DESCRIPTION
Many women find that the abdominal
area tends to become more flaccid with age and after
pregnancy.
Most of this flaccidity occurs in the lower abdominal
area between the umbilicus and pubic region. Although
this condition is most frequently seen after multiple
pregnancies and childbirth, it may occur simply as result
of aging tissues. The age at which these changes occur
varies individually among patients. Patients of varied
ages, ranging from the late twenties to late fifties,
frequently present with this complaint and desire correction.
The correction is a surgical procedure commonly called
a “TUMMY TUCK” or an “ABDOMINOPLASTY”
or “ABDOMINAL
LIPECTOMY”. These are all terms used to describe
the same procedure and are interchangeable. The great
majority of “tummy tucks” are performed
on women, however men comprise a significant rising
percentage. The overall purpose is to correct the existing
flaccidity and reshape the area.
There
are variants of the tummy tuck. However, for the purpose
of this discussion we will speak about a Traditional
Tummy Tuck (or TTT) and a “Mini-Tummy Tuck”(or
MTT).
PROCEDURE
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The
TTT is performed by making a transverse incision that
extends from one hip, across the area just above the
pubic region and then on to the contra lateral hip.
The extent of each incision will vary with the patient's
figure. As you are already aware, body shapes are widely
varied. It is safe to assume that the heavier and more
pendulous the abdomen, the longer the incision will
need to be. TTT can range from removing just a small
amount of skin and fat to removing a fairly large amount
of tissue.
This incision allows the elevation and dissection of
the entire abdominal skin and fat, from pubic region
to the costal margin or rib cage, and breastbone or
xyphoid. The umbilicus does not get removed or cut off.
Dissection is carefully done around the umbilicus while
the rest of the skin and fat are lifted. Dr. Perez-Gurri
is then able to remove the entire portion of skin and
fat that lies between the umbilicus and pubic area.
Although this greatly improves the situation of the
excess skin and fat it does not address the flaccidity
of the underlying muscular abdominal wall.
Underneath the skin and fat of the abdominal wall lies
the muscular layer of the abdomen. The main muscle of
the abdomen is the rectus abdominis. This is a muscle
consisting of two narrow and straight muscle strips
that extend from the lower abdomen near the pubic region
to the costal margin or rib cage. Usually these two
strips of the muscle are very close together. As a result
of pregnancy, weight gain and overall flaccidity, the
muscle strips have separated. The resultant area is
left very thinned out and weak. During this part of
the operation, Dr. Perez-Gurri will suture these muscle
strips together, side-to-side from the pubic region
to the breastbone. This in effect creates a “corset”
like effect, thereby tightening and strengthening the
abdominal wall.
Next, the skin that was originally at the level of the
umbilicus is now free to be pulled down to the pubic
region. It is then sutured in place. Drains will be
placed underneath the skin and brought out separately.
These drains are usually removed during the first post-operative
week depending on the amount of drainage. The patient
has sterile dressings applied followed by an abdominal
binder or some other type of compressive surgical garment.
The MTT varies from the TTT in the amount of tissue
that is removed, the size of the incision and the amount
of muscle work that is performed. In a MTT the amount
of skin is limited to an area just above the pubic region
and below the umbilicus. Dissection of the umbilicus
is not performed and muscle suturing is only done in
the area below the umbilicus. The MTT is a limited operation
reserved for special situations usually involving younger
patients who are not overweight.
POST-OP RECOVERY
You
will be allowed to go home after your surgery. You will
need to wear the abdominal binder for the following
4-6 weeks. It should be tight fitting but not uncomfortably
tight. Dr. Perez-Gurri will see you the following day.
If you are in the hospital, he will see you before discharge.
If you went home, he will make a home-visit the following
day. We want you to be comfortable at home so please
wear loose fitting clothes and flat shoes. We strongly
suggest the use of a recliner for the fists few days.
In bed, prop pillows under your thighs and behind your
head. This will allow your body to bend at the waist
and therefore take some tension off your suture line.
It is absolutely normal to feel tight and experience
pain and discomfort in the abdomen, rib cage and back.
These symptoms will improve with each passing day.
Your
prescriptions will be given to you prior to surgery,
have them filled. Always have someone else administer
your medication to prevent excess ingestion of medicines
by self-medication. You may walk and go to the bathroom
on the evening of your surgery. Certainly by the next
morning you should be walking short distances in your
house. If you have any questions, call the office.
You will visit the office during the first week to have
your drains and sutures removed. It is extremely important
that you accurately record the drainage coming from
your drains every twenty-four hours. These values will
determine when we will pull the drains out. Don’t
fret; removing the drains does not hurt.
Most patients require two weeks of recovery time before
they return to work and /or drive their car. If your
work requires strong physical activity, it may be wise
to plan for three to four weeks of recovery. Exercise
may be continued after 6 weeks and regular household
chores within three weeks. Every patient will experience
some thing different. If you feel great, don’t
over do it.
COMPLICATIONS OF ABDOMINOPLASTY
Although
complications are not frequent, you need to be aware
that the following complications may occur:
HYPERTROPHIC/KELOID SCARS, LOSS OF TISSUE AND /OR UMBILICUS/ALTERED
SENSATION (EITHER INCREASED OR DECREASED), SEROMA FORMATION
(COLLECTION OF FLUID UNDERNEATH SKIN), HEMATOMA, BLEEDING,
CONTOUR IRREGULARITIES, POSSIBILITY OF PULMONARY COMPLICATIONS
INCLUDING BUT NOT LIMITED TO PULMONARY EMBOLUS (blood
clot)
Some of these complications if severe enough, may delay
recovery time, require further surgery for correction
at additional costs and may involve other specialists
within medicine. Please be aware that smokers, diabetics
and overweight individuals have a higher incidence of
complications when compared to those who don’t
smoke, have diabetes and/or are overweight. You should
also note that patients undergoing combined procedures
(i.e. hysterectomy and tummy tuck) will have a higher
complication rate than those undergoing a single procedure.
WHAT & WHAT NOT TO EXPECT
These
procedures are considered body contouring in nature.
They are not meant as substitute for weight reduction
or an exercise routine. We have found that one of the
key factors in achieving patient satisfaction is patient
expectation.
There seems to be an inverse relationship with expectation
and satisfaction. That is, the higher the expectation,
the lower the satisfaction. Body image is unique and
what the patient frequently sees may not be what is
seen by the surgeon. Therefore, it is important that
you become keenly aware of your expectations for the
procedure, know its limitations and fully discuss any
concerns that you may have regarding the procedure with
Dr. Perez-Gurri. We encourage questions and have allowed
ample time to answer them personally or with our literature
and videotapes.
OTHER QUESTIONS
What
if I get pregnant?
Although there is no official position on this, there
have been cases of women getting pregnant without
any difficulty and carrying their baby to full term.
The skin is a wonderful elastic organ capable of being
stretched over time. It has been our experience that
patients may or may not need further surgery following
their pregnancy.
Will I gain weight again?
The
portion of skin and fat that was removed will never
come back again. However, if you do not watch what
you eat and neglect to exercise it is very likely
that you will gain weight in all other areas.
Are my results permanent?
Although we cannot state that they are, we know of
many cases that were performed more than fifteen years
ago, that have remained flat.
Will I be completely flat?
Maybe yes and maybe no. Remember that if you are overweight
there is always a residual amount of fat underneath
the abdominal skin following surgery that will not
allow you to be flat. Even patients who are within
their weight limit may not be “completely”
flat because their expectations exceed the possible
surgical outcome. A better term that we like to use
is to leave you “flatter”. Also remember
that even thin persons when sitting will have some
hanging skin and fat.
Will my stretch marks go away?
Very possibly. There are no permanent cures for stretch
marks. Different creams and remedies exist that temporarily
hydrate the skin making the stretch marks less visible
but they do not remove stretch marks. Lasers have
been utilized to treat stretch marks but are only
effective in reducing the color intensity of red/bluish
ones. If your stretch marks exist below the umbilicus
the likelihood is very high that a TTT will remove
them. However, if the stretch marks are above the
umbilicus or on the hips they will not be removed.
With a TTT the stretch marks above the umbilicus will
lie near the pubic area following your surgery.
The
above information has been compiled as a benefit to
you. We hope that this document has served to better
inform you on the proposed procedure. We encourage
dialogue. Dr. Perez-Gurri and his staff at Imagos
Institute of Plastic Surgery, Inc welcome your questions.
It is our sincerest wish that your surgical experience
at IMAGOS INSTITUTE OF PLASTIC SURGERY, INC. be a
pleasant and informative one. We recognize that all
patients will experience pre-operative anxiety and
fear of elective surgical procedures is normal. Our
trained professional staff and doctors are here to
serve your needs and answer your questions.
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