A tummy tuck also called an abdominoplasty is an operation in which the excess skin and fat from the tummy is removed. If the muscle layer of the abdomen is stretched or damaged this can be repaired at the same time.
Anyone with excess skin and fat on the tummy may be suitable or people whose muscle layer has been stretched or damaged. Usually the procedure is carried out on people who have lost weight or following pregnancy. Lower tummy scars such as caesarian section scars often cause a line over which the extra skin folds. This fold is often what causes people to seek a tummy tuck. Tummy tucks are increasingly being sought by people who have lost large amounts of weight following special diets or weight loss surgery (bariatric surgery).
You are admitted to hospital on the day of your operation. The precise time depends on when your operation is scheduled. The operation is carried out under a general anaesthetic (asleep). The operation usually takes between two and half to three and a half hours. The stitches are usually absorbable (‘dissolving’) and are placed under the skin, so that you can not see them. A dressing is place over the wounds at the end of the operation. Drain tubes are usually placed next to the wound to reduce the build up of blood and tissue fluid under the wound. You will be prescribed regular painkillers while you are in hospital and to take home. Usually the drains are removed the second day after the operation and you are discharged home. If you have had a repair of the muscle wall you may be placed in an elastic binder or lycra garment which you should wear for at least 4 weeks. You are offered a dressing check one week after surgery and you have a follow up consultation with your surgeon four weeks after the operation. If you are worried at any time after you have gone home you can phone the ward, phone the cosmetic nurse advisor or the consultant’s secretary for advice. If necessary you can return to the ward at any time for a check (please phone first).
A long incision is made across the lower tummy and the lower tummy skin is lifted up off the muscle layer of the body. An incision is made around the tummy button which is left in place. The muscle layer can then be repaired or tightened if necessary. The excess tissue removed and the skin from the upper part of the tummy brought down to close the incision. Finally the tummy button is brought out through a hole in the skin.
A mini tummy tuck is an option where there is a small amount of extra skin to remove in the lower tummy and there is no looseness above the tummy button. It not usually possible to tighten the muscle layer with a mini tummy tuck. If you have a mini tummy tuck the operation and the recovery are shorter. It is also less expensive.
A Fleur de Lys tummy tuck is a standard tummy tuck but where an extra piece of skin is removed from the centre of your tummy, running from your breast bone to the pubic area. This is a larger and longer operation than a standard tummy tuck. It is best for people who have significant excess skin across the tummy as well as from top to bottom. It is most frequently used for those who have lost very larger amounts of weight, such as following bariatric surgery (gastric bands or by-pass). A disadvantage of the procedure compared with the standard abdominoplasty is the long vertical scar. Where such a scar already exists from a previous operation then the Fleur de Lys option becomes more attractive.
Tummy tuck is usually a very successful operation and the great majority of people are very pleased with the results. The loose extra skin and fat is removed so the tummy is flatter and smoother. The pubic area and groin usually is lifted which helps to give a more youthful appearance. It is normal for the skin of the lower tummy to be numb following the operation. This numbness usually reduces with time.
It is important that you accept that there will be a scar running across your lower tummy but this will usually lie behind normal underwear. There is also usually a scar around the tummy button. Sometimes a short vertical scar is necessary between the tummy button and the pubic area. Scars frequently stay red or pink for at least 6 months and sometimes considerably longer. They usually fade with time.
People vary a lot in the time they need to recover from surgery. The following gives some idea. Some people will require less time and others more. If you experienced complications then recovery may take longer.
When can I go home from hospital?
Most people go home from hospital on the second day after surgery.
When can I shower or have a bath?
There is usually no problem in having a shower after 48 hours. Soaking the wounds for long periods in the bath is best avoided until the wounds are fully healed, usually at least 2 weeks.
When can I start driving a car?
It is illegal to drive with in 48 hours of a general anaesthetic. Most people return to driving after 2 to 4 weeks after surgery. The most important consideration is that you feel comfortable and safe to drive. You have to be able to react appropriately in an emergency. If you are taking medication such as painkillers you need to check and consider whether these may affect your ability to drive.
When can I return to work?
Usually people return to office type work about four weeks after surgery. Some people are back sooner or work from home. More active work may require longer. Very active work will require 6 to 8 weeks off vigorous activity. You will need to be guided by your body, if working is causing you pain and swelling you may be doing too much.
When can I start picking things up?
Lifting small things around the house is not a problem. It is best to be guided by your body, so if it hurts stop. It is best to avoid lifting anything heavy for 2 weeks. You should not be straining to lift anything for 2-4 weeks. If you have had a repair of the tummy wall then you should avoid lifting for 8 weeks.
When can I go back to exercise / the gym?
Walking only for 2 weeks after surgery. Light exercise 4-6 weeks. Back to normal 6-8 weeks.
When can I start swimming?
You should avoid swimming until the wounds are fully healed. You should normally avoid swimming for 4-6 weeks following surgery.
When can I have sex again?
Sex should be avoided until the wounds are fully healed and you feel comfortable and ready. Sex will not do any actual harm as long the tummy is not squashed, the scars and tummy wall are not strained. Most people would not feel ready for sex for at least 4 weeks after surgery.
When will I be back to normal?
Most people feel they get back to normal between 6 and 8 weeks after surgery. Although the tummy may still be tender at this stage.
The great majority of healthy people undergoing a tummy tuck have an uneventful recovery and are very pleased with the outcome of their surgery. However as with all surgery there is the potential for complications. Complications include those of having a general anaesthetic, complications that may occur with any operation and those that are particular for a tummy tuck.
There are the risks of having a general anaesthetic such as allergic reactions, chest problems such as a chest infection and the possibility of clots in the legs (deep vein thrombosis). Underlying medical conditions e.g. asthma can be aggravated. In general if you are healthy modern general anaesthetics are very safe. If you are concerned about your anaesthetic we can arrange for you to meet with an anaesthetist before your surgery to discuss your concerns.
General risks of surgery:
Bleeding, infection, slow healing, poor scarring. Bleeding and haematoma: During surgery great care is taken to stop bleeding. However after the end of the operation, particularly if the blood pressure is raised, a bleeding point may start bleeding again. This causes a build up of blood under the wound called a haematoma. If this happens it usual to take you back to the operating theatre, re–anaesthetise you and remove the build up of blood. Most people will then recover normally. It would be most unusual to need to give someone a blood transfusion following a tummy tuck.
What are the special risks of a tummy tuck?
Skin necrosis and loss of the tummy button: during the tummy tuck the skin on the front of the tummy has to be lifted up and the tummy button moved. This can reduce the blood supply to the skin and rarely this can die. This may result in the need for further surgery. Healing may be slow and the scarring may be poor once it has healed. These complications are more likely if you are overweight, a smoker or have other medical conditions such as diabetes. In healthy non smoking people this is a very rare complication.
Infection and slow wound healing:
As tummy tuck surgery is quite extensive there is a significant potential for wound infection. Most wound infections settle down with a short course of antibiotics. If a wound becomes badly infected the wound may open up and take time to heal up.
Seroma is a build up of tissue fluid in the wound. This causes swelling which may need to be drained but usually resolves on its own. Draining a seroma is usually done with a syringe as an outpatient.
As the scars may be quite long it is important to understand that scarring varies from one person to another. Some scars can be thin pale lines but this can never be guaranteed. Poor scars may stretch and be wide or become lumpy, hypertrophic or keloid. Scars may not be symmetrical.
Deep vein thrombosis (DVT):
A tummy tuck is a long operation and usually your mobility is reduced in the early recovery phase. This does increase the risk of a thrombosis (clot) in the deep veins of the legs, a DVT. A serious complication of a DVT is where a thrombus breaks off and travels to the lungs in what is called a pulmonary embolus or PE. A large PE can be fatal. During your operation and time in hospital we will take measures to protect you from DVT formation although these can not guarantee complete protection. Once you go home the best protection is regular walking.
Ideally a tummy tuck should be carried out when you are at the correct weight for your height and your weight is stable. Tummy tucks can be carried out on people who are overweight but the risks of complications are increased.
For women it is usually best to finish having a family before having a tummy tuck. Pregnancy following a tummy tuck is possible but there would be an increased risk of stretch marks.
A corset is a simple way of controlling extra skin and fat on the tummy. It is simpler, cheaper and risk free!
Tummy tuck should not be considered an alternative to weight reduction with diet and exercise. It is best carried out when you are at a normal, stable weight.
Where the problem with the tummy is mainly a discrete area of extra fat, then liposuction can be a good option. It does not usually deal with the situation where there is a significant excess of skin.