An abdominoplasty is usually indicated in someone whose weight is stable and who has excess abdominal skin and fatty tissue. This is usually a consequence of previous pregnancies or a recent weight loss. Often associated with this skin excess, which may be above or below the navel, are stretch marks. These will not be removed individually although many of them will be removed with the skin that is excised during the surgery. Often associated with the extra skin and fat is “diastasis,” or separation of the abdominal muscles, which usually comes with the stretching of pregnancy or weight gain. A hernia or generalized weakness of the abdominal wall may also be present along with a variable amount of fat. One or all of these may be present in any individual, and each procedure is altered accordingly. I do not feel that this operation should be performed on someone who is planning further pregnancies soon or significant weight changes of more than 20 lbs. It is better to lose the weight first.
The procedure takes from 1 to 2 hours and is done under sedation in my office in my accredited ambulatory surgery center or occasionally in the hospital with an overnight stay, depending on the extent of the surgery and your general health. The scar is low on the abdomen and extends toward both hipbones. We can design the incisions so they are hidden by your own bathing suit the day of the surgery. The skin removed is primarily that skin below the umbilicus (navel) and above the pubic region. During surgery, the skin and fat of the abdomen is elevated up to the level of the lower ribs. The upper skin is brought down to the pubic area and the original navel, which is on a stalk, is brought through the abdominal skin. Its actual position is not changed. The abdominal wall is tightened with permanent sutures (stitches) and excess skin is then removed. Liposuction is usually used for final contouring (“lipoabdominoplasty”). Sometimes additional liposuction of the lumbar rolls or “love handles” can be done at the same time to further slim your waistline, although this is a separate procedure.
A mini-abdominoplasty is less complex than a full abdominoplasty in some ways. We can leave the navel alone and only remove some of the skin of the lower abdomen, or completely avoid the plication on someone who has extra skin but has great abdominal wall muscle tone. Occasionally, when the navel is high on the abdomen, it can be lowered by transecting it at the base leaving no scar around the navel (called “floating the navel”).
When you awaken from surgery, you will be in a semi-sitting position to keep tension off the stitches. Since 2015, I have almost never placed an abdominal drain in an abdominoplasty. You will bring a girdle to the office the day of surgery and will wear that home. You may need to take an over-the-counter iron supplement (SlowFe) for 1 month after your surgery. You should walk a little every day after surgery but must refrain from vigorous exercise for 2 weeks post-operatively. Please allow 2-3 weeks for recovery.
Complications from this procedure are unusual but include bleeding (which is possible in any surgical procedure). Infection may rarely occur after surgery, especially because the incision is close to the groin area. The risk of this is less than 2% in my practice. Some of the skin may not heal well, and this can lead to a scab which will eventually heal on its own. This is rare, except in smokers who do not heal well. This procedure should not be performed in smokers unless they can absolutely abstain from tobacco for 1 month before and after surgery. Nicotine screening may be necessary the day of surgery. Many patients have numbness of the lower abdominal skin; this is usually temporary. The scar is well hidden within the bathing suit line. For the past few years, I have been using dissolvable internal staples called Insorb sutures, and the scars have been much finer. Some abdominoplasty scars fade very quickly, but others can be quite noticeable for up to several years. This is unpredictable. Patients who are “chunky” at the time of surgery seem to take significantly longer for swelling to resolve.
Four other recent innovations in my abdominoplasty practice are Exparel, progressive tension sutures (quilting sutures), Dysport and scarless navel. Exparel is a long-acting numbing solution/anesthetic and is injected into the wound while you are under sedation. As expected, it has dramatically helped with post-operative pain for the first week after surgery. What I have been pleasantly surprised to discover is that the second and third weeks are much better as well. This apparently has to do with “memory stimulation” and pain pathways. I am also injecting a muscle relaxant (Dysport) into the muscle to help with post-op discomfort. This is as part of a study discussed elsewhere on my website. Progressive tension sutures (quilting sutures) are now used to tack the skin down to the abdomen during surgery so that the drain is not necessary. Finally, since the beginning of 2018, I have been able to eliminate the external navel scar and have a much more natural-appearing navel. In the past, this scar has sometimes kept a patient out of a two-piece bathing suit; this problem should be solved.
The worst complication that can happen from abdominoplasty is probably the development of a clot in one of the veins of the legs which can go to the lungs and cause a pulmonary embolus. Luckily, the risk of clots in the legs and lungs is divided by half when the procedure is performed under deep sedation, as it will be in my office, as compared to surgery done under general anesthesia. In order to prevent clots, you will need to get out of bed the very first night after surgery and make sure that you keep walking so that blood does not have a chance to clot in your legs. You will also have “intermittent venous compression stockings” on during the procedure to help blood flow. If you are significantly overweight or have other risk factors for clots, I will probably have you use a blood thinner, Lovenox, to prevent this complication. Because of this risk, I am reluctant to do this procedure on extremely overweight patients who are at increased risk or to combine other complex procedures at the same time with an abdominoplasty (“mommy makeovers”) unless the combined procedures will be less than 3 to 4 hours of anesthesia.
I will purchase health insurance for you that will cover the rare incidence of a medical complication within a month of your surgery. This program is called “CosmetAssure” and is needed because your medical insurance does not cover any complication from a cosmetic procedure.
I hope that this information has not been overwhelming in that it describes all the possible complications of this procedure. The vast majority of patients have successful, uncomplicated surgery and are quite pleased with the results. I will be happy to discuss the details of this procedure and show you before and after photos in my office in consultation.
Please do not hesitate to call my office with any questions (804-320-8545).