Abdominoplasty
What is Abdominoplasty?
The purpose of this surgery is to achieve a firmer and flatter abdomen.
Abdominoplasty is a surgical procedure where excess skin and fat are removed from the lower abdomen (abdominal apron) and the abdominal muscles are tightened.
There are several types of cosmetic surgeries that can be performed on the abdomen, and the choice of the most suitable one for you depends on the quality of your skin, excess fat and skin, and the tone of the abdominal muscles (after pregnancy, especially multiple pregnancies, the abdominal muscles become weaker).
Abdominoplasty is often performed after significant weight loss that results in an unattractive and uncomfortable abdominal apron.
In some cases, it can be combined with liposuction, but the indications for this combination should be discussed with your surgeon.
Abdominoplasty is a difficult surgery that results in defining the contour of your body; it is not a procedure that can help you lose weight.
If you wish to become pregnant or continue to lose weight, abdominoplasty is not recommended as the aesthetic results achieved will deteriorate after pregnancy or further weight loss.
If you have already undergone abdominoplasty and continued to lose weight, and you no longer find the aesthetic results satisfactory, a new intervention can be performed by approaching the scar resulting from the previous surgery.
Before the Surgery
Before surgery, during the first consultation, you must inform the doctor about your potential health problems, previous surgeries, and treatments followed or allergies; you will establish together with the doctor what expectations you have from the intervention and what results can be achieved, as well as the surgical intervention that suits you.
To prepare for the abdominoplasty surgery, oral contraceptives must be stopped at least 6 weeks before, you should avoid taking aspirin or other nonsteroidal anti-inflammatory drugs (such as ibuprofen or ketoprofen).
It is recommended to quit smoking one month before the surgery and during the postoperative recovery period of abdominoplasty, to reduce the possibility of postoperative complications related to scarring. If you cannot quit smoking, try to reduce the number of cigarettes smoked per day as much as possible.
It is preferable that the date of the surgery does not coincide with menstruation, as this increases the risk of bleeding.
The Abdominoplasty Surgery
Often, abdominoplasty surgery is performed under general anesthesia. In some cases, when a mini abdominoplasty is practiced, local-regional anesthesia can be used.
The duration of the surgery varies between 1 to 3 hours depending on the complexity of the procedure.
The incision is made at the natural fold of the lower abdomen just above the pubic hairline, and it is designed in such a way that it can be concealed by underwear.
The length of the incision varies depending on the surgical procedure: in the case of a mini abdominoplasty, the incision is shorter (slightly longer than a cesarean scar); in the case of extensive abdominoplasty, the incision can stretch from one iliac spine to the other.
After the incision, the abdominal skin and fat are dissected from the muscular abdominal wall. The exposed muscles are then strengthened using special non-absorbable sutures (this maneuver increases the resistance of the abdominal wall and narrows the waist).
The excess skin and fat (usually located below the navel) are excised. The navel is preserved but will be repositioned. The surgeon will make an incision around the navel and dissect it to the level of the muscular wall. After the excision of excess skin and fat, the lower incision is temporarily closed to identify the most suitable location for reinserting the navel. An incision is made at the measured spot, and the navel is stitched in place at this level to achieve a harmonious appearance of the abdomen.
Depending on the size of the abdominoplasty surgery, 1 or 2 drainage tubes will be inserted, which will be removed in the following post-operative days.
Finally, the lower incision is closed using several layers of absorbable sutures, with the last layer being beneath the skin leaving only a few loops visible.
In the case of a mini abdominoplasty, the procedure is more limited and there is no need to reposition the navel.
Hospitalization lasts between 2 and 5 days.
Even though the sutures are absorbable, their absorption takes time, so the loops that remain on the surface will be removed after 15 days.
After Abdominoplasty
Post-operative pains can be significant, but they are controlled with the help of medications (intravenously while in the hospital and in tablet form at home).
After surgery, it is advisable to lie in bed with your legs slightly bent to avoid straining the stitches, and wear a special corset continuously for at least 4 weeks, day and night.
The time taken to resume normal activities varies, but you should plan for at least 2 weeks of medical leave. Normal physical activity can be gradually resumed approximately 6 weeks after surgery.
The consistency and appearance of the scars can vary depending on the individual characteristics of your skin. Initially, the scars are linear, reddish, somewhat rough, and tender to touch. Once the scars have formed, it is recommended to massage them systematically with a moisturizing cream for at least 15 minutes every day to avoid the formation of abnormal scars. Take into account that the scarring process is a long one, and the appearance of your scars may change for up to 2 years.
It is recommended that you avoid exposure to UV radiation (sun or tanning beds) for about 6 months after abdominoplasty, as this can cause permanent pigmentation of the scars.
The final result of the abdominoplasty surgery can be evaluated one year post-operatively.
Abdominoplasty Complications
Abdominoplasty is a challenging surgery, and despite being considered safe, it can be associated with various complications:
Thrombosis (formation of blood clots in the blood vessels that can mobilize and reach various organs) - to prevent this complication, you will receive a subcutaneous injection of an anticoagulant before the surgery and then for the following 7 postoperative days. Early mobilization is also recommended (you should get out of bed as soon as possible and make multiple leg movements while seated, as directed by your doctor).
Major complications such as pulmonary thromboembolism, myocardial infarction, or stroke are very rare and result from the mobilization of blood clots formed in the lower limbs; the probability of these complications is the same as in most surgical interventions that involve bed rest.
Infections - systematically treated with antibiotics and drainage (to avoid this, post-operative prophylactic antibiotic therapy is recommended for 7 days).
Skin necrosis – may be marginal or more extensive. Marginal skin necrosis most commonly occurs in the middle of the scar where tension is the highest. It involves an area that heals more slowly and may result in a less aesthetically pleasing scar in that area. Extensive skin necrosis is very rare, especially in smokers; it usually requires a second surgical intervention.
Seromas - a common complication after the removal of the drainage tubes. This can be prevented by wearing the corset. If they still occur, they can be aspirated.
Hemorrhage - a rare complication, occurring when a blood vessel continues to bleed. A second intervention is performed to achieve hemostasis. This complication occurs immediately post-operatively.
Hematoma - occurs rarely when there is a well-defined collection of blood (in 3 - 4% of cases). If it is small, it can be absorbed, but if it is larger, surgical intervention may be required for drainage and hemostasis.
Loss of normal sensitivity in the abdominal wall - this can occur due to extensive dissection. Sensitivity progressively returns after a few months post-operatively.
Fat necrosis (steatonecrosis) - is a complication that can frequently occur in obese patients. If localized, it appears as hard nodules on the abdominal wall which soften over time with massage. If significant, a second surgical intervention may be needed for lavage and removal of non-viable tissues.
Hypertrophic or unsightly scars.
