Abdominoplasty (Tummy Tuck) Surgery

Tummy Tuck, or Abdominoplasty surgery, involves a long curvilinear incision that extends from one hip bone to the other, at a level just above the pubic hairline. The tummy skin and fat is then dissected or lifted up to the level of the rib cage, free of its internal attachments to the deeper muscular layers. The finished scar from the operation extends from one hip bone to the other, and the aim is usually to keep most of the scar hidden inside a hipster panty line. The scar may be longer in some circumstances. Every attempt is made to keep the scar around the belly button as inconspicuous as possible. Liposuction is often used in conjunction with tummy tuck surgery to assist with contouring or shaping of the waist, flanks and hips.

Before Surgery

• You need to re-read all of your instructions, allowing enough time to call us for any clarification prior to your surgery.
• Nothing to eat or drink (no sips of water) from midnight before surgery. Anything by mouth could cancel or postpone your tummy tuck surgery.
• Prescriptions: have your scripts filled prior to surgery.
• Constipation: to prevent constipation problems developing prior to and after the surgery, we recommend Guardian Flakes cereal (from Coles/Woolworths), and increased water intake.
• NO ASPIRIN, IBUPROFEN OR MEDICATION CONTAINING ANTI-INFLAMMATORIES.
• No vitamin E internally (pill) or externally (on the skin) should be used a minimum of seven days prior to tummy tuck surgery.
• Arnica tablets (homeopathic remedy that will help to minimise bruising and swelling) should be taken. Two tablets, three times per day sucked or chewed (not swallowed) for seven days prior to surgery and seven days after surgery. Please purchase 84 tablets (6×14 days) from your chemist.
• Any tablets that you are taking should be reported to the doctor and then taken or discontinued as instructed.
• No alcohol should be taken within 48 hours prior to surgery. Alcohol impairs clotting.
• If you smoke, we recommend that you stop. Nicotine markedly impairs the healing process by encouraging infection and poor circulation.
• The morning or evening prior to your tummy tuck, you are requested to wash your hair and take a shower.
• Arrange for transportation to and from the hospital. Perhaps include a pillow and blanket in the car for your comfort post-operatively.
• Arrange for someone to stay with you at home for 24 hours after your surgery.
• If you experience any signs or symptoms of illness from prior to your tummy tuck operation, you need to call us. Early treatment could prevent postponing your surgery.
• Remove nail polish, contact lenses, jewellery and all make-up whilst at home.
• Bring loose fitting, front opening and comfortable clothing to wear home.

Day of Surgery

• No food or liquids from midnight the evening before your Tummy Tuck surgery.
• Dr Konrat will meet you to review your surgery. She will be able to address any of your concerns. Your consent forms are signed at this time.
• It is important to wear comfortable clothes, preferably something that buttons down the front.
• Please remove your nail polish, contact lenses and do not wear jewellery and ensure you do not bring valuables with you to hospital.
• After you have been admitted to the Day Surgery Hospital, your anaesthetist will consult with you prior to your surgery. Please advise him/her of any medical conditions or tablets you may be taking, or any allergies you are aware of.
• If you have any concerns post-operatively, please don’t hesitate to contact Dr Konrat.
• Dr Konrat’s preference is always to have early knowledge of any problem or concern, as early intervention and treatment can prevent more serious post-operative complications.

After the surgery, your tummy may feel bruised, swollen or tender. All of the bruising and swelling may take up to 4 weeks or more to resolve. DO NOT BE UNDULY WORRIED ABOUT THIS.

Panadol/Panadeine and Celebrex may be prescribed for post-operative pain. It is important to take the tablets with food and plenty of water as directed.

You will also be prescribed a course of antibiotics (e.g. Keflex – one tablet three times a day). Please ensure you finish the course as directed.

A water resistant dressing will cover the wound on your tummy and over your belly button. Please do not remove it until you see the nurse/doctor at your first post-operative checkup. When you begin showering, please pat your dressings dry with a towel. DO NOT BLOW DRY. Do not take a bath or submerge yourself in water.

The surgery nurse will advise you of your appointment for any remaining stitches or skin clips to be removed. At this visit your dressings will be changed and you will be given special surgical tapes to be worn over your scars. You will change this surgical tape yourself once a week for 6 weeks, for healing purposes. Any questions with regards to when you can resume physical exercise, housework, etc., will be answered at your consultation.You may experience numbness in some areas of the abdomen. This may take several weeks or even up to 9 or 12 months to return to normal.

If there is excessive bleeding, swelling, pain or fever, please call Dr Konrat at the clinic on 07 3391 5710, or on the after hours emergency mobile phone number.

Rest

Usually tummy tuck procedure is day surgery, but requires at least 5 – 7 days of rest with mobilisation on the hour each hour. On discharge, go home and rest. Have someone drive you and stay with you overnight. Elevate your head on 3-4 pillows with knees bent and resting on pillows to prevent tension on the wound. Tension on the wound can lead to wound breakdown and delay in wound healing.

When resting, flex calves by pointing toes towards the ceiling then towards the ground. This will maintain leg circulation and avoid clots in the veins of the legs. Do this 10 times per hour. Start gentle mobilisation as soon as possible.

Wound Care

The large dressings covering your abdomen must be kept dry and intact until your first shower the day after tummy tuck surgery. In some cases post-operative wound drainage tubes will be placed in each side of the abdomen. If you have wound drains, you will be required to measure and empty the drained fluid daily and keep a record of these amounts (bring this record to your next appointment). ‘Re-vacuum’ the drains (this should be explained to you by the Recovery nurses at the hospital when you are being discharged). The drains, if present, will be removed at a time decided by Doctor Konrat. You will need to wear a compression/support garment day and night (except when showering) for the next 6 weeks.

Once the main dressings are removed, it is recommended that surgical tapes be worn over the wounds for the next 4-6 weeks (change every 7 days). You will be provided with these tapes and you can shower, but not bathe, swim, spa or submerge in water for 6 weeks post-operatively. Tapes may be patted dry with a towel after showering. Drying with a blow-dryer is prohibited. There are stitches beneath the skin which will dissolve over the next few weeks and months, and the wounds may feel hard and lumpy for several months.

Bruising subsides after 2-3 weeks and some swelling may persist for several months after a tummy tuck. Decreased sensation or numbness may also be experienced. It is only when the scars have completely matured, lightened and flattened that the abdomen will assume its final shape: this usually takes up to 1 year.

Bleeding / Infection

Minor bleeding is normal for the first 2-3 days post–operatively. Wound infection is an infrequent occurrence, but it is important for the patient to detect early signs of bleeding or infection.

Contact Dr Konrat if you experience any of the following: increased, heavy or prolonged bleeding, increased pain, widespread redness or discolouration of the skin, significant temperature changes, or offensive odour and discharge from the wounds.

Pain Relief

• A script for pain relief will be provided. If you run out, Panadeine should be adequate.
• Do not take aspirin/aspirin-based drugs (unless prescribed) for 10 days post-op, as it prolongs bleeding.
• You may be prescribed antibiotics – take as directed.
• Take some pain relief tablets prior to leaving home for your first doctor’s visit.
• Contact Dr. Konrat if pain relief is inadequate.
• Guardian Flakes (from Coles/Woolworths) will prevent constipation.

Exercise

• Avoid bending, strenuous lifting, sexual intercourse, aerobic exercises and swimming for 4-6 weeks post-op.
• Do not drive a motor vehicle for 2-3 days post-operatively.
• Start with gentle exercise such as walking.
• Light household chores may be resumed in 1 week.

CALL Brisbane Cosmetic Clinic IF YOU HAVE:

• Severe pain not responding to pain medication.
• Significant swelling, especially if much more one side than the other, fevers or shivers, or if you are feeling very unwell.
• Drains (if you have them) that fill rapidly and have to be emptied more frequently than twice a day.

Post-operative Recovery

Although there is normally no extensive pain related to the Abdominoplasty operation, pain medication is prescribed. Where the muscles are tightened, there may be some muscle discomfort, rather like after having had a big gym workout. You may feel a degree of numbness in the abdominal skin that will normally improve within a period of 6-9 months. It is natural to be concerned about the presence of bruising and swelling. The swelling will begin to disappear within the first couple of weeks after a tummy tuck.

All surgery, including cosmetic surgery, carries risks. Although the vast majority of Abdominoplasty patients do not suffer complications, you should not undergo Tummy Tuck surgery without understanding the risks involved. There are two types of risk; those that apply to any kind of operation, such as bleeding, anaesthetic risk and wound infection; and those that apply only to Abdominoplasty (Tummy Tuck) surgery.

Wound infection, redness, discharge, pain, slow healing of the wound because of wound infection, fat necrosis or wound dehiscence.

Bleeding at the wound site or hematoma from bleeding deep in the wound, bruising, discharge etc.

Lung infection because of accumulation of secretions.

Clotting in pelvic, leg or arm veins (deep venous thrombosis – DVT) with rare but possible traveling of a broken clot to the lungs. This is called a pulmonary embolus (PE).

Circulation problem to the heart or brain resulting in a heart attack or a stroke.

Death is possible due to severe anaesthetic or surgical complications.

The specific risks of this operation, which include but are not limited to:

Scars: The operation always leaves behind a long gently curvilinear scar just above the pubic hairline to the hip on either side. Like all surgical scars it may be initially noticeable. It may take up to 6 months for the scars to improve. Occasionally, the scars may be persistently red, itchy, lumpy or keloid like for a long time and they may need some treatment for improvement. Generally speaking, taping the scar for the first 4-6 weeks after the surgery and avoidance of the over-activity and straining would allow the scars to mature early.

Dog Ears: describes a characteristic puckering of the skin that can occur after surgical wound closure. They are very common. If desired, these can be treated with revisional surgery. A surgical fee and associated day surgery costs will be incurred.

Pubic hairline: Because of the tension on the pubic skin while closure, the pubic scar may be raised by a couple of centimeters.

Wound closure under too much tension and requiring Vertical Scar Technique: Despite careful planning, occasionally it may be impossible to close the skin with a linear horizontal scar as planned. In such circumstance a lower vertical scar may be added to achieve the wound closure. The skin circulation of the abdomen is also affected if the abdomen has other scars such as from an open gall bladder operation. Some part of abdominal skin may die (necrosis) because of the circulation problem. This is a rare but possible complication and patients may need further reconstructive surgery at a later date.

Position of the Umbilicus: The umbilicus is always skeletonised (with little tissue around) on a tiny pedicle in abdominoplasty operation. Rarely the navel may not develop a new blood supply and may die after the operation, which is a recognised although rare complication of this operation. The risk of this happening is slightly more in patients who have scars from other operations around the navel including the laparoscopic procedures. If the navel does fail to survive, a further minor operation may be needed to recreate a navel-like scar. The level of the navel cannot be predicted with absolute certainty as it depends on the stretch of the skin around it.

Abdominal wall fascia and muscles: Dr. Konrat normally will incorporate the tightening of the muscles of the abdominal wall in the midline. In the early post-operative period, this procedure may cause some muscle soreness or feeling of tightness in the tummy. She also advises wearing of a surgical compression garment for a period of 6-8 weeks to support the muscle stitches as well as to prevent the sudden pain that some women may experience with lifting of heavy objects in the early post-operative period.

Sensory Changes: Abdominoplasty operation normally would cause numbness in some parts of the abdominal skin. This is because of the cutting of some of the nerves during the operation of lifting the skin off the abdominal wall muscles. The sensations normally return within 6-9 months. Occasionally there may be residual numb areas. These however have hardly ever been reported to be any concern.

Seroma formation: Seroma is collection of the fluid under the skin. It is not an uncommon complication after the abdominoplasty, because the large area of the skin is lifted off the muscles. Application of a surgical compression garment reduces the risk of this complication but does not completely avoid it. When it occurs, it may need aspiration during follow up visits on a few occasions, or rarely a surgical drainage if there is infection.

Wound breakdown and delay in wound healing: this occurs due to a number of factors. These factors include: infection, seroma, surgical scar under too much tension – commonly over the pubic area, excess exercise too early post- operatively.

Complications: Most of the general and specific complications are listed above. Patients on certain drugs such as aspirin, warfarin, oral contraceptive pills, steroids, anti-arthritis medications, etc, may be prone to more complications than others. It is therefore crucial to reveal all the medications as well as the habits such as smoking to Dr. Konrat prior to the operation. Dr. Konrat or any of the other specialists or GP may advise stopping some drugs (even contraceptive pills) before the operation. Smoking markedly affects the circulation in the skin and hence increases the risk of skin necrosis or wound healing problems after the surgery. Ideally Dr. Konrat advises cessation of smoking (even patches) at least 3 weeks before a planned operation. Please feel free to discuss your individual case with Dr. Konrat.

You should not undertake Abdominoplasty surgery unless you accept the possibility that you may wish to have, or need to have, further surgery at some time in the future. If further Tummy Tuck surgery were required due to complications there will be an out of pocket expense. This will include the hospital and specialist anaesthetist fees.