An abdominoplasty is an elective (or cosmetic) procedure in which the abdomen (stomach or belly region) is surgically reshaped in accordance with the client’s needs and/or wishes.

What does this surgery entail?
A typical abdominoplasty is a procedure in which the surgeon makes a horizontal incision through the skin and fat of the abdomen near the typical level of an undergarment’s waistband. This incision site is chosen as it is at or near the lower border of the abdominal region (anatomically speaking). A second incision is then made under or around the navel. Both incisions are then lined up and then sutured together at the level of the first incision. This stage of abdominoplasty may have given rise to the popular nickname for the procedure: the ‘tummy tuck’.

Additional steps following the first incision may also be included in the procedure. For example, if the patient carries excess skin between the two incisions, this will be removed. The size and shape of this skin flap may be determined by many factors, including the patient’s wishes and the surgeon’s best judgement. In addition, some patients may have excessive abdominal fat that can be removed at this stage. This is normally done using liposuction, in which fat is taken out through a thin cylindrical implement known as a cannula. Some candidates may even find that they require longer incisions, looping around the midsection, to remove excess skin and/or fat from the lower back area during surgery.

The initial incision may also be followed by procedures that tighten abdominal muscles. This is done in cases of divarication or diastasis of the recti (the muscles of the abdomen, which are arranged in a two-by-three conformation throughout the region). This will also contribute to a flatter appearance for the patient’s stomach. The skin is then sutured along the two main incisions as above. In some cases, the navel may be ‘islanded’ (i.e. additional incisions that isolate it from abdominal skin may be made). This is often done in cases for which skin and fat removal needs may be advanced. An ‘islanded’ navel may also require a newly-shaped circular incision through re-positioned abdominal skin as it is pulled down when the two major incisions as outlined above are joined together. This step ensures that the navel is still in its ideal position relative to the rest of the body after surgery.

abdominoplasty

The procedure described above may be referred to as a traditional or conventional abdominoplasty. There are also variations that have been developed over the years. An example of these is a minor (or ‘mini’) abdominoplasty, in which a relatively short incision is made along the ‘waistband’ region. This corresponds to a shorter incision below the navel, to minimize scarring. The patient’s abdominal muscles are then re-modeled as above through this shallower aperture. These are often less intensive operations for people with limited excess skin or fat. ‘Keyhole’ abdominoplasties, in which the recti are re-modeled using advanced surgical tools that can operate through a very small abdominal incision, are also possible.

Is an abdominoplasty a good option for me?
Abdominoplasties are intended to help potential patients who feel that the current shape of their stomach is a source of considerable adversity in their day-to-day lives. These effects may include discomfort, distress or even reduced mobility. Some patients may be subject to severely reduced confidence or self-esteem. Others may find that they have developed conditions such as dermatitis, skin infections or even ulcers as a result of carrying excess belly skin. Medical authorities in some regions may stipulate that these negative effects (particularly skin conditions) may be persistent over some time without responding to other, non-surgical forms of treatment or to alternative measures such as lifestyle changes directed at reducing body fat (e.g. building muscle to manage loose skin or excess fat).

Women with overly-stretched skin or diastasis as a result of pregnancy may be suitable candidates for conventional, ‘mini’ or ‘keyhole’ abdominoplasties. In addition, people who have been affected by significant weight gain in the past, but have subsequently reduced their body mass, may also be suitable candidates. These individuals often find that they are left with large areas of excess, uncontrollably loose skin over their stomachs. It may even form an ‘apron’ that can hide the entire ‘underwear’ region. This requires an abdominoplasty that includes a comprehensive skin-flap removal step (an ‘apronectomy’). Other suitable candidates may find that their belly fat remains resistant to a new lifestyle resulting in appreciable weight-loss. In these cases, they may find that an abdominoplasty combined with liposuction is for them.

What are the potential risks of abdominoplasty?
An abdominoplasty is a major surgery, which requires sedation levels up to and including general anesthesia. Therefore, it carries risks typically associated with these procedures. These may include infection at the suture site; unexpectedly severe scarring, pain or numbness at the surgical wound site and reduced mobility due to pain. Some patients may also experience haematomas or seromas, in which blood or fluid pools under the skin at the wound site. This may require further treatment, such as drainage. Some patients may even develop large blood clots in their veins. They can be found in the legs or lungs, and may also require treatment to prevent serious health issues. The best risk management strategies include maintaining a healthy weight and refraining from lifestyle choices that affect said risks. For example, a history of smoking may increase your chances of developing blood clots, impaired healing after surgery, and possibly even excessive scarring. In addition, people with pre-existing conditions that affect their susceptibility to clots, and/or who are on medications to prevent them (e.g. warfarin or aspirin) may not be eligible for this procedure.

What should I expect after an abdominoplasty?
The general aim of a surgeon performing an abdominoplasty is to provide the patient with a flatter stomach without scarring that cannot be concealed by underwear or bathing suits. This can be avoided by taking all precautions recommended by your medical and surgical teams after surgery (also known as ‘after-care’). A potential patient should also understand that the long-term size and length of the post-surgery scar will be proportional to the extent of incision required, and is determined by the steps required in their particular abdominoplasty. Most patients are kept in hospital for up to five days immediately following their abdominoplasty. This allows their healthcare team to apply dressings and wound drainage (if necessary) and give advice on aftercare, as above. For example, only light to moderate movement may be recommended for the first 10 to 20 days post-surgery. The typical patient may be able to resume more vigorous activity (including exercise, sports or movement-intensive hobbies) after six weeks of recuperation from surgery.

abdominoplasty-before

Most post-abdominoplasty patients are pleased with the results of their surgeries. However, in the event of serious dissatisfaction with their appearance, or that of their scars, they may have to undergo secondary or revision surgeries. These procedures may involve more liposuction, scar revision or skin removal, depending on the patient’s needs and the best judgement of the surgeon.

abdominoplasty-after

This surgery seems right for me. What’s next?
Many patients start their pursuit of an abdominoplasty by speaking to their usual doctor or general practitioner. Provided that you are a suitable candidate, you may be referred to a suitable cosmetic surgeon in your area. A meeting with this surgeon may involve an assessment of your abdomen. You can then discuss which abdominoplasty type, and which additional procedures (e.g. liposuction), will address your needs.

If you can safely undergo an abdominoplasty, remember to keep up with your after-care and to follow any other advice offered by your healthcare professionals.