Preparation & Recovery
Abdominoplasty, or tummy tuck, is a cosmetic surgery procedure that provides both aesthetic and practical benefits. Tummy tuck patients have usually achieved significant weight loss, or have given birth to one or more children, and wish to restore a lean, toned midsection.
Patients must understand that in order to ensure a successful procedure, extensive preoperative planning is essential. Meanwhile, recovery will involve very specific instructions from your surgeon that should be followed closely.
A tummy tuck almost always involves the removal of excess skin, fat, and other tissue, along with the tightening of the underlying abdominal muscles. It requires both internal and external healing. Therefore, it is especially important for your surgeon to make certain that any risk of excessive bleeding and other complications during surgery is minimized.
During a pre-op consultation, you should be prepared to discuss your medication and supplement regimen in great detail. You should also be prepared to talk about your own medical history. Both of these aspects have to be reviewed in order to assess your risk of developing potentially dangerous blood clots and bleeding excessively during surgery. If you use tobacco, you must also understand that you will be expected to stop nicotine intake of all kinds at least three months prior to surgery, and continue to abstain during recovery.
Depending on the extent of your surgery, you can expect to spend anywhere from three days to a week or more limiting yourself to minimal physical activity. You certainly will not be bed ridden during this time, but you will be expected to avoid activity that is more strenuous than walking very short distances. You will also have to take very special care to avoid placing any strain on your incisions.
Gaining an understanding of the entire abdominoplasty process from pre-operative planning to full recovery can play an important role in the success of the surgery. This knowledge can help you feel confident in your decision to undergo body contouring, and help you play an active role in achieving the best possible results and the longest-term satisfaction with your refined midsection.
The Pre-op Assessment
During the pre-op assessment, you can expect your surgeon to conduct a close evaluation of your risk of thrombosis, or the formation of blood clots inside blood vessels. Blood clotting is a natural process that is essential in healing. For example, when you experience a minor cut on your skin, the scab that forms is a result of blood clotting. In most cases, blood clots dissolve on their own. However, when a blood clot inside a blood vessel fails to dissolve, it can obstruct proper blood flow to the lungs, brain, and other areas, which can cause serious health complications.
In order to minimize your risk of developing blood clots, you will be asked to stop taking birth control at least two weeks before surgery. You will also have to stop taking any hormones or supplements such as fish oil, and aspirin. The American Society of Plastic Surgeons requires that you sign a consent form confirming the cessation of all supplement intake. In addition to reducing your risk of developing blood clots, stopping your intake of supplements and other medications also helps to minimize bleeding during surgery.
Your risk of developing a dangerous blood clot may be higher if you have previously had deep vein thrombosis, or the formation of a blood clot in your leg. If you have had cancer, or if you have a family history of cancer, this must also be considered. Another part of assessing your risk of thrombosis involves a test called the Caprini Risk Assessment Model. It takes note of factors such as your age and any recent injuries or surgeries. A point system indicates whether it is safe to proceed with abdominoplasty, or if any special measures should be taken to ensure your safety during surgery.
Umbilical and Ventral Hernia
Umbilical and ventral hernias are conditions that must be addressed prior to undergoing abdominoplasty. An umbilical hernia occurs when a portion of the small intestine protrudes through a natural opening between the abdominal muscles. Though the condition is fairly common and usually does not create any painful or debilitating symptoms, it can complicate abdominoplasty.
A ventral hernia occurs when part of the intestines push through a tear in the abdominal wall. These tears are sometimes the result of an incision made during a prior surgery. Either of these conditions can inhibit blood flow, which can in turn complicate the healing process. During a patient's initial consultation, I conduct my own physical analysis of the patient and a review of his or her medical history to determine if either of these conditions are present.
Your Ideal Body Weight
Patients frequently pursue abdominoplasty surgery because they have experienced significant weight loss, leaving them with stretched skin and separated abdominal muscles. These conditions can be quite uncomfortable, resulting in rashes and irritation. Meanwhile, they can obscure the results of the patient's weight loss achievement.
Once patients have undergone a tummy tuck, it becomes very important to avoid dramatic weight fluctuation in the future. That is why I always spend time during the initial consultation to help the patient determine their ideal weight, and evaluate whether he or she is currently within a reasonable proximity of that weight.
If, for example, the patient wishes to achieve further weight loss, we must consider whether the results of abdominoplasty might be more flattering once the patient's goal has been met. On the other hand, we must consider the likelihood that the patient will be able to maintain their ideal weight. By discussing the patient's lifestyle and goals in great detail, we can determine whether the planned extent of surgery will provide results that will be compatible with the patient's lifestyle for the long run.
Abdominoplasty and Pregnancy
Many abdominoplasty patients are mothers who wish to refine their midsection following childbirth. Carrying a child can cause the abdominal muscles to separate, and stretch the abdominal skin. In addition to considering ideal body weight, female patients must contemplate the likelihood of wanting more children in the future. Often, the best time for a mother to have abdominoplasty is when she is certain she does not wish to have more children.
Extent of Treatment and Extent of Recovery
The extent of your treatment is the greatest determining factor in the amount of downtime needed following surgery. There are three primary classifications of abdominoplasty surgery: mini, standard, and extensive.
A mini tummy tuck focuses on the area below the navel. It typically involves an incision placed between the hip bones, some tightening of the abdominal wall, and the removal of excess fat and tissue. It usually only requires about a week of minimized physical activity before patients can resume more rigorous activity.
A standard tummy tuck is similar to a mini tummy tuck, but can include treatment above the navel. An extensive treatment usually involves liposuction and other treatment extending to the flanks, or love handles. Both of these tummy tuck procedures can require weeks of minimized activity following surgery.
Both standard and extended abdominoplasty often require that I place drainage tubes that help prevent the buildup of blood and fluid at the incision site. I will usually remove the first of these tubes after about three days, and the remainder are removed a few days later. I always provide a special support garment that can further prevent the buildup of fluid.
Meanwhile, patients should understand that they will not be expected to be immobilized during recovery - nor should they be. By getting up and walking around the house to carry out simple day to day tasks, patients can further reduce the risk of developing harmful blood clots. In other words, while a patient who had surgery days ago should not lift a heavy bag of groceries onto the counter, they are encouraged to stand up and walk to the kitchen for a glass of water. During recovery for any extent of abdominoplasty, it is very important for patients not to do anything that could place strain on their incisions. Incisions are usually fully healed after two weeks.
Each patient's case is different, but generally speaking, those who have sedentary jobs that mainly require sitting at a desk can return to work about a week after abdominoplasty. Those with more physical jobs will probably require at least two to three weeks before returning to work.
You should expect to visit your surgeon the day after surgery to fully assess your condition. During this appointment, I usually fit the patient with their support garment, which will help to prevent the formation of blood clots. After the first follow-up, I schedule weekly visits. These continue depending upon the patient's extent of treatment, as well as his or her risk factors in developing blood clots and other complications.
Nicotine Compromises the Ability of the Body to Heal
It's no secret that tobacco use is a potentially deadly habit that can have many adverse affects on your health. However, many patients do not realize that nicotine can severely compromise the body's ability to heal. Considering the extent of treatment abdominoplasty can require - incisions, liposuction, excess skin removal, and tightening of the abdominal muscles - a patient who smokes must make a commitment to detoxifying themselves at least three months prior to surgery, and continue to abstain from cigarettes as they heal. This also involves taking measures to avoid second-hand smoke. Ideally, they will cease smoking altogether once healing is complete.
Smoking specifically hinders two very important functions: the ability of cells to divide and grow, and the ability of white blood cells to eliminate bacteria that can lead to infections.
Nicotine causes blood vessels to become more narrow, making it difficult for red blood cells to deliver oxygen to the skin cells at the incision site. When the delivery of oxygen is inhibited, it can delay healing considerably. Meanwhile, if the function of white blood cells is compromised, a patient has a much greater likelihood of developing an infection, which can result in serious health complications and take a toll on the aesthetic results. If you are a smoker who is considering undergoing abdominoplasty, it is not too early to begin exploring strategies to eliminate nicotine from your life for good.
Medication and Pain Management after Surgery
Obviously, you can expect some pain and tenderness following surgery, but your surgeon will provide you with a recommendation for pain management. I personally administer EXPAREL®, an injectable painkiller that provides three to four days of relief, and eliminates the need to take oral medication in order to maintain comfort. It is important to keep your bowels moving after abdominoplasty, so I always recommend that patients take laxatives during recovery. I also prescribe antibiotics to further reduce the risk of infection.
Alcohol and pain medication absolutely do not mix, but once a patient is finished taking pain meds, I usually allow him or her to have a glass of wine when they choose, which can be a nice way to relax.
Patient Profile: Jeanette
My patient Jeanette underwent abdominoplasty about four months ago. She said the level of comfort and mobility she experienced during the first week of recovery was surprising.
"That same day after my surgery was completed, I was able to walk by myself and get dressed," Jeanette said. "The pain wasn't there at all. It felt tight, but I was moving around just fine. As Dr. Barone instructed, I just took it easy. Wearing my support garment helped a lot, and I went on with doing what I needed to do with no issues. My friends and family were like, ‘Wow, we cannot believe you just had surgery.'
"I had drains placed. I think having them hanging felt a little awkward and uncomfortable, but that was only for about a week. I didn't accumulate a lot of fluid because I wore my garment all the time. When it was finally time for them to come out, it was painless."
Jeanette was able to start working out after about six weeks. After 8 weeks, she was able to incorporate abdominal exercises into her routine. She says anyone planning to undergo abdominoplasty surgery should be prepared to follow the doctor's orders closely, and be patient as swelling subsides.
"Personally, I think people need to mentally prepare themselves," she said. "You just had surgery, so of course your body will swell. You will be thinking, ‘Okay, I'm going to get a tummy tuck, and then I'm going to look amazing.' But that takes time. It's a process, and you need to be aware of that. You won't see an amazing new tummy after one or two days. It will be flat, but the swelling takes up to a year to finally subside."
Prepare for Success
Thorough preparation and a proper, well-monitored recovery spent carefully following your surgeon's instructions can result in a beautiful, natural-looking enhancement that provides you with many years of comfort, satisfaction, and boosted self-esteem. Patience is a virtue in every stage of your treatment. Be ready to discuss your medical history in great detail during your pre-op evaluation, and understand that you will be dramatically reducing your physical activity immediately following surgery.
If you find a surgeon who is willing to take a thorough and patient approach to preparation and recovery, and if you are willing to take every measure to cooperate with your surgeon's recommendations, abdominoplasty can provide you with a flattering new body tone and an improved quality of life.
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