Abdominoplasty
Abdominoplasty
is the operation in which excess skin and subcutaneous fat is removed from the
abdominal area, in order to create a younger and slimmer torso contour.
Patients are usually women, middle-aged, post-pregnancy, with many stretch
marks and excess skin.
Like
pregnancy, central obesity, usually seen in men, increases intra-abdominal
pressure, causing the muscles of the abdominal wall to atrophy and gradually
separate, leaving a loose and weak wall in the middle. This condition is known
as abdominal wall dissociation and must be corrected during an abdominoplasty.
Abdominoplasty is therefore aimed at both men and women of all ages, who have
lost weight and/or have sagging in the abdominal area. The type of surgery that
will be chosen depends on the patient's age, history and needs.
WHAT CAN BE DONE?
Excess skin, the presence of stretch marks below the navel, the presence of a small-medium amount of fat on the anterior and lateral abdominal wall and finally the dissection of the abdominal muscles can only be treated surgically and the surgery is called abdominoplasty. The purpose of the surgery is to sculpt a slimmer and tighter torso. In a classic tummy tuck, excess skin and fat between the navel and pubic area is removed, with the navel remaining at its original height. There is always one incision around the navel and one horizontally just above the pubic bone that extends to the pelvic bones. The operation is combined with liposuction and, when there is a dissection, with suturing of the muscle. In addition to the classic, there is also the vertical (fleur de lis), mini abdominoplasty and apronoplasty. The doctor will explain which technique is indicated for you based on your history and clinical examination.
VERTICAL TUMMY PLASTIC (FLEUR DE LIS)
Vertical
abdominoplasty is usually recommended for patients who have lost a lot of
weight and who have horizontal excess skin above the navel and vertical below
the navel. As a result of the surgery, in addition to the horizontal incision,
there is also a vertical one in the midline. The issue of postoperative scars
should be discussed extensively with the patient before surgery, while the
choice of vertical abdominoplasty is easier when there is a previous midline
abdominal incision from previous surgery.
MINI-ABDOMINISM
A
mini-tummy tuck is useful for patients with a small excess of skin in the
hypogastrium, i.e. the skin below the navel. The operation leaves a smaller
scar, approximately 15cm, at the level of the classic abdominoplasty incision.
The umbilicus is not prepared, it remains united with its neighboring skin, but
it is pulled down 2-3 cm from its original position. And the mini
abdominoplasty, like the classic one, can be combined with liposuction,
correction of abdominal hernia, umbilical hernia or dissociation of the rectus
abdominis muscle.
APRONOPLASTY
Apronoplasty
(apron = apron) is a reconstructive and not an aesthetic operation. Patients
are usually women, older, with a hanging belly, and excess skin mainly in the
hypogastrium. This excess causes difficulty in walking and dressing while often
causing chronic dermatitis from friction. The purpose of the operation is to
relieve the patient and improve his/her quality of life. The operation
eliminates the horizontal scar of the classic abdominoplasty. The umbilicus is
not prepared, it remains united with its neighboring skin, but it is pulled
down 2-3 cm from its original position. And apronoplasty, like classic
abdominoplasty can be combined with liposuction, correction of abdominal
hernia, umbilical hernia or dissection of the rectus abdominis muscle.
WHO IS ABDOMINOPLASTY FOR?
Candidates
for abdominoplasty are patients with the aforementioned characteristics, who
have stabilized their body weight, have obtained a normal BMI (body mass index)
and have no other serious health problems. Female patients should have
completed their family planning. If there is an umbilical hernia or abdominal
hernia, it is corrected by a general surgeon during the abdominoplasty, without
additional incisions.
WHAT IS THE TYPE OF ANESTHESIA?
Abdominoplasty
is performed under general anesthesia in an organized clinic. The duration of
the surgery is 2.5 to 4 hours. After surgery, it is advisable to stay in the
clinic for a few hours and immediately mobilize the patients.
WHAT WILL THE SCARS BE LIKE AFTER ABDOMINOPLASTY?
The
type of scars depends on the surgery that will be chosen. If a classic
abdominoplasty is performed, in addition to the horizontal low incision at the
height of the caesarean section, there will be an incision around the navel. In
mini abdominoplasty and apronoplasty there is only the horizontal incision and
the navel is pulled a few centimeters lower. In the vertical (fleur de lis)
abdominoplasty, which is performed when there is already an incision in the
midline of the abdomen and the patient has a large excess of skin throughout
the torso, there is also a vertical incision. The scars are covered by the
swimsuit and underwear. For the majority of women however, even with vertical
abdominoplasty, these are negligible compared to the relief they feel from the
improvement in contour and strength of their torso. To avoid misshapen or
hypertrophic scars, you will be given instructions immediately after the
stitches are removed, and you will be put on a follow-up program if you have a
history of keloids.
HOW LONG WILL THE RESULTS LAST?
The
results are almost permanent and will remain stable as long as patients do not
gain much weight or women do not become pregnant. Scars will be visible for the
first 8 months, after which they fade and sag.
WHAT ARE THE
LIMITATIONS?
In a
tummy tuck, the skin below the navel is removed, along with old stretch marks
and scars. Surgery will not correct the quality of the skin above the navel and
patients should be aware that stretch marks and thinning of the skin will
remain after surgery but will be less noticeable because the skin that is
preserved is stretched.
Among
the most serious limitations of the abdominoplasty surgery are the existence of
old incisions in the abdomen, serious problems of the gastrointestinal and
respiratory systems, large hernias and the possibility of future pregnancy.
Also, patients with serious health problems, who cannot receive general
anesthesia or those with dysmorphic syndrome should be prevented from cosmetic
surgeries.
WHAT ARE THE RISKS OF ABDOMINOPLASTY?
The doctor will assess your general condition and your history and, if she decides that you are suitable for surgery, she will inform you about the possible complications and what needs to be done to reduce the possibility of their occurrence. You will also be asked to stop smoking and refrain from using supplements that affect blood clotting. The anesthesiologist will then talk to you about the type of anesthesia you will receive and the possible complications.
WHAT YOU SHOULD DO BEFORE SURGERY?
Depending
on your age, you will be given instructions on the medications you may be
taking and should be stopped or replaced, as well as on the additional testing
you may need to do to investigate hernias. Your weight should remain stable at
the lowest levels, because possible fluctuations may postpone the surgery.
The
doctor will explain the value of smoking cessation and proper nutrition in
wound healing. One week before the surgery, measurements will be taken to order
a special pressure garment, you will be photographed and the consent form will
be signed.
WHAT SHOULD YOU DO AFTER THE OPERATION?
You
stay in the clinic for the first 24 hours, but your time off work must have
been calculated at 2 weeks. This doesn't mean you won't be able to do light
work much sooner, but you'll generally feel overwhelmed. It is also recommended
to refrain from sports for 1 month.
When
you leave the surgery you will wear a special pressure garment which you will
keep for 6 weeks. You will likely have a drain that will be removed in the
first 24 hours, and you will need to be mobilized as soon as possible. You will
be given antibiotics for a few days. Pain and swelling when present are easily
treated. Because the sutures are intradermal there is no need to remove
sutures.
WHAT IS THE COST OF ABDOMINOPLASTY?
The
cost of abdominoplasty is calculated by adding the cost of the clinic, in which
the patient is operated and treated, the fee of the Plastic Surgeon and the
Anesthesiologist. If there is a hernia (umbilical hernia or abdominal hernia),
the General Surgeon's fee is also calculated. The purchase of the special
pressure garment must be included in the costs.