Abdominoplasty

1. About abdominoplasty

The first group usually consists of younger people, both overweight and those of normal weight. If you have normal, elastic skin, a fat removal (liposuction) will usually be sufficient.

On the other hand, if you have loose, excess skin on your abdomen, a surgical procedure to tighten the skin will be the best option. The loose skin may be a result of age, weight reduction or pregnancy. Being overweight in combination with a severe strain on the skin, like during a pregnancy, may eventually lead to a protruding abdomen. In such cases, we first remove the fat, before we perform a abdominoplasty – usually in one procedure.

Former surgical operations (such as a caesarean operation) may also cause disfiguring folds of fat and skin near the scar tissue. In such cases, a so-called scar revision will be performed at the same time as the abdominoplasty, either in order to improve the scar or to remove it completely.

2. Pregnancies and loose abdominal muscles

Abdominoplasty combined with having the muscles stitched into position, will usually take care of the problem. In some cases, the entire abdominal wall is severely stretched and too thin for the muscles to be stitched back together again. With surgery such as this, it is a clear advantage that the woman has not planned any future pregnancies. A new pregnancy will stretch the skin and muscles again. It is not harmful, but it is likely to cause the need of another abdominoplasty later.

Chapped skin caused by pregnancy will be improved to only a small degree. This is because only a part of the chapped skin will be removed in the procedure.

3. How is it performed

Here is how you can check your stomach on your own: lie on your back and lift your legs slightly. You can now feel the abdominal muscles harden. The soft tissue on the outside of the muscles consists of fat and skin. In some cases one can feel a ”crack” between the muscles of the abdomen. This ”crack” can be closed with an operation.

With liposuction and mini-tummy tuck surgery, we use local anesthesia combined with a sedative. Complete abdominoplasty is performed either under local anesthesia or under general anesthesia. See Pain management.

In short, abdominoplasty is performed as follows: In most cases, the fat on the stomach and toward the hips is removed by means of liposuction. The incision is made crosswise, just above the pubic area. Then the skin is separated from the abdominal wall and the navel. The skin flap is stretched down and the excess skin is removed. Finally, the wound is sutured (see the illustrations ”How to do a abdominoplasty” in the Photo series Abdominoplasty). How conspicuous the scar will be, depends on each patient’s ability to heal.

We distinguish between complete and partial abdominoplasty (mini tummy tuck). Complete abdominoplasty means that the skin is loosened all the way up to the edge of the ribs. In order to stretch the skin down, the navel must be separated from the surrounding tissue, and a new hole is made for it. By mini tummy tuck, we mean that the skin is only separated up to the navel. Thus, with this type of procedure no loose skin above the navel is tightened.

A third alternative is to perform a mini tummy tuck and at the same time perform a liposuction of the upper part of the stomach.

4. Who will benefit from an abdominoplasty?

Incidentally, before the operation it is required that you not use certain types of medication, such as acetylsalicylic acid (Dispril, Albyl, etc.). Cigarettes and alcohol need to be avoided – both before and after surgery. With complete abdominoplasty it is required that you not smoke for at least two weeks prior to and one week after the procedure. The same goes for snuff and nicotine chewing gum. Due to the risk of complications, a complete abdominoplasty cannot be performed on patients with severe obesity. In such cases, we require a weight loss before an operation can take place. In addition, we require that you stay in the Oslo-area for a couple of days after the procedure, depending on the size of the operation.

5. Before the operation

During the first-time consultation, the surgeon will inform the patient about the extent of the operation and about the type of anesthetics recommended. During this consultation, you will be asked to inform us about such things as smoking, former illnesses, allergies and use of medicine. Usually, photographs of the body part in question are also taken.

In many cases, it will be necessary to discuss which of the alternatives are best suited in your case. We will explain the difference between complete and partial abdominoplasty, and discuss which alternative is best for you. The need to undergo surgery is yours to make, while the surgeon decides on the method of surgery and which type of anesthetics to use – in consultation with you. Sometimes, the anesthetist will be consulted in this phase.

After the consultation, we recommend that you take some time to consider your options carefully. If you decide to go through with the operation, we schedule you for surgery and ask you to make a deposit. Not long before the day of the procedure, you will receive instructions on how to prepare yourself for surgery by post.

6. Costs and public health services

If your stomach has changed due to pregnancy, or causes you physical unpleasantness, you may be entitled to a paid sick leave for about two weeks after surgery. This also applies if you have been overweight and have a ”fat apron” from the weight loss.

7. The day of the operation

Wash your stomach and abdomen with an antibacterial soap (for instance ”Hibiscrub”) on the night prior to and the on the morning of the operation. Remove the upper two thirds of the pubic hairs on the night before the operation. Be careful to avoid any sores of the skin.

You arrive fasting, usually in the morning. Our clinic nurse will greet you and help you with practical details, such as medical certification of sick leave and payment. Then you will be given a sedative before your stomach is cleaned with alcohol and covered up. Now the anesthetics are administered. Your stay in our clinic lasts from four to twelve hours, depending on the procedure and which anesthetics are used.

8. After the operation

Since any type of plastic procedure on the stomach will cause some amount of pain the first 24 hours, you will be given pain-relieving medicine to bring home with you. The bandage, which is quite large and tight, will limit your activities. The first two days after surgery, you are to spend the majority of the time in bed. During these two days you need to move your arms and legs from time to time, and also to get up every two hours in the daytime and walk around a bit. Walk with your upper body bent slightly in order to minimize the strain on the stitches the first three or four days. Overall, you need to be careful the first couple of weeks after surgery: Avoid any lifting or stretching. Do not twist your upper body. Avoid sitting bent forward. A ”stressless” recliner is ideal to sit on because it allows your hips to rest in a comfortable position.

Be extra careful if your stomach muscles have been stitched together. Avoid coughing, lifting and any other use of the abdominal muscles (which cause you to ”push”) for at least one month. Constipation must also be avoided – we recommend a fiber-rich diet in order to stay regular. Drink plenty of fluids and avoid large meals. Alcohol, nicotine and acetylsalicylic acid must not be used during the first week after the operation.

Often small tubes are inserted into the wound. They are called drainage tubes and their job is to prevent fluid build-up underneath the incision. The drainage tubes are removed a day or two after the procedure. They may leave the skin bruised and more or less swollen. There may be bruises beneath the skin, formed as small ”lumps”. These should be massaged gently for a few weeks until they disappear. Only occasionally do we use stitches that need to be removed.

Because of the swelling, it will sometime take a long time – even months sometimes – before you see the result of cosmetic surgery on the stomach

9. Possible complications

Occasionally there may be complications related to the operation wound. Smokers and people who are overweight are more likely to experience poor wound healing. Excess fluids in the operating wound (not to be mistaken for an infection) and wound dehiscence are seen occasionally. Both conditions will prolong the recovery, and it may be necessary with more frequent check-ups and treatment, though the result will not be affected by the complications in most cases. Infections are extremely rare in private clinics. Numbness of the abdominal skin is common, but in most cases, it will disappear in time.

10. What kind of results can I expect?

Sometimes there will be little ”dogs-ears” in the corners of the scar. The more excess skin having been removed, the worse this problem will be. Usually the ”ears” will disappear without help within a year. Having them removed surgically by a minor operation under local anesthesia can be done.

Virtually everyone is pleased with the results and they feel that they are rid of a burden. An abdominoplasty may improve both your appearance as well as well-being. Even so, one can never be sure that an operation will give you the stomach you hoped for. Thus, those who plan to go through with the procedure need to keep the expectations at a realistic level.