Pregnancy and weight fluctuations can do a number on women’s abdomens. Three things tend to go wrong. Often there are genetically-determined pockets of fat in the mid-abdomen and flanks (muffin-top) that are difficult to diet or exercise away. There can be skin relaxation (and sometimes stretch marks!) that won’t tighten up, no matter how many sit-ups you do. The central abdominal muscles (the rectus muscles….these are the ones that create the horizontal lines in “6-pack abs”) can be stretched apart, creating a permanent “pooch” in the lower abdomen.
The pockets of fat can be dealt with by liposuction, which is often used as an additional tool during abdominoplasty to enhance the results. The excess skin can be removed. The rectus muscles can be pulled back together to flatten the tummy. The trade-off is scar. An abdominoplasty scar is located in the lower abdomen and usually runs from hipbone to hipbone. There is also a scar around the bellybutton. When liposuction is performed on the flanks, there is a small scar in the buttocks as well. The scar can be placed so that it is underneath your panties or bathing suit bottom. When you are naked the scar will be visible. You have to decide yourself if the permanent scar is okay with you. However, there is really no other way to get a smooth abdomen again without removing the extra skin, and that requires a scar.
The type of abdominoplasty you would need depends on your particular anatomy. Some women can get by with a “mini-abdominoplasty” which tightens the area below the bellybutton only. This works well in thin women with no upper abdominal skin relaxation. I find that women who have had a C-section birth sometimes get a small overhang of skin over that scar, and removing that scar and a little extra skin will smooth out the lower abdomen. Some women have relaxation in both the upper and lower abdomen, and need a full abdominoplasty. The scar is a bit longer, and the abdominal wall can be tightened to the upper abdomen. This offers the best tightening. Patients who have had a large weight loss through dieting or post-bariatric surgery will need to also consider a “circumferential abdominoplasty”. This involves removing skin from both the lower abdomen and the lower back. The scar goes all the way around the lower torso. During your consultation, I will look at your body carefully and let you know what your options for improvement might be. We can discuss the pros and cons, and come to a decision on how you wish to proceed.
Abdominoplasty is performed in our surgery center here at 95 Scripps Drive. You arrive one hour prior to your scheduled surgery time. During that hour you change into a surgical gown, talk to the anesthesia doctor, and I mark your abdomen with the planned incision lines and areas to suction. The surgery itself takes 2-3 hours, and then you stay in our recovery area for another couple of hours. We send you home wearing a girdle (to reduce swelling and bruising) which you wear for about four weeks after surgery. You will have a “drain” which is a small tube that collects the weeping tissue fluid that is created by the fatty layer. We need to draw this fluid out to again reduce the swelling and discomfort. The drain usually stays in place for 1-2 weeks. I also use a “pain pump” which is a reservoir of local anesthetic fluid. The reservoir is attached to some very thin tubing that sits next to the abdominal muscle repair. The pump automatically dispenses local anesthesia to the area to keep it somewhat numb for the first three days after surgery. The use of the pain pump greatly reduces your discomfort, and your need for pain medication.
Once you are home, we want you up and moving as quickly as possible. The worst risk of any type of abdominal surgery is a blood clot in the calf, known as a deep venous thrombosis or DVT. Abdominal surgery can create pressure in the groin area that slows the blood flow back from the legs. Slow blood flow can result in a clot. If a clot forms, it can cause pain or swelling in the leg. If the clot “breaks off” it can travel in the bloodstream to the lungs (pulmonary embolism or PE) and cause chest pain, shortness of breath, and palpitations. It can be life-threatening! Thus, it is very important that abdominoplasty patients be up and moving quickly, drinking plenty of water, and aware of the signs and symptoms of DVT/PE. The risk is greater in women who are overweight, on hormones, or smokers. I will always encourage women to try and reduce their BMI below 30 prior to any abdominal procedure. It not only reduces your risk of complications, but improves your result and your overall health outlook.
The recuperation after abdominoplasty usually requires between 2-4 weeks. The first 2-3 days are a bit rough, but after that you will notice slow and steady improvement. You will look really good at one month, but to get to a “final” result usually takes about 4 months. The abdominal skin will feel somewhat numb after surgery, and takes a few months to return to normal. Sometimes the skin just above the scar centrally will feel a bit different long-term, but is usually not at all bothersome. Scars will take a year or two to fully mature and fade as much as they will.