The tummy tuck or abdominoplasty is a great operation which makes a dramatic improvement in the abdominal contour. After childbirth or large fluctuations in weight, there is no amount of diet and exercise which will get those abdominal muscles back into normal anatomic position or restore the youthful elasticity of the skin. Although you should be watching what you eat and exercising, surgery is necessary to restore the youthful appearance of the abdomen.
There are three variations of the tummy tuck which can be performed and can be individualized to your particular needs:
Mini Abdominoplasty
Mini abdominoplasty is an operation for individuals with mild to moderate skin laxity. You will recognize this as a slight hooding of the belly button and a bit of excess skin above the pubic area. In this situation a small incision across the top of the hairline extending just beyond it is all that is required to tighten the abdominal muscles and remove a small ellipse of skin.
Modified Abdominoplasty
Modified abdominoplasty is an operation for someone withslightly more skin excess but not enough to remove all the skin from the belly button to the hairline. This operation requires a longer incision, always placed within a garment line. There are 2 variations of this operation. The first involves lowering the belly button position on the abdominal wall. The belly button can only be lowered so much and still maintain an aesthetic appearance. The upside is no incision around the belly button. The second variation involves leaving the belly button on the abdominal muscle but accepting a vertical scar between the belly button and the hairline. This is necessary when there is too much skin to lower the belly button but not enough to get all the skin from the belly button to the hairline out. The vertical scar is within the garment line and generally heals well. The overall improvement in the abdominal contour is worth the trade.
Formal Abdominoplasty
The formal abdominoplasty is for the individual who has enough excess skin to remove all the abdominal skin from the level of the belly button to the hair bearing skin. The incision generally runs from hip bone to hip bone and is always within a garment. The length of the incision is dictated by the amount of skin to be removed. The belly button is left on the abdominal muscles and is restored to its normal position after the skin is removed. While the skin is elevated, the abdominal muscles are brought together with sutures. This is the maneuver which sets the foundation for the abdominal contour. How the muscle is manipulated and the skin is removed dictates the final contour achieved. Traditionally a strong vertical removal of skin was performed which made the skin tight but did not create an improvement in the appearance of the waist. The high lateral tension abdominoplasty technique places less tension in the middle of the abdomen and removes more tissue to the side of the abdomen creating a more pleasing feminine contour and decreasing wound healing problems after surgery.
The procedure is performed as an outpatient. However, I have my patients spend the evening of surgery at the surgery center attended by a registered nurse. The operation is done under general anesthesia and local anesthesia is placed in the muscle to allow for a comfortable awakening. If pain is prevented it generally does not escalate after surgery. The following morning you may return home or arrangements can be made for further care at a Nurse attended after care facility. I encourage this for individuals with small children and those who can not have someone with them at home the first few days.
Generally speaking you are off pain medications by 7 days and drains are removed between 7-10 days. Return to work is possible by 2 weeks or even sooner depending on the individual and the work they perform.