This is an operation to remove excess skin and fat from the anterior abdominal wall, to re-shape and re-profile it. As part of the procedure, I will usually tighten the two 6 pack muscles (recti muscles) which have become loose with ageing or with pregnancy. I will often carry out liposuction to the lateral hips because if the abdomen is tightened without attending to the hips, the hips can look disproportionately larger after surgery. Sometimes in younger patients there is not a great deal of excess skin and fat and it is possible to carry out a mini abdominoplasty which avoids a scar around the umbilicus and leaves a shorter transverse scar in the lower abdomen. Patients will often recover slightly quicker from this.
The indications for full abdominoplasty are middle age spread, weight loss leaving loose and excess skin, ladies who have carried a large number of babies, twin births or large babies and sometimes tethering from caesarian section scars.
The operation is carried out under general anaesthetic and patients are usually admitted on the day of surgery. The operation takes 2 hours and after surgery there will be 2 drains in place, all the stitches apart from around the tummy button will be of the dissolving type and the wounds simply taped. Following surgery, you will have to wear anti thrombus stockings for 2 weeks and a soft girdle for 4-6 weeks. Although after 2 weeks, you may change from the girdle to using support like pants, which you may find more comfortable. You will need to simply body wash to keep clean in the first 10 days, but after this, you should be able to return to normal bathing and showering. The stitches around the tummy button are usually removed between 7 and 10 days.
Recovery & Aftercare
In terms of pattern of recovery, most patients will require help around the house or with children for the first week and are up and about and pottering by the end of this week. Patients can usually return to driving in between 2 – 3 weeks and return to a light job in 2 weeks and a heavy job at 3 weeks if the recovery goes well. It is possible to return to light sport at 6 weeks and build up thereafter.
All patients notice numbness of the lower abdominal skin and this can last for up to 3 months. Although the sensation returns, it never returns fully.
There is a varying degree of bruising and swelling, particularly in the side of the hips where liposuction is carried out. This usually lasts two to three weeks.
There are disadvantages and risks as with all surgery.
Most patients’ abdomens have settled well at 6 weeks, but it does take up to 12 weeks to settle fully and the scars themselves can take longer. Whilst many patients scars settle and look fine at 3 months, some patients can take up to 2 years for the scars to settle fully. There is some discomfort on vigorous exercise, which is common in the first few months, but in some patients can last up to 9 months.
- Scarring– Most scars settle well, they start off as a fine line and become red and will often go lumpy particularly in the centre of the abdomen and then will settle. In some patients, however, the scarring takes a lot longer to settle and my take up to 2 years. This is called hypertrophic scarring. Rarely, some patients develop keloid scarring where the scars grow to become quite unfavourable. However, in the majority of patients the scars settle and look reasonable at 3 to 4 months.
- Discomfort on Exercise– This is some discomfort on vigorous exercise commonly within the first few months, but in some patients this can last up to nine months. This is due to pulling on the repaired recti (6 pack) muscles.
Risks and minor complications
- Infection and Bleeding– There is a small risk of infection and bleeding which can delay and sometimes spoil the end result and necessitate secondary surgery.
- Necrosis– The death of some of the skin is rare but can occur and is more common in heavy smokers, the elderly and sometimes in re-do abdominoplasty (this is where the skin does not survive the insult of being lifted up and pulled tight).
- Delayed Healing – Occasionally, there can be delays in healing which requires dressings for a longer period than the usual few week period.
- Secondary Minor Surgery – Sometimes as the fat and skin settle there can be fullness at one part of the scar requiring minor revisional surgery which is usually carried out under local anaesthetic and will not usually incur further costs.
- Blood Clots– Rarely, there is a small chance of blood clots in the legs, as with any abdominal surgery and we try to reduce this risk by requesting that patients stop the contraceptive pill one cycle prior to surgery and by giving anti thrombosis stockings to wear for the first two weeks after surgery.
Quite often one side of the surgery will settle quicker and different from the other. Initially, you should not be upset or concerned about this as it is quite common and to be expected. The slow healing side will catch up with the fast healing side usually over the first twelve weeks.
It is important after undergoing abdominoplasty to adjust ones life style i.e., keeping ones weight stable and keeping reasonable abdominal muscles toned with regular exercise in order to avoid reverting to the pre operative state.
I insist that patients who smoke stop 2 weeks before surgery and if they are on the contraceptive pill this must be stopped one cycle before surgery. This is to reduce the risk of delayed healing and blood clots respectively.
Due to the subtleties and intricacies of the healing tissues sometimes there can be minor imperfections following surgery that may benefit from some revisional surgery. It is my policy not to charge any professional fees for this surgery however the hospital will make a charge for this unless it has arisen following an acute complication such as infection or bleeding.