What is Abdominoplasy?
This
operation is performed to remove excess skin, fat and tighten the muscles of
the tummy (abdomen). It is Usually performed when all three components of the
abdominal (tummy) wall are excessive or stretched. This procedure is often
performed at the same time as certain gynaecological procedures e.g.
hysterectomy, bladder lift etc. It has been observed in certain cases that
lower back pain can be improved by tightening the muscles of the tummy wall.
helpful advice
General Questions
Prior to the operation the incision line is marked with the patient standing. The incision is roughly W-shaped starting at one hip bone and down towards the groin. It then curves upwards just along the upper border of the pubic hair and down to the opposite groin. From there is courses upwards towards the opposite hip bone. It is important to mark the incision in such a way that it is not visible later on wearing high cut costumes or bathing suits. The operation is usually performed under general anaesthetic.
During the operation the skin and fat of the tummy wall is lifted from below upwards all the way up to the rib margin. The belly- button is usually cut free and remains in position. The muscles of the tummy wall are then stitched together with a non-absorbable suture. The excessive skin and fat is then removed so that the skin from just above the belly-button ends up on the incision line. A new opening is made for the belly-button. In certain cases this is combined with liposuction of the adjacent areas.
In cases where the belly-button has been previously affected by surgery, a new belly-button is made. At the end of the operation, to facilitate closure of the incision, the patient is placed in a so-called jack-knife position, 3 pillows below the knees and the upper part of the bed is raised by 35°. The incision is then closed with 2 soft silastic drains in place.
The
patient is then transferred to their bed in the jack-knife position. This
position is maintained for the first few days. Post operatively the patient
stays on strict bedrest in the jack-knife position for 24 hours. Mobilisation
is encouraged after 24 hours.
Bleeding
and infection are always a risk with any form of surgery. This can usually be
controlled. It is believed that patients with underlying risk factors e.g.
obesity, smoking, high blood pressure, diabetes etc. are at a higher risk of
developing deep vein thrombosis. In cases where the risk factors for deep vein
thrombosis (clots in the leg veins) are identified, preventative measures are
taken. This involves the use of elasticated stockings and even drugs to thin
the blood.
There is
also a risk of poor blood supply to the skin edges in patients who have had
previous tummy surgery or heavy smokers. In these cases one sometimes sees
areas of skin death due to insufficient blood supply along the edge of
incision. If this area is small it can be cut out and the wound re-sutured. In
rare cases where the area is too big, a skin graft is necessary. In 10 — 15% of
cases, there is a collection of fluid between the skin and muscles of the tummy
wall. If this is a small accumulation, it may be drawn out with a syringe and
needle in the office. If the collection is larger, it may require placement of
a drain for this reason.
Before
surgery please do not take any products that contain Aspirin or large doses of
Vit.E for 3 weeks pre-operatively. If you take any form of over-the-counter
medication please notify your doctor well before the operation.
Ideally
smokers should stop smoking completely at least 2 weeks before the operation.
If this is not possible, we would request smokers to cut down to the 3 — 4
cigarettes a day and abstain from smoking completely for 24 hours before
surgery. Please note that smoking carries a high risk of poor blood supply to
the skin edges as mentioned above. Also note that smoking causes coughing which
leads to undue tension on the wound closure.
Please
report any signs of a cold, infection, boils or pustules appearing within 3
weeks of Surgery.
Please note
that for 24 hours after surgery, strict bed rest in the jack-knife position is
maintained. This is rather uncomfortable and is associated with moderate pain.
Once mobilisation starts after this, patients are unable to stand up straight
for about 2 weeks post operatively.
During the
first 2 weeks of recovery, maintenance of the jack-knife position becomes less
and less important. Within a week to 10 days, patients are usually able to
sleep on their side or with minimal elevation.
It is important to remember that the lower tummy skin (between belly-button and scar) will remain numb for 2 — 3 months after the operation. The area of numbness will gradually decrease until one is left with a small patch (about the size of the palm of your hand) between belly-button and scar. This patch of numbness usually remains permanently. It is also important to understand that the scar is usually under significant tension. This usually results in a slightly stretched scar which takes about 18 months to 2 years to settle completely.
This scar may be somewhat red, itchy, raised and 3 —- 4mm wide for the first
few months after surgery. Treatment of the scars may be necessary using tape,
creams or injections to improve their appearance. However, abdomino plasty
scars (including the scar around the belly-button) will always be noticeable
and do not usually fade well. This is considered part of the “trade-off” for
this procedure.
Please wear
loose fitting clothes that are easy to slip on and off.
After 3
weeks you can resume most normal activities except for sport or strenuous
exercise which can be resumed usually after 8 weeks.
Please take
note that most patients feel tired and run-down for up to 6 weeks after the
operation.
Kindly note that the contents of page remain the intellectual property of Dr L. van Oudenhove