Project Description

Abdominoplasty, sometimes called a “tummy tuck”, is performed on women and men to remove excess skin which can result from a dramatic loss in weight or where an ‘abdominal apron’ has developed. Abdominoplasty can also remove stretched and scarred skin following pregnancy. It can be performed in conjunction with a number of procedures like liposuction of the thighs or breast augmentation, or as a preliminary procedure to a full body lift.

Abdominoplasty surgery is an extensive and uncomfortable procedure and is performed under general anaesthetic. Patients will have limited mobility for the first few days and will also find it difficult to straighten up for up to two weeks. The abdomen softens over the next few days in hospital, and by the time you are ready to be discharged from hospital you will be able to care for yourself and slowly manage your movements.

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An Abdominoplasty can be so much more than aesthetically pleasing, performed correctly it can restore core strength and function to the body.

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Reasons

Having children is wonderful event in a women’s life.  However, pregnancy stretches apart the midline of the abdomen which may not shrink back after childbirth and can leave a permanent weak area.  This alters the way the abdomen works.  It now bulges on standing and the weakness also spreads to the back and pelvis, leading to back pain and a weak pelvic floor with stress incontinence.  The skin of the abdomen has been stretched in pregnancy and this may not shrink either after the second or third child.  It can exhibit stretch marks, localised fat collections and sagging.  A lot of women put up with this as they push their needs to the background looking after children, accepting their bodies have changed for the worse and that is the price they pay for pregnancy.

It doesn’t have to be that way. It amazes me the things women put up with.  If your knee was injured, you wouldn’t just accept it, you would get it fixed.  The post pregnancy abdomen has the same impact on daily life as it can impede on your ability to get out of bed in the morning, get up off the floor, lift children or heavy shopping bags into cars,   jump on the trampoline (or even laugh or cough) without bladder leakage. It is everyday life function an abdominoplasty operation will restore – core strength, continence and as a side benefit, the wrinkly lower abdominal skin will be removed and the waist lowered and narrowed, producing a more ‘hour glass shape’.

A large majority of my patients who present for abdominoplasty are fit, well-toned women who are regular gym attendees.  Often they have spent hours working on their abs to improve the tone and strength of their muscles but to no avail. Unfortunately, despite the best efforts, exercise will not help a sagging tummy or a bulging one as exercise will only tone muscle.  Exercise can’t tighten skin or fascia nor can it repair the torn or separated muscle wall which can occur during pregnancy.
The development of abdominal hernias following pregnancy is very common.   Some women stretch their midline so severely during pregnancy the previously thick tissue becomes very thin and can tear, like swiss cheese. This  leaves holes for the abdominal contents to poke through, however there are a number of women who suffer from hernias prior to pregnancy who can also benefit from this procedure.

A hernia to use a medical definition is “an unusual protrusion of abdominal contents through a hole in the abdominal wall”.  They are usually seen in the midline of your abdomen as a lump about the size of 20 cent piece and are frequently tender.  Symptoms can include soreness and uncomfortable swelling and bloating.  Occasionally layers of the bowel can be caught up in the protrusion and this could be serious if it gets twisted or gangrenous in the hernia.

The very nature of the abdominoplasty surgery allows a more exposed repair which is stronger and more reliable than the traditional methods.  Operative exposure of the abdominal wall during an abdominoplasty allows easy reduction of the hernia and the extending of the muscle repair from the chest to the pubis, removes the weak midline problem.  With the tension shared equally down the abdomen in a muscle repair, no plastic mesh is required.
Removing an umbilical hernia at the same time as the abdominoplasty can be tricky as the blood supply to the remaining umbilicus can be affected by the hernia repair.  Sometimes the umbilicus needs to be sacrificed and reconstructed with a skin graft.

Liposuction has been the greatest advance in body contouring in the last 20 years.  The ability to remove fat beneath bulges with only a couple of small remote incisions was revolutionary.  Liposuction however can’t fix all woes and there is still a place for excisional surgery.  In many cases, liposuction combined with skin excision can be performed to produce a superior result.  Liposuction of the lateral thighs, inner thighs, knees and flanks can be combined with an abdominoplasty to successfully take years off a figure.
I was intrigued to see an article in a magazine recently trumpeting “Half their Size”.  The article showcased people celebrating the loss of between 80-90kg.  This is an amazing result achieved either through sheer will power or stomach surgery.  Significantly though, all the post weight loss pictures were clothed.  It is great people can go from wearing a tent to fitted clothing but the truth is the picture is not so pretty once clothing comes off.

Massive weight loss leads to significant skin redundancy.  Body types may differ, but generally people weighing over 130kg will carry a ‘spare tyre’ which is largest right in front.  Depending on the amount of weight lost, this fatty apron can hang down almost to their knees.  Once the weight is lost the skin rarely retracts and the flap is left behind An abdominoplasty allows me to repair the separation of the abdominal muscles, liposuck the uneven flanks and remove at least 50cm or more of excess skin.    Removing this apron of skin leads to a much more comfortable existence.

Often referred to as the ‘Mummy Makeover” the opportunity to combine an Abdominoplasty with Breast augmentation can restore a women’s pre-baby figure and deliver a WOW result with only one period of recovery.

 

Considerations

The best way to determine if you are a candidate for abdominoplasty is to put your thumb in your belly button and your finger above the pubis, anything you can grab gets cut away.

Removing a wedge of lower abdominal skin means a long incision from one hip to the other dipping down over the top of the pubic hair. The incision is designed to be as inconspicuous as possible and be hidden as much as possible by a modern bikini, or by higher cut underwear. It is not possible to guarantee the scar will be hidden by all swimwear, particularly as the fashion in these garments tends to change.

Once the incision is made the skin and the fat of the abdomen is lifted up, off the muscle wall up as far as the ribs the extent of the undermining is shown by the orange. The umbilicus is separated from the skin of the abdomen and left attached to the muscle wall. At this stage the divarication of the rectus muscles is repaired. The skin of the abdomen is then pulled down and in, the excess is trimmed off and the wound closed in several layers over two suction drains. The umbilicus is then brought through to the new abdominal wall, in its new position.

Dr Taylor uses drains postoperatively.  The use of the drains provides a number of benefits to the patient.

Following surgery, fluid builds up around the surgical site, drains remove this fluid and therefore the swelling and stretching is reduced as is the pain associated with this.  This fluid can also collect and form seromas or possible infections.  Dr Taylor with a clear picture of what is happening inside – if there is a problem it can be seen in the drain and acted on immediately rather than when you are at home and not sure what to do.

Dr Taylor performs abdominoplasty surgery either at Sole’vita Surgery or Calvary John James Hospital in Deakin.  Admission to the hospital is on the day of surgery.  The surgery can take between 4 and 5 hours depending on the extent of repair which must be addressed.  Patients return from theatre with a catheter, patient controlled anaesthetic (PCA) and drains.  The catheter and PCA is removed on day two and the drains are removed on the day of discharge.  On return from theatre patients are placed in a very tight fitting compression garment.  This garment is worn 24 hours a day (excluding showering) for the first two weeks and then during the day for another 4 weeks.

Following such extensive surgery bruising and swelling are to be expected. The liposuction component of the surgery will cause the most discomfort and often patients describe the straightening up process like a chinese burn. It is for this reason we recommend a prolonged hospital stay.

Patients are encoraged to take a minimum of 3 weeks off work and plan not to be back to normal routines for at least 6 weeks.  A discreet medical certificate will be provided to ensure patient recovery is not compromised.

Dr Taylor will visit you in hospital everyday and manage your recovery, sutures are removed at two weeks and Dr Taylor will see you then and again at the 6 week and 6 month stage of your journey.

Over the past few years we have tried to establish processes which help our patients recover faster from this surgery.  Working with Movehappy Healthcare we have introduced the ‘Early Intervention Program”.  This program allows our patients to straighten up faster, decrease the pain, and generally feel more in control in their recovery.

Patients are offered this progam as option to their recovery.

In the excitement of the surgery patients often overlook the importance of preparing for it.  What  patients do in the lead up to surgery and knowing how to plan appropriately for your recovery can make the difference between an anxious process or a more relaxed one.

Because we were frequently approached by patients who wanted to know what they could do in preparation for the surgery we put together a “pre-surgery program”.  Now seven years later we know the value of this program and offer it to our patients as part of the service we provide.

If your surgeons doesn’t offer this then you can do it yourself.  We use a multivitamin to ‘detox’ the body which aids recovery getting patients back on their feet faster.  We also use a herbal medication to reduce the bruising and swelling associated with the surgery, again we have found this to be highly effective.

Knowing what to expect is vital to the planning of your recovery.  Understanding what you can and cannot do will ensure you are not put in a position where you put yourself or the success of your surgery at risk.  All this will depend on your personal situation.  How much time do you need off work? Do you need to drive?  Do you live alone?  Do you have a family that relies on you? Do you have small children? Do you have to lift children or heavy objects in your day to day life? Do you play sport? What is going on in your life for the first six weeks after surgery?

Again answering these questions will ensure you have planned appropriately for your surgery and your recovery.

In a majority of cases Abdominoplasty is claimable on both Medicare and your Private Hospital Insurance.

Basically there are four fees associated with the surgery; • Surgeons fee • Anaesthetic Fee • Theatre Fee • Hospital Accommodation Fee

Your surgeons fee should include the fee for the surgeon to perform the surgery and all post operative care including any post operative complications or the management of any adverse event Your Anesthetic fee should include the fee for the anaesthetist to administer anaesthetic (sedation or general anaesthetic).

The theatre fee includes the cost of equipment, consumables, drugs, staff, insurance and overheads associated with performing the surgery. The Hospital accommodation fee may either be a ‘day stay’ or an ‘overnight’ fee.  It will include the bed, staff, drugs, insurance, consumables and insurance required to recover a patient from an anaesthetic or surgical procedure.  In the case of abdominoplasty you can expect a three to five night stay in hospital.

Uninsured patients can expect to pay between $16- 18,500 (depending on the number of nights in hospital) out of pocket and insured patient $10-11,00.

Following your consultation with Dr Taylor a more accurate quote will be provided.

Specifc Risks for Abdominoplasty

The umbilicus needs to be cut away from the skin, when a large amount of skin is removed from the lower abdomen. It is left attached to the muscle of the abdomen and then brought out to its new position on the abdominal skin flap. Occasionally there is not enough blood supply from the abdominal wall to keep the umbilicus alive and it dies. The wound then heals slowly. The scar at the new attachment of the umbilicus to the skin can become thickened and unsightly. As much as possible, this scar is hidden deep, where it will not be as visible.
Skin necrosis is the loss of skin from the wound due to lack of blood supply. Normally the blood supply to the abdominal wall comes from around the flanks and also from the muscle below. The contribution from the muscle is removed during the operation as the skin flap is raised, so the blood supply to the skin suffers. As the skin is repaired under some tension after the excess is excised, the blood supply may be further impaired, leading to areas of skin loss. It is rare that skin grafts are required. More likely the wound will heal and the larger scar can be revised later. Smoking will cause skin necrosis in this operation. Smoking causes small blood vessels to constrict decreasing blood supply. Previous operation scars, such as old style gall bladder incisions can also affect the blood supply.
Bleeding can occur directly after the operation. After the skin flap is raised over the abdomen and replaced, there is a large thin space that still exists between the muscle and the skin. Bleeding can occur into this space and, while rare, if severe enough may warrant another trip back to the operating theatre to tie off the bleeding vessel.
A seroma is a collection of serum, the thin straw coloured fluid that the body exudes when healing wounds. The space between the skin flap and the muscle can be filled with serum. This can lead to irregularity in the final contour of the abdomen, to the increased possibility of infection and occasional troublesome drainage of serum from the abdominal wound. Preventing a Seroma means making the skin flap and muscle wall heal together as fast as possible to minimise the space between. To this end, suction drains are used in the cavity to drain excess serum as it forms and a pressure garment is used around the abdomen to press the two layers together. If a seroma collects, after drain removal, it will need to be drained by needle every few days. In difficult cases a drain may need to be reinserted. This will require a further trip to the operating theatre.
Poor scarring can be a problem with abdominoplasty. This is a long wound. All efforts are made to avoid scar problems but they can occur. The two problems are stretching and thickening. Stretching leads to a wider scar. The scar is flat or indented, soft, pink and may be up to one centimetre in width. It is a cosmetic problem and is not uncomfortable. Thickened scars can be a problem. In this case scars become raised, hard and wide. They are often red and itchy. Dr Taylor will ask you if you have had any previous keloid or thickened scars. Keloid scars can be treated with pressure therapy and steroid injection, should they occur. Thickened scarring occurs most commonly over the pubis, less so laterally.

At CAPS we are well aware this can be a significant issue for patients and have a full scar managment program which will minimise this risk.

 

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Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner (eg. your GP).