other scars on the body which have healed in the same way. Treatments are available to improve these thickened scars. It is quite common following the surgery for the scarring to be asymmetrical (wonky) and for the scars to move. Scars can generally be hidden in regular underwear but this may not be the case when patients have a lot of tissue in the flank region as the scars will need to be longer to address these bulges.

Chest infections – can occur following general anaesthesia and are more common in those who smoke or those who have chest problems such as asthma.

Deep vein thrombosis (DVT) –  Mr Morritt and his team take multiple precautions both during and after the surgery to minimise the risk of this rare but potentially life threatening complication.

Permanence of the result – the results from abdominoplasty can be affected by fluctuations in weight and Mr Morritt therefore advises patients considering abdominoplasty to only proceed with the procedure once they are at a stable weight that they can maintain comfortably.

 

External links – Tummy tuck (abdominoplasty)

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