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FREQUENTLY ASKED QUESTIONS:

What is an abdominoplasty?
This is an operation designed to improve the appearance of an abdomen that may be overly protruding, or may have excess loose skin and fat. There are variations of the standard operation including "mini-tucks" which may be of benefit to patients who require only tightening of the abdominal muscles or removal of a small amount of skin. On the other hand, patients with massive weight loss may require a more extensive operation.

Who can benefit from this surgery?
  • Patients who are healthy but have excess skin or fat that does not respond to diet and exercise.
  • Patients who have undergone significant weight loss and have hanging skin.
  • Women with loose skin and stretch marks following pregnancy
  • In older patients , loss of skin elasticity.
How is the operation done?
Usually, under general anesthesia, an incision is made across the lower part of the abdomen. A circular incision is made around the navel that stays attached to the muscle. The skin is then separated from the muscle, up toward the ribs, so that it can be pulled down like a window shade. The tummy is then "tightened" (narrowing and flattening the abdomen) by stitching the muscles together.

Mini-tummy tucks can benefit patients who have a small amount of excess skin and fat or protruding of the lower abdomen. Mini-abdominoplasty does not involve moving the navel position. Liposuction may be used alone or in conjunction with a tummy tuck to benefit selected patients.

What kind of anesthetic is used?
A general anesthetic is most common, although mini-tucks may be done with local anesthetic and intravenous sedation. Standard abdominoplasty generally requires a short "hospitalization" of 1-2 days.

What are my limitations in activity post-operatively? After surgery, the bed will be positioned so that you are bent at the hips (waist) to keep tension off the newly tightened skin. Within 24 hours, you will be walking in a bent-over position. Although strenuous activity and lifting more that ten pounds must be avoided for six weeks, some people can return to work and daily activities as soon as two weeks after surgery. Softening of the surgical scars, return of sensation, and loosening of the tight sensation may take several months.

Will insurance pay for my surgery?
In general, "tummy tucks" are considered cosmetic surgery. Several conditions, however, may be covered completely or in part, by insurance. These include defects of the abdominal wall, such as hernias, diastasis (separation of the muscles), or trauma resulting in muscle loss, weakness or painful scar contracture. In addition, a large abdominal panniculus, frequently seen after massive weight loss, is removed for purely functional reasons, and therefore should be a covered expense. Pre-authorization may be required from your insurance company; they will require photographs to document your condition.

What are the risks of surgery?

Initial

1. GENERAL RISKS of surgery include infection, pain, delayed wound healing, hematoma (a collection of blood at the surgical site), bleeding or reactions to anesthetic.

2. BLEEDING: When blood collects beneath the skin it causes excessive discoloration. Sometimes lumps which last many months may occur. If blood collection is discovered, it is usually removed by taking out a few stitches and squeezing the clot out, or inserting a needle and aspirating it. If bleeding continues, it is sometimes necessary to return to the operating room to stitch the bleeding vessels. This risk is increased in people who take aspirin or who bruise easily. Let your doctor know if this is the case. Do not use aspirin or aspirin-containing products for two weeks before and two weeks after surgery. (See list of medications that may increase bleeding.

3. LOSS OF SKIN: The skin will sometimes lose its blood supply. When this happens, an area of skin will fail to survive and a number of weeks are needed for healing. Rarely, a skin graft may be needed to obtain healing. This risk is increased in smokers; therefore, you must stop smoking at least 4 weeks before and 4 weeks following surgery.

4. INFECTIONS: A significant wound infection requires antibiotic treatment and a longer stay in the hospital. Sometimes the wound must be opened to drain the infection and then the healing process is slowed.

5. SEROMA: On occasion, a clear yellowish fluid collects in the wound under the skin. It may require aspiration with a needle and syringe in the office. Aspirations may have to be repeated for several weeks.

6. NUMBNESS OR PAIN: Many little nerves are cut as part of the operative procedure. These must grow out again over a period of some months. Numbness of the abdominal skin will be noticed during this period. Sometimes the sensation does not return completely. Occasionally scar tissue forms around a healing nerve, causing pain. Usually this disappears within a period of several months.

7. UNSATISFACTORY SCARS: The scars are expected to be quite prominent and unsightly during the first 6-12 months after the operation. As the scars mature, they soften, become lighter in color and flatten out. An occasional patient forms excessive scar tissue and the maturing process is greatly delayed. Very rarely a patient will form a "keloid": the scar becomes larger and does not go away. If you have a history of true keloids, you should not have this operation. Some patients require an additional "midline" scar (an upside down "T" shaped scar) to close the abdominal incision if there is a large amount of loose lower abdominal skin.

8. BLOOD CLOTS IN THE LEGS OR LUNGS (Thrombosis and Pulmonary Embolism): Some people (particularly older people) tend to form blood clots in the legs after abdominal surgery, especially if their hips are in a flexed position. These blood clots can break off and go to the lungs. It is possible for such an event to be fatal. It is important for patients to get up out of bed and begin walking as early as possible after surgery to avoid this problem. Pneumatic compression stockings will also be used to help prevent this problem.

9. ATELECTASIS AND PNEUMONIA: Following a general anesthetic, there is a tendency for the air sacs in the lungs to stick together. It is very important for patients to take deep breaths and to cough vigorously at frequent intervals after surgery to inflate the air sacs. Once in a while, some air sacs will stay collapsed, causing patients to have a fever. The area in the lung that is affected can often be seen as a shadow on a chest x-ray, and is called "atelectasis". Patients must then make every effort to breathe deeply, to cough frequently and to expand the air sacs, otherwise, pneumonia can result and hospitalization will be prolonged.

10. CONTOUR IRREGULARITIES: Areas of depressions, waviness, "lumps" or asymmetries may occur. Some improve over time while others require additional surgery for improvement.

11. UMBILICUS (NAVEL) LOSS OR MALPOSITION: As with skin loss, poor circulation can result in partial or complete loss of the navel. Smoking within four weeks of surgery increases this risk Furthermore, on occasions, the position of the navel may be higher or lower than desired or even slightly off midline position.

12. DEHISCENCE or separation of the incision occurs on occasions. This can result from excessive activity, trauma, infection, or tearing of the sutures. This will delay healing.

13. DEPRESSION: Some patients may experience an emotional let-down after cosmetic surgery. This may be related to the normal chemical changes after extensive surgery, or overly high expectations. It is usually self limited and does not require treatment.

14. ALTERNATIVES: Diet, exercise, suction lipectomy, or no treatment.

15. PHOTOGRAPHY: Photographing, filming, or videotaping of the treatment or procedure for educational or diagnostic use is a standard and required part of patient care.

16. NO GUARANTEE: The practice of medicine and surgery is not an exact science. Although good results are expected, there cannot be any guarantee, nor warranty, expressed or implied, by anyone as to the results that may be obtained.

17. COMPLICATIONS AND ADDITIONAL SURGERY: Any of these problems noted above may require additional surgery, hospitalization, and time away from work. If this occurs, there will be additional costs for surgical fees, supplies, anesthesia, etc., depending upon the required operation. Complications of cosmetic surgery generally will not be covered by medical insurance.

18. ANY FUTURE REVISIONAL SURGERY WILL INCUR ADDITIONAL COSTS TO BE PAID BY THE PATIENT.


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