Frequently Asked Questions: Abdominoplasty (Tummy Tuck)
The Abdominoplasty operation is designed for men and women who have excessive, loose abdominal skin and fat that is concentrated on the abdominal area. In some cases, these conditions are inherited. In other instances, substantial weight loss can cause the abdominal skin to become flaccid. Another component of the abdominal deformity includes laxity of the abdominal muscles. The Abdominoplasty operation tightens these muscles which have been weakened by pregnancy and age. The procedure is successful at treating stretch marks when these are located below the navel.
Your Personal Consultation:
The Aesthetic Surgical Associates work hard to make your consultation as personal as possible. Drs. Guerra and Metzinger have developed the section “Frequently Asked Questions” to help you prepare for your consultation. By preparing yourself in this manner, a large portion of your questions will be answered and when you come into the office, we can discuss your specific desires during the consultation period. This helps us to understand your expectations and determine whether they can be realistically achieved. The goal of our entire staff is to make your cosmetic surgery experience easy and comfortable and to provide you with the best results achievable.
1. How do I find out if I’m a good candidate for Abdominoplasty (Tummy Tuck)?
If you have one or more of the following conditions, you maybe a good candidate for Abdominoplasty:
- If you have excessive or sagging skin in the lower abdominal area.
- If your abdomen protrudes and is out of proportion with the rest of your body.
- If your abdominal muscles have been separated and weakened by pregnancy or another condition.
- If you have excessive fatty tissue concentrated in your abdominal area.
2. How will my plastic surgeon evaluate me for an Abdominoplasty (Tummy Tuck) operation?
As your personal plastic surgeons, Drs. Guerra and Metzinger want to understand your expectations and desires for Abdominoplasty. We may ask you to fill out some materials to determine whether your expectations can be realistically achieved. We will have an opportunity to discuss your medical and surgical history during the consultation period and perform a physical examination of your abdominal area. Our plastic surgeons will examine your abdominal skin, fat and muscles while you are standing and then lying down. The tone of your skin and degree of skin looseness in the abdominal region will be assessed. We will consider several factors in our decision to perform the Abdominoplasty operation for you. These factors include the amount of excess skin and fat distribution. In some cases, the degree of skin excess can extend all the way around the back and is beyond the limits of the Abdominoplasty. In such cases, we may recommend a more comprehensive procedure such as the Body Lift Procedure, which can treat the entire trunk area. Additionally, you may only have minimal amounts of fat and skin excess and weakness only in the lower parts of your abdominal muscles. In this case, a Mini-Abdominoplasty, which concentrates on the lowest part of your abdomen, is all you will need to reestablish harmony with the rest of your body. Patients which have lost excessive amounts of fat after weight-loss surgery may need other variations of the Abdominoplasty, which can include removal fat pads and excess skin laterally over both sides of the hip bones. This is called the Extended Abdominoplasty. Another variation includes removal of centrally located skin excess above the umbilicus, called the Fleur-de-Lis Abdominoplasty.
You should come to the consultation prepared to discuss your medical and surgical history. This includes information about medical conditions, drug allergies, medical and surgical treatments you may have received in the past. Knowledge of any familial medical conditions will be helpful. It is important for you to provide complete information.
3. How will my doctor perform my surgery and what are common variations with the Abdominoplasty technique?
Factors related to your individual excess skin, fat and muscle weakness will determine which technique is used for your Abdominoplasty. Any plans for surgery are personally tailored to your needs. Some patients with good skin tone, little skin excess and excellent muscle function will be treated with Liposuction alone to remove abdominal fat. Endoscopic Abdominoplasty is another technique for minimizing scars and may be useful when patients have only a mild degree of excess fat and muscle laxity. The Mini-Abdominoplasty can be used when problems occur in the lower portions of your abdomen. With this technique, incisions around the navel can usually be avoided and only a short horizontal incision is used. For patients with large amounts of skin that needs removal in a horizontal fashion an Extended Abdominoplasty will likely be recommended. For patients with massive amounts of weight loss, a Fleur-de-Lis Abdominoplasty which removes any vertical excessive skin components can be utilized. Other patients with massive weight loss may benefit from a complete body contouring procedure, such as the Body-Lift Procedure. Drs. Guerra and Metzinger will discuss with you the particular method recommended for achieving the best result in your particular case.
4. Will my insurance help cover the cost of surgery?
Abdominoplasty is considered a cosmetic procedure by most insurance carriers and is generally not covered by most insurance plans. In some cases, however, a patient may have a hernia associated with their abdominal deformity. Other patients wishing to have a hysterectomy along with their Abdominoplasty may qualify to have this part of their surgery covered by their insurance plan. Many factors determine your eligibility for coverage, including the specific terms of your insurance policy. A letter of predetermination may be required by your insurance company prior to surgery and can cause significant delays in scheduling your surgery. We will be happy to discuss specific matters with you during the consultation period.
5. Where are the incisions placed?
A horizontal incision is placed within or just above the pubic area. The lateral extent of the incision depends largely on the amount of skin to be removed. The design of the incision will vary according to the structure of your abdomen and the style of bathing suit you prefer. We attempt to keep all incisions within your bathing suit lines, but this may not always be possible. Individual factors such as amount of excessive skin, amount of stored fat and the condition of your abdominal musculature will play a critical role in determining the specific technique and incisions used selected to smooth and flatten your abdomen. If there is loose skin above the navel, the surgeon may make an incision around the navel to release the umbilicus. The skin and fat layer is separated from the abdominal wall muscles. To tighten the abdominal musculature and fascia into a more youthful position, our surgeons will bring the loose underlying tissue and muscle together with permanent sutures. Skin of the lower abdomen that contains stretch marks is usually completely removed. Any stretch marks remaining above the naval may be flattened and improved, but you should not expect a dramatic change in their appearance. As the abdominal skin is pulled down to meet the incision of the pubic area, excess tissue is removed. A small opening is made to bring the navel through. The incisions from the procedure will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible. In many instances, the incisions eventually fade to become only faint lines. Some individuals may have incision lines that are more noticeable. Fortunately, the incisions for your Abdominoplasty are placed in locations concealed by most bathing suits and undergarments. Our surgeons are will work closely with you to establish a surgical plan which best suits your needs.
6. What happens if I get pregnant or loose weight in the future?
You should inform your surgeon if you are planning to become pregnant or decide to loose a significant amount of weight in the near future. Our surgeons may recommend that you stabilize your weight prior to undergoing surgery. If you wish to become pregnant in the future, you should mention this to your surgeon. Although there is no evidence that having an Abdominoplasty can affect your pregnancy, the reverse is not true. In general, pregnancy is likely to alter your abdomen in an unpredictable manner and could affect the long-term results of your Abdominoplasty (tummy tuck). We are happy to answer any questions that you may have on this matter during the consultation period.
7. How do I prepare myself for surgery?
If you are a smoker, your plastic surgeon will ask you to stop smoking well in advance of surgery. Aspirin and other anti-inflammatory drugs which can cause increased bleeding should be avoided at least 2 weeks before surgery. A full list of other medical and non-medical substances to avoid will be provided to you at our office. Additional preoperative instructions will also be given to you at that time. Abdominoplasty is usually performed on an outpatient basis either in a hospital, free-standing ambulatory facility or office-based surgical suite. You should arrange for someone to drive you home after surgery and to stay with you at least the first night following your surgery. You should obtain all you medical prescriptions before the date of surgery and have those available at home. You will need to obtain a surgical garment designed for body contouring surgery from our office and bring this with you on the day of surgery. In certain cases, Abdominoplasty is performed in conjunction with a medically necessary procedure such as hysterectomy or hernia repair. This will likely require a short hospitalization. You will also be given an Abdominoplasty Instruction Sheet, which you should keep at home as a reference guide during the postoperative period.
8. What happens during surgery?
Intravenous medications are administered for your comfort during the surgical procedure. Local anesthesia is used for patients undergoing Abdominoplasty to complement general anesthesia. A special bladder catheter is inserted to monitor urine output for most of our cases. When surgery is completed, you will be taken into a recovery room where you will be closely monitored. Your abdomen will be covered by sterile surgical dressings and a surgical garment. You will notice small drain tubes that have been placed within the abdominal tissues to help avoid accumulation of fluids. You may also notice the drainage tube that has been placed your bladder to monitor urine output. Most often the bladder tube is removed right after surgery, but occasionally we send a patient home with it and remove it the next day. You may be permitted to go home after a few hours, unless you and your plastic surgeon have arranged for you to stay in a hospital or surgical facility overnight.
9. How will I look and feel initially?
Most patients experience some discomfort immediately after surgery. The next day, you will be encouraged to get out of bed for short walks in order to promote blood circulation. You may not be able to stand up completely after surgery. We encourage you to get out of bed and sit in a chair during the first few days after surgery. Straining, bending and lifting heavy objects are to be avoided for 6 weeks. You may find it more comfortable to sleep with several pillows under your back and a few pillows under your knees. Surgical drains will require special care until they are removed. Depending on the Abdominoplasty technique used, you may be instructed to wear a support garment for several weeks. Generally, stitches will be removed in stages over a period of approximately one or two weeks. Swelling and bruising is to be expected. The bruising and much of the swelling will disappear over the next few weeks. However, it may be several months before all swelling subsides and up to one year before you see the final result of your Abdominoplasty. Numbness over portions of the abdominal area is an inevitable result of Abdominoplasty, but with time it improves. Incisions will be reddish pink in color soon after surgery and can remain this way for many months following surgery. All incisions eventually become more normal in color and fade with time.
10. When can I resume my normal activities?
The amount of time it takes for recovery varies greatly between individual patients. Depending on the extent of your Abdominoplasty and your overall physical condition, you may be able to return to non-strenuous activity from one to three weeks after surgery. You can resume most of your normal activities, including some form of mild exercise, after a few weeks; however, vigorous activities should be avoided. The day after your surgery, you should be up and about. Any dressings will be removed within several days, and you should wear your supportive post-surgery garment at all times. Your plastic surgeon may permit you to shower 48 hours after surgery, but occasionally you may have to sponge bathe for up to 5-7 days. Stitches will be removed 10 to 14 days after surgery. It is important to follow the guidelines in your Abdominoplasty (Tummy Tuck) Instruction Sheet at this point. You may experience mild, periodic discomfort and swelling for several weeks after your surgery. When the swelling begins to resolve, you may have to get a new postoperative compression garment to contour your body for a full 6 weeks. Any pain that is severe and not controlled by your pain prescription should be reported to your doctor immediately. You should avoid any sexual activity for a minimum of two weeks, and your plastic surgeon may advise you to wait longer.
11. What are the risks of Abdominoplasty Surgery?
In 2002, 85,752 patients underwent Abdominoplasty surgery. This represented a 37% increase in Abdominoplasty over the previous year. Before you undergo Abdominoplasty surgery, you should understand the risk, benefits and imponderables associated with this type of surgery. The potential complications that are personally discussed with you during the consultation period include reactions to anesthesia, blood accumulation that may require surgical drainage and infection. Tissue loss along the horizontal incision is a possibility when the Abdominoplasty is performed. When this complication occurs, delays in healing and prolonged recovery may result. Tissue loss during Abdominoplasty is more common in patients who smoke or have medical conditions such as diabetes and blood vessels disease. Revision surgery may be required in certain instances where incisions may have healed poorly. Following surgery, fluid may accumulate under the skin is a possible complication of Abdominoplasty. Removal of this serum is usually painless but may require several extra visits to our office. Another potential complication with Abdominoplasty is the formation of blood clots in your leg veins. These clots can lead to severe leg swelling, leg pain and can travel to the lung where the clots can cause devastating damage to your heart and lungs. Fortunately, this problem is rare (1/7,000 cases) when Abdominoplasty is performed alone, but slightly more common when Abdominoplasty is performed with another procedure (1/3,500 cases). We make every attempt to provide our patients with the best available prophylaxis against these kinds of blood clots. You can help to lessen certain risks by following the advice on the Abdominoplasty (Tummy Tuck) Instruction Sheet and following any other instructions given by your plastic surgeon. Additionally, during your consultation with our surgeons you will be asked to review and sign an Abdominoplasty (Tummy Tuck) Risk Disclosure Sheet which should answer all your questions regarding potential risks and imponderables associated with Abdominoplasty.
12. I understand that every surgical procedure has risks, but how will I learn more so that I can make an informed decision?
The subject of risks and potential complications of Abdominoplasty surgery will be discussed with you on a very personal basis between you and your plastic surgeon. Fortunately, significant complications from Abdominoplasty are not frequent. Each year, many thousands of people undergo successful aesthetic surgery of the abdomen without experiencing any major problems and are very pleased with the results. Anyone considering surgery, however, should be aware of both the benefits and risks. More information can be obtained from our office and can be picked up at you convenience. Remember, Drs. Guerra and Metzinger are happy to discuss with you all of the potential risks and benefits of Abdominoplasty during the in-office consultation in great detail. Additional information can be obtained from the links below:
13. How long will the results of my Abdominoplasty last?
Abdominoplasty will reshape and rejuvenate your abdominal area. You will likely find it easier to wear certain styles of clothing. Like many patients who have had an Abdominoplasty, you may have a boost in self-confidence. In general, the results of your Abdominoplasty will be long-lasting. Unless you gain or lose a significant amount of weight or become pregnant, your abdomen should remain firmer and flatter for many years. However, gravity and the effects of aging can eventually alter the shape of your abdominal area. After a period of years, you may become dissatisfied with the appearance of your abdomen and you may choose to undergo a second procedure to restore a more youthful body contour.
14. It is important to maintain a long-term relationship with my plastic surgeon?
You will return to our office for follow-up care at prescribed intervals. Follow the Abdominoplasty Instruction Sheet to see a typical postoperative follow-up schedule. Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon.
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