Abdominal wall surgery

Definition

Abdominal wall surgery is surgery that improves the appearance of flabby, stretched-out abdominal (belly) muscles and skin. It is often called a "tummy tuck." It can range from a simple “mini-tummy tuck” to more complicated, extended surgery.

It is not the same as liposuction, another way to remove fat. But abdominal wall surgery is sometimes combined with liposuction.

Alternative Names

Cosmetic surgery of the abdomen; Tummy tuck; Abdominoplasty

Description

Your surgery will be done in an operating room in a hospital. You will receive general anesthesia. This will make you unconscious and unable to feel pain during the procedure. The surgery takes 2 to 6 hours. You can expect to stay in the hospital for 1 to 3 days after surgery.

After you receive anesthesia, your surgeon will make an incision (cut) across your abdomen to open up the area. This incision will be just above your pubic area.

Your surgeon will remove fatty tissue and loose skin from the middle and lower sections of your abdomen to make it firmer and flatter. In extended surgeries, the surgeon also removes excess fat and skin (?love handles?) from the sides of the abdomen. Your abdominal muscles may be tightened also.

Your surgeon will close your incision with sutures (stitches). Your surgeon may insert small flat tubes called drains to allow fluid to drain out of your incision. These will be removed later.

A firm elastic dressing (bandage) will be placed over your abdomen.

For a less complicated surgery, your surgeon may use medical devices called endoscopes. Endoscopes are tiny cameras that are inserted into the skin through very small incisions. They are connected to a video monitor in the operating room that allows the surgeon to see the area being worked on. Your surgeon will remove excess fat with other small tools that are inserted through other small incisions. This surgery is called endoscopic surgery.

Why the Procedure Is Performed

Most of the time, the surgery is called “elective” or “cosmetic” surgery because it is something you choose to have. It is not usually needed for health reasons. Cosmetic abdomen repair can help improve appearance, especially after a lot of weight gain or loss. It helps flatten the lower abdomen and tighten stretched skin.

It may also help relieve skin rashes or infections that happened under large flaps of skin.

Abdominoplasty can be helpful when:

• Diet and exercise have not helped make very weak muscles stronger. This can be true for women who have had many pregnancies.
• Skin and muscle cannot regain its normal tone. This can be a problem for very overweight people who lost a lot of weight.

Abdominoplasty is not used as a way to lose weight.

Risks

The risks for any anesthesia are:

• Reactions to medicines
• Breathing problems
• Heart attack or stroke

The risks for any surgery are:

• Bleeding
• Infection
• Bruising
• Swelling
• Scarring
• Blood clots in the legs or lungs

Risks of abdominoplasty are:

• Damage to internal organs
• Nerve damage that can cause pain or numbness in part of your belly
• Having a very low body temperature during surgery

Before the Procedure

Always tell your doctor or nurse:

• If you could be pregnant
• What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

Before your surgery:

• Several days before surgery, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that affect blood clotting.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help.

On the day of your surgery:

• You will usually be asked not to drink or eat anything after midnight the night before your surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will have some pain and discomfort for several days after surgery. Your doctor will prescribe pain medicine to help you manage your pain. It may help to rest with your legs and hips bent during recovery to reduce pressure on your abdomen.

Wearing an elastic support similar to a girdle for 2 to 3 weeks will provide extra support while you heal. You should avoid strenuous activity and anything that makes you strain for 4 weeks. You will probably be able to return to work in 2 to 4 weeks.

You will need to schedule a visit with your doctor to have your stitches removed.

Your scars will become flatter and lighter in color over the next 3 to 6 months. Do not let the sun shine directly on your incision. Keep it covered when you are out in the sun.

Outlook (Prognosis)

Most people are happy with the results of abdominoplasty. Many feel a new sense of self-confidence.

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References

Burns JL, Blackwell SJ. Plastic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 73.