A tummy tuck can be an extensive procedure. Other less extensive procedures such as suction contouring, liposuction, liposculpture, tumescent liposuction, ultrasonic liposuction etc, may be more appropriate. If your condition is such that there is
Significant amounts of hanging skin, or skin that is very crinkled and you can’t stand it !!! – then read on
If the amount of excess skin is nil to some (an inch or so) then also check the liposuction pages.
You are interested in information regarding the procedure for removal of excessive skin and fat of the abdominal area. Sometimes there is very little skin and fat but it may be that the quality of the skin is so unacceptable that the individual will trade their situation for a scar. This procedure is known as tummy tuck, abdominalplasty, abdominal lipectomy, abdominal dermatolipectomy, panniculectomy, etc. and is usually combined with liposuction. The names mentioned do reflect some differences in the procedures but it is ‘beyond the scope’ of this informational session to explain the differences. For the sake of simplicity, the terms ‘tummy tuck’ or abdominalplasty will be used during the discussion. Suffice it to say that during a ‘tummy tuck’ both fat and skin are removed from the abdominal area.
Your pre-operative evaluation is very important. During this evaluation, Dr Capuano will advise you what, in his experience, would be the most appropriate. Some think that because they can pinch extra skin, they need a ‘tummy tuck’.
While technical details as to how the operation is accomplished may vary, generally the procedure involves making an incision in the crease at the pubic hairline (the groin area). The incision may extend from one hipbone area to the other usually in a gentle curve. Smaller incisions are possible. Tailoring of the incisions to an individual’s life style is the GOAL not a guarantee. So if you wear bikinis – incisions may differ –
Through the incision the tissues (both skin and fat ) are lifted off the tummy wall, all the way to the breast bone and the lower ribs. The belly button is freed up during the process leaving the base and skin of the belly button standing in the middle of the tummy. The layers of the tummy may be tightened, if indicated, by stitches.
A point about anatomy –
The layers of the abdominal wall include fascia (a coating over the muscle of tough white tissue – you can see this around a beef steak), the muscle, and then more fascia. You may have heard that the muscles are tightened. This is in a manner of speaking. As far as I know and have seen, actually the fascia is tightened. The muscles are drawn with the fascia. As you may know, muscle does not hold a stitch very well. Actually even the fascia may not hold a stitch over time. You may have heard of ‘recurrent’ hernias – that is what happens when the fascia does not hold the stitch and the hernia pushes through the repair.
After tightening the fascia if indicated, suction removal of fat is usually done.
The extra skin and fat is brought down and removed. The incisions are then sewn together at the area of the pubic hair line, and the remainder of the incisions are closed after the belly button is brought back through the fat and skin.
Drainage tubes are brought out to allow for healing without collections of fluid (although this may still occur). A dressing which wraps around and is held by a Velcro elastic binder is then applied. This keeps the layers of skin and fat tight on the tummy wall so that there is less of a chance that fluid will accumulate.
You should be aware of the possible risks and complications associated with surgery, which include, but are not limited to bleeding, infection, slow wound healing, risks of anesthesia, irregularity of the skin, numbness in the areas treated, collection of fluid in the area, thickened scars, and the possibility of the need for further surgery. Most of these problems have been minor in Dr Capuano’s experience. The need for blood transfusions in tummy tucks has been zero in the past fifteen years. The incidence of a severe infection has also been zero. Anesthesia is safe in today’s day and age. But no matter what we tell you, there is always that chance that an adverse happening could occur. The statistical probability can be discussed with you if you have specific concerns.
There are many factors to be considered in this surgery, and many judgments to be made by Dr. Capuano. We try to make as many decisions as possible before surgery, but some judgments can only be made at the time of surgery.
During surgery, an incision that was intended to be lower may have to be made higher. This is because the skin might not stretch enough. After surgery, scars can change position, and especially drop. For these reasons final scars may not be exactly where you anticipated.
Rare cases of skin loss, heart and lung problems, hemorrhage, and even death have been recorded. Thankfully, these have not occurred with any of Dr. Capuano’s patients. They are listed for your information. These and other remote risks must be accepted by you if you decide to go ahead with surgery. We do not anticipate that these problems will occur, but there is always a chance that one or more of these problems may occur.
If you have questions regarding these risks, please ask the Doctor.
These procedures are scheduled as “extended stay” surgery. This means that if Dr. Capuano feels you need to stay over, or if you do not have someone to care for you for the first day after your surgery, arrangements are made for an overnight stay at the hospital. An estimated 60-70 percent of our patients can go home the same day, but these arrangements are made for your safety. There is an additional charge for the extended stay that must be pre-paid to the hospital. If you do not need the extended stay, this amount will be refunded to you after surgery..
As described above, this procedure is quite extensive and can last anywhere from three to five hours. It involves making an incision in the skin of the abdomen in the area above the pubic area, which usually extends to both hip areas. The tissues are freed up, and then the skin is pulled downward. Suction lipectomy, (removal of excess fat by means of suction) of the area is usually performed at this time. Excess tissue is then removed, the muscles and tissues of the “belly” may be tightened, and the “belly button” repositioned. The skin is then closed, usually with a combination of surgical steel clips and sutures.
We ask that you refrain from taking any products containing aspirin for at least two weeks prior to your surgery. Do not eat apples, as they contain an aspirin-like substance. Aspirin thins the blood, which may cause more bleeding during surgery. If you are taking aspirin on the advice of a physician, please let us know.
Following your surgery, you will have a large dressing in place. Two drains will be in place, which will be removed as appropriate after surgery. This dressing must remain clean, dry and on.
You will be given prescriptions for medications for swelling, infection and discomfort. Take these medications until they are gone, unless advised otherwise. If you have a problem with a medication, please call the office.
If you plan on staying anywhere other than your own home following surgery, notify the office. We need to be able to contact you after surgery.
At the time of your first post-operative visit, the dressing will be removed, and you will be advised regarding wound care. Showers are usually allowed after this first visit.
You should not engage in any stressful activities at home, and should rest and relax. You may have visible “black and blue” in the areas. This is to be expected. You can also expect numbness in the areas. This may be present for quite some time, but sensation should gradually return. This may take anywhere from three months to one year.
If you notice increasing swelling, redness or a sudden onset of discomfort, please call the office immediately. A problem we have encountered repeatedly with patients undergoing abdominalplasty is that they tend to resume their usual activities too quickly. This is not good for healing. It can cause accumulations of blood and/or fluid, slow wound healing, opening of the incision and infection.
We must urge you to take it easy, especially during the first two – three weeks following surgery. Do not overdo it. Try to rest and relax, and if at all possible it is preferable that you not return to work for at least two weeks. People who have desk (sitting) jobs are especially prone to aggravate a healing wound. In summary, abdominalplasty is extensive surgery. While the number of unanticipated problems encountered to this point in Dr. Capuano’s experience have been few, and while problems are not anticipated in your particular case, they may occur. We certainly hope that you will do well and be as pleased with the result of your surgery as others have been. A good result and a happy patient are our goals, but these cannot be guaranteed.