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If you're considering abdominoplasty...
Abdominoplasty, known more commonly as a "tummy tuck," is a surgical procedure to remove excess skin and fat from the middle and lower abdominal and (in mayor tummy tucks) to tighten the muscles of the abdomen wall. The procedure can dramatically reduce the appearance of a protruding abdomen. But bare in mind, it does produce a permanent scar and, even tough this scar usually heals in an inconspicuous way, it can extend from hip to hip (depending on the extent of the original problem and the surgery required to correct it). If you're considering abdominoplasty, this will give you a basic understanding of the procedure--when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the individual patient. Please ask the surgeon about anything you don't understand.
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The best candidates for abdominoplasty
The best candidates for abdominoplasty are men or women who are in relatively good shape but are bothered by a
large fat deposit or loose abdominal skin that won't respond to diet or exercise.
The surgery is particularly helpful to women who, through multiple pregnancies, have stretched their
abdominal muscles and skin beyond the point where they can return to normal. Loss of skin elasticity in
older patients, which frequently occurs with slight obesity, can also be improved. Skin and fat redundancy
to an extent where there is a hanging "apron" can only be corrected by surgically removing them.
Abdominoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your
looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery,
think carefully about your expectations and discuss them with the surgeon.
All surgery carries some uncertainty and risk
Thousands of abdominoplasties are performed successfully each year. When done by a qualified plastic surgeon
who is trained in body contouring, the results are generally quite positive. The Riley Surgery Center boasts
an excellent staff of doctors and nurses, as well as a state-of-the-art Surgical Suite. Nevertheless,
there are always risks associated with surgery and specific complications associated with this procedure.
Postoperative complications such as infection and blood clots are rare, but can occur. Infection can be
treated with drainage and antibiotics, but will provoke or prolong hospital stay. You can minimize the risk of
blood clots by moving around as soon after the surgery as possible. Poor healing, which results in conspicuous
scars, may necessitate a second operation. Excessive accumulation of body fluids at the operation site (seroma)
may require repeated needle aspiration. Smokers should be advised to stop, as smoking may increase the risk of
complications and delay healing. You can reduce your risk of complications by closely following the surgeon's
instructions before and after the surgery, especially with regard to when and how you should resume physical activity.
Planning your surgery
In your initial consultation, the surgeon will evaluate your health, determine the extent of fat deposits in
your abdominal region, and carefully assess your skin tone. Be sure to tell your surgeon if you smoke, and if
you're taking any medications (aspirin!), vitamins, or other drugs. Be frank in discussing your expectations with
your surgeon. He will be equally frank with you, describing your alternatives and the risks and limitations of each.
If, for example, your fat deposits are limited to the area below the navel, you may require a less complex
procedure called a partial abdominoplasty, also know as a mini-tummy tuck, which can often be performed on an
outpatient basis. You may, on the other hand, benefit more from partial or complete abdominoplasty done in
conjunction with liposuction to remove fat deposits from the hips, for a better body contour.
Or maybe liposuction alone would create the best result. In any case, the surgeon will work with you
to recommend the procedure that is right for you and will come closest to producing the desired body contour.
In your initial consultation at the Riley Surgery Center, the surgeon will also explain the type of anesthesia
to be used and a preoperative evaluation by the anesthesiologist is standard, typically the day prior to the operation. During the consultation, before and after pictures are displayed to help you better understand the concepts presented. The surgeon will also explain the type of facility at the Riley Surgery Center where the surgery will be performed, and the costs involved.
Preparing for your surgery
The surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and
drinking, smoking, and taking or avoiding certain vitamins, and medications. If you smoke, plan to quit at least one
to two weeks before your surgery and not to resume for at least two weeks after your surgery. Avoid overexposure to
the sun before and after surgery, especially to your abdomen, and do not go on a stringent diet, as both can inhibit
your ability to heal. You will be asked to bathe with an anti-septic soap prior to surgery (prescribed). Though it
is rarely necessary, the doctor may recommend that you have blood drawn ahead of time in case it is needed during
surgery. This is called autologous blood donation, which means you receive your own blood during surgery. In any
case, iron tablets and folic acid are prescribed well in advance of the surgery to make sure that you have a more
than healthy blood count so loss of some blood during the operation is permitted without leaving you feeling weak.
Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home
after your surgery, and to help you out for a day or two after discharge, if needed.
Where your surgery will be performed
Mini-tummy tucks are performed at the Riley Surgery Center (in day care, which means you do not stay overnight).
Mayor tummy tucks, which include tightening of the abdominal muscles, are performed either in the Riley Surgery
Center or at the Horacio Oduber Hospital, adjacent to the clinic, typically during a 4 to 7 day stay. The decision
to perform the surgery as an inpatient depends on how extensive the surgery is anticipated to be and is judged by
the surgeon. Only gross over weighted patients are operated on as an inpatient, the majority of mayor tummy tucks
are performed at the Riley Surgery Center in day care.
Types of anesthesia
In the Riley Surgery Center, tummy tucks are performed under general anesthesia, so you'll sleep through the entire
operation. Sometimes, upon the patient's request or if general anesthesia is contraindicated, we may use a local
anesthesia, combined with a sedative to make you drowsy, so you'll be relaxed but awake and discomfort will be minimal. The anesthesia is generally completed with a spinal block, which provides prolonged postoperative pain relief, an adjuvant our patients become to appreciate. In any case, a nurse anesthetist and anesthesiologist are present to make sure you are completely secured during the procedure. In the Hospital, general anesthesia complete with spinal block is standard.
The surgery
Complete abdominoplasty usually takes 2 to 3 hours, depending on the extent of work required.
Partial abdominoplasty may take an hour or two. Most commonly, a long incision from hipbone to hipbone, just
above the pubic area is made. A second incision is made to free the navel from surrounding tissue. With partial
abdominoplasty, the incision is much shorter and the navel may not be moved. Next, the surgeon separates the skin
from the abdominal wall all the way up to your ribs and lifts a large skin flap to reveal the vertical muscles in
your abdomen. In mayor tummy tucks, these muscles are tightened by pulling them close together and stitching them
into their new position. This provides a firmer abdominal wall and narrows the waistline. The skin flap is then
stretched down and the extra skin is removed. A new hole is cut for your navel (only in cases where the navel is
freed), which is then stitched in place. Finally, the incisions will be stitched, dressings will be applied, and
a temporary tube is inserted to drain excess fluid from the surgical site. A snug elastic surgical garment is
then fitted on to support the operation that should be worn for several weeks. In partial abdominoplasty,
the skin is separated only between the incision line and the navel. This skin flap is stretched down, the
excess is removed, and the flap is stitched back into place. The operation may be combined with other body
contouring procedures, such as liposculpture of the hips and inner thighs to achieve a more harmonious result.
After your surgery
For the first few days, your abdomen will probably be swollen and you're likely to feel some pain and discomfort
which can be controlled by medication. If a spinal block was done, postoperative pain is minimal and remains so,
even after several days. Depending on the extent of the surgery, you may be released within a few hours or you may
have to remain hospitalized for 4 to 7 days. In mayor tummy tucks, a reflex position in bed is applied
(with elevated upper body and knees) to minimize stress at the operation site. This position is gradually
straightened to the normal position over the period of a couple of days. Your doctor will give you instructions
for showering and changing your dressings. And though you may not be able to stand straight at first, you should
start walking as soon as possible. Stitches will be removed in tw0 to three weeks. The elastic surgical support
garment, which is actually amazingly comfortable and can easily be hidden under your clothes, should be worn for
4 to 6 weeks post operatively.
Getting back to normal
It may take you several weeks to feel like your old self again. If you start out in top physical condition with
strong abdominal muscles, recovery from abdominoplasty will be much faster. Some people return to work after
two weeks, while others take three or four weeks to rest and recuperate. Exercise will help you heal better.
Even people who have never exercised before should begin an exercise program to reduce swelling, lower the
chance of blood clots, and tone muscles. Vigorous exercise, however, should be avoided until you can do it
comfortably, typically after 4 to 6 weeks. Your scars may actually appear to worsen during the first three
to six months as they heal, but this is normal. Expect it to take nine months to a year before your scars
flatten out and lighten in color. While they'll never disappear completely, abdominal scars are quite inconspicuous
and do not show under most clothing, even under bathing suits.
Your new look
Abdominoplasty, whether partial or complete, produces excellent results for patients with weakened abdominal
muscles or excess skin and fat. And in most cases, the results are long lasting. You may find that you are more
comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy diet and
getting regular exercise, you can help to maintain your new shape. If you're realistic in your expectations
and prepared for the consequences of a permanent scar and a relatively lengthy recovery period, abdominoplasty
may be just the answer for you.
The costs
Minor tummy tucks at the Riley Surgery Center have an all-inclusive price of US$ 3750,00.
This includes peri-operative consultations and companionship, pre-operative anesthesia consult, operating room,
anesthesia fee, same night anesthesia nurse visit, 2 surgical elastic garments and before and after photos
(which can also be e-mailed to you). Operation report and a cost breakdown are provided on request free of
charge. Initial consultation (US$ 50,00), ambulatory nurse care (US$ 30,00 per visit) and all prescribed medication
are excluded. Mayor tummy tucks as an outpatient in the Riley Surgery Center have a price tag of US$ 4500,00
(all-inclusive). Mayor tummy tucks in the Hospital as an inpatient are broken down into two components:
the surgeon's fee and the hospital's. Surgeon fee is US$ 3000,00. This includes peri-operative consultations,
2 surgical elastic garments and before and after photos. Hospital price vary depending on the length of stay,
class chosen and duration of the operation. A typical 5-day stay at the hospital in second class with an average
operating time would amount to approximately US$ 2300,00. Additional costs for additional procedures (such as
liposculpture) may apply, although significant reductions are standard. Financing is available. In addition,
quoted prices are subject to discounts if you are local or medically associated.
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