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This procedure is the removal of excess skin and fat from the abdominal (stomach), area. It is used to improve the cosmetic appearance of the stomach including the umbilicus. It has gained more popularity in the private sector over the last few years due to restrictions imposed in the NHS on offering this surgery due to the lack of funding. I have noticed a significant increase in the numbers of this type of surgery in my private practice over the same period.

The abdominoplasty procedure also includes tightening of the sheath of tissue that surrounds the abdominal muscles which brings the muscles closer and gives the curved appearance around the central tummy. This curved appearance is known by some by the term “champagne flute” and is a feature of the younger pre-pregnancy or weight gain tummy.

A tummy tuck is not a substitute for exercise, however, it is beneficial following considerable weight loss and/or following the changes of pregnancy, where the skin may appear loose with an overhang known as an apron.

Even after frequent exercise some women are unable to tighten the abdominal wall, therefore a flatter and smoother abdomen can be achieved with this procedure. Stretch marks although reduced in number as a result of skin excess removal; nonetheless they are still present in the remaining skin albeit in smaller numbers.

A tummy tuck is not to help reduce weight, and the best results are obtained by already being the correct weight in proportion to height, which is the body mass index (BMI). The BMI is advised to be 30 or less prior to the surgery. Weight stability is also important following the surgery as significant weight variations can impact negatively on the long-term results of the surgery.

Although combining liposuction of the tummy skin at the same time as an abdominoplasty has been described and is practiced; however, in my 18 years of experience and weighing the risks and potential complications I feel that it is best to perform this at a later stage if warranted or desired.

I do perform liposuction to other areas e.g. the flanks (love handles), at the same time as a tummy tuck. This can give a nicer improved contouring in selected patients without significantly impacting the blood supply of the skin or increasing risks.

A number of abdominoplasty types exist, which include a mini-abdominoplasty that is designed to deal with tummies with limited excess in the lower third with no overhang, good quality skin and good muscles. A mini abdominoplasty can be combined with liposuction safely.

A traditional abdominoplasty is the commonest type performed and is designed to tackle the excess of fat and skin excess (overhang, panniculus) below the belly button. The belly button is repositioned and its hooded look is improved. This surgery can be performed with liposuction to adjacent areas like the love handles (flanks), at the same time. The scarring for this type of tummy tuck is a transverse scar in the bikini line and a scar around the belly button.

A Fleur De Lys abdominoplasty adds tightening to the sides of the tummy especially when patients have lost significant weight at the expense of adding a vertical scar, which extend from the lowest part of the sternum bone (xiphisternum) to the area above the pubic hair, with repositioning of the umbilicus.

In patients with very large weight loss either by diet or following weight loss gastric surgery a belt Lipectomy is added which improves the flanks and lower back and also to a certain extent the buttocks. This surgery includes liposuction to the lower back and flanks. The scarring for the belt Lipectomy will follow the upper aspect of the buttocks in a curved fashion and joins the transverse scar of the tummy tuck to the sides. It is the aim to contain the scars in all tummy tuck types within the bikini or lingerie lines; however, this may not be possible in all patients.

Other procedures to contour the body can be added at the same time as a tummy tuck, which can then be known by the term “yummy mummy” makeover.

WHAT TO EXPECT

An abdominoplasty in its different forms is usually carried out under general anaesthetic and involves being in hospital for 1-2 nights. When combined with other procedures a third night stay may be favoured.

You are advised to cease taking the contraceptive pill one cycle before the surgery and take other precautions. You are also required to stop smoking 4-6 weeks prior to surgery, and 3-4 weeks after surgery to improve healing and reduce risks of infection.

The stitches are usually dissolvable and will be trimmed at 10-12 days following the surgery. Surgical drains are used in my practice, which in the majority of patients are removed at discharge. In a very small number of patients the drains may remain until following discharge, however, they are unlikely to remain more than 10 days after the surgery.

Bruising may occur especially when liposuction has been performed, this bruising is likely to improve over the following 2-3 weeks. Swelling is expected and in the majority of patients improves in stages, the first 3-4 weeks, then 3 months onwards. This can be helped with special massages designed to assist and improve the lymphatics. All this can be discussed with the surgeon on your first post surgery follow up. In addition scar management will be discussed with at the same follow up.

In some patients swelling may not be symmetrical and as such there is nothing to be alarmed off as in the majority this will settle.

The scars pattern can also differ between patients as this depends on the skin excess, laxity, and its distribution, in addition the scars locations in as small number of patients may not always be symmetrical. Prior to surgery in some patients the belly button may not be central prior. Hence, the surgeon will do their best to reposition it centrally, however, this may not always be possible.

Pain is patient dependent and is usually treated by pre-emptive management, painkiller injections during surgery are given to block the pain, and then by injection on the ward until discharge. Tablets for pain control are also dispensed for your use when at home.

With the more major procedures injections under the skin may be given to reduce the risks of clots in the legs. A corset is usually is worn in the first 4-6 weeks. Return to daily living activities, driving and work can vary between individuals. This can range between 4-6 weeks, and in the more major surgery can be 6-8 weeks.