Sunday, 29 May 2011

Abdominoplasty or Tummy tuck


Overhanging bellies with excess fat and loose, sagging skin are commonly seen following pregnancy, weight fluctuations or due to genetic predisposition. However a flat abdomen conveys a physically fit appearance. Women who desire a narrower waistline and firmer abdomen  after childbirth are good candidates for abdominoplasty. Abdominoplasty removes excess skin and fat from the abdomen, may tighten the abdominal muscles as well as refashion the navel to result in a flatter, tighter abdominal profile and a youthful looking navel. 

Tummy-tuck can be performed on patients with existing medical problems such as diabetes, hypertension etc. The existing medical condition must be well under control and the primary physician managing the condition should be consulted prior to surgery. The type of anaesthesia and extent of surgery may be modified. Similarly, the experience and skill of your cosmetic surgeon is paramount to ensure a safe and optimum result.

Tummy-tuck is performed in an operation theater under suitable anaesthesia. I prefer to do it using a combination of spinal and epidural anaesthesia. This is relatively safer and provides excellent pain relief post-operatively as compared to general anaesthesia.
The first step involves liposuction in the upper abdomen and flanks. This reduces the unwanted bulges in these areas and gives a good waistline.                                                                                                     
Next, an incision is made across the lower abdomen (a little above the pubic area). The length of this incision varies as per the severity and extent of skin laxity. An incision is also made around the umbilicus (navel / belly button) to free it from the surrounding skin.
The skin apron (skin and subcutaneous fat) is separated from the abdominal wall and lifted up to the rib cage.
The abdominal muscles (if weak) are tightened to provide a stronger abdominal wall as well as to make the waist smaller. If there are any abdominal hernias present, these are repaired at this stage.
The skin is then lowered and the excess is removed. A new opening is made for the navel at the proper position. The navel is sutured to this new opening to give a better looking and more youthful navel.
The incisions are closed with absorbable sutures. Small suction drain tubes a routinely kept to prevent fluid accumulation. A sterile dressing is placed over the area and entire abdominal area is generally covered with a customized compression garment.                 

The entire surgery generally takes 2 to 4 hours.

After surgery, any pain and discomfort is controlled with medications and / or epidural analgesia.

The next morning, you will be encouraged to walk around to promote circulation. You will be instructed to bend forward at the hips slightly in order to relax the tension on the stitches.  While in bed, there may be 1-2 pillows kept under your knees to flex them and the hips so as to have the same relaxing effect on the stitches.
The drainage tubes are usually removed at 48 hours; after which you will be discharged from the hospital. A light dressing will be required for two weeks and this should be kept dry.
Some swelling and bruising is expected, but will settle in 2 to 3 weeks time. You should take it easy for 5 to 7 days and may resume most normal activities after 10 to 14 days. You may begin exercises 4 to 6 weeks after surgery. Numbness if any will gradually return to normal, but may take several months. 

The healing process is gradual, so you should expect to wait a while before fully enjoying the results of your tummy tuck. Regular gentle to moderate massage (as advised by the doctor) of the abdominal area will facilitate faster and smoother recovery. As months pass, the incision line will gradually fade.

There are many variations of tummy-tuck surgery. These as well as potential problems of this procedure will be discussed in future postings.

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