- Before a tummy tuck
When you continually gain and lose weight, the excess tissue composed of skin and fat in the lower part of the tummy becomes a real problem for some people. This excess tissue along with the underlying lax muscles can be dealt with by a surgical procedure known as a tummy tuck, otherwise known as an abdominoplasty. Removing the “muﬃn top” (the tissues between the belly button and pubis), then re-draping the skin from above the belly button to meet the skin on the pubis and repositioning the belly button, are the basis of all tummy tucks.
One of the keys to a tummy tuck is ﬁnding out how much excess skin and fat, as well as, muscle laxity you have in your tummy, is to bend over at the waist and “let it all hang out.” The next step is to pinch these tissues and tighten the tummy muscles, which will give you an idea of how much of the tissues need to be removed.x
Also, you will notice that most of the tissue bulk is in the midline and fades out at the sides. If you imagine this excess tissue as an ellipse on the lower tummy, it will give you an indication of how long the scar will be from one side of the hip to the other. I tell all my patients that the resulting scar can be concealed, that it will generally fade with time, but will always be there.
Just prior to beginning the tummy tuck, I mark the tummy while the patient is standing up. I mark the midline from the xiphoid (“breast bone”) to the pubis. This enables me to realign the midline after removing the excess tissues and to place the belly button in the midline. A second line indicates the position of the lower-tummy incision. This usually lies quite low in the tummy since the most common garment worn by women today is jeans. Finally, areas for liposuction are marked in the upper tummy, the hips and lower ﬂanks (liposuction thins the tissues and allows them to re-drape better).
Our anaesthetists use a laryngeal-mask airway (a breathing tube that sits at the back of the throat) and do not paralyse the patient, allowing them to breathe independently during the entire operation. I begin the tummy tuck operation with liposuction to the tummy, hips and lower ﬂanks. Then, I incise the skin around the belly button which is still attached to the underlying muscle wall. After making the lower tummy incision, I widely undermine the tissue up to the level of the belly button. I continue the dissection above the belly button to the level of the xiphoid process (lower part of the sternum), making a central tunnel (about the size of a hands width). I then “lace-up” the separated muscles of the midline from above and below the belly button.
Next, the patient is bent at the waist to 45 degrees, and the excess tissues removed so that the two skin edges may be closed without tension. Two drains are brought out below the pubic hairline to capture any excess ﬂuid that may build-up in the tissues. These usually are taken out between day 3 to 5 when the drainage is less than 30 ml’s or so. Lastly, I bring out the belly button at the midline, usually 12 to 15 cm above the lower tummy incision and place a tummy binder on the patient at this time and adjust it to allow for moderate compression.
The patient is kept in a bent position at the waist and knees as they are transferred to the recovery bed.
After a tummy tuck, the patient will continue to wear TED (compression) stockings and automated calf compressors for 24-48 hours and be commenced on blood thinning agents the following day to lessen the chance of deep vein thrombosis (clots in the legs) or pulmonary embolism (when these clots break away from the legs and migrate through the venous system to the lungs causing a “lung attack”).
The patient is instructed to sleep with several pillows behind her back and a pillow beneath their knees.
They are encouraged to walk to the bathroom the following day, have showers and to undergo regular chest physiotherapy. Patients are advised to wear the tummy binder continuously for the ﬁrst 4 weeks after surgery, except when they wash themselves or the binder. After this period, I allow them to wear it only at night if they wish, but many choose to wear it longer. I also advise patients that it takes 4 weeks to get back to normal activities of daily living and 6 weeks to resume aerobics exercises.
Question: What questions do you have about tummy tuck surgery? You can leave a comment below.