Setting

The operation is always under general anaesthetic. A “mini abdominoplasty” can be performed as a day surgery procedure. A full abdominoplsty is performed as an in-patient procedure. The usual length of stay in hospital is 2-3 days.

Duration

1-3 h

Surgical Technique

“mini abdominoplasty”

This technique is only suitable for patients with a very small amount of excess tissue. A horizontal skin/soft tissue ellipse is removed from just above the pubic area and the wound edges are sutured together. As the dissection does not extend above the navel its position will be moved downwards slightly when the tissues are pulled down and tightened. Sometimes the navel needs to be detached from the undersurface to allow more movement. If there is some weakness of the muscle fascia confined to the area below the navel, some tightening stitches can be placed in the fascia along the midline. The length of the final scar depends on the degree of tissue excess.

Abdominoplasty

The full abdominoplasty uses the same skin incision as the “mini abdominoplasty”, however it usually extends from hip bone to hip bone or even a bit further. The skin and soft tissues are freed along the muscle fascia right until just below the rib cage. The navel is completely freed from the surrounding skin, but its stalk is left intact. If necessary the diverged muscles are tightened in the midline with running sutures. The freed up skin and soft tissue is then pulled downwards and the excess removed so the wounds can be closed without tension. The navel is brought out through a separate incision at its anatomically correct height and also sutured in. If necessary remaining small fatty deposits, e.g. love handles, can be reduced with liposuction. 

 

 

Suture material

Both the deep and superficial (skin) sutures are made from absorbable material and do not have to be removed.

Aftercare

Since the wound areas are usually quite large at least one or multiple drains will be placed into the wound through the skin during surgery. These prevent excess wound secretions and blood to accumulate inside the wound cavity, which may cause healing problems. The drains are removed once the output is minimal (usually when less than 30ml/24h).

A binder or compression garment must be worn for 4-6 weeks after surgery day and night.

Even after a full abdominoplasty you will be allowed and also encouraged to get out of bed and mobilize freely immediately after surgery. For the first few days it is recommended to do so slightly bent over. Especially if the muscle fascia has been tightened you will need to avoid any strain on your abdominal wall. This includes applying manual pressure on your abdomen when coughing and sneezing. 

The dressings can usually be left intact after discharge until your first follow-up appointment. You may shower over the dressings, but should not bathe or swim until the wounds have healed.

Every day activities and light work (e.g. office work), including driving, can usually be resumed about 1-2 weeks after surgery. Lifting heavy objects weighing more than 5 kg (including children) and physical activities (sport) should be refrained from for at least 6 sometimes even 12 weeks.

Follow-up

Routine follow-up appointments with your surgeon will be at 1-2 weeks, 6 weeks, 3 months and 1 year after surgery. 

As with every surgical procedure abdominoplasty is associated with both anaesthetic and surgical risks. Preexisting conditions such as Diabetes, obesity, heart and blood vessel diseases, immune diseases and smoking significantly increase the risk of complications.

General complications of all surgical procedures include:

            Bleeding/Hematoma, infection, thrombosis (including pulmonary embolism)

The most common surgical complications after abdominoplasty are:

            - delayed wound healing or wound breakdown

            - hematoma

            - seroma

            - infection

            - unsightly or asymmetrical scars

            - dog-ears

            - permanent numbness of the skin

            - loosening of the muscle fascia repair/ recurrent bulging

Rare complications

            - compromised blood supply to the navel, in extreme cases loss of the navel

            - skin necrosis

Do I need to stop my own medication prior to surgery?

Most medication can be continued normally. Some drugs such as blood thinners (e.g. Aspirin or Warfarin/Marcoumar) can increase the risk of postoperative bleeding and may need to be stopped or replaced before the procedure. We ask you to bring a complete list of all your medication and their dosages to your first consultation.

Does my GP need to perform or organize any special investigations or tests before surgery?

Before any surgery the surgical team including the anaesthetist will need to be aware of any preexisting conditions (especially cardiovascular or lung diseases) which may be associated with an increased anaesthetic risk. Previous abdominal surgery can also pose an increased risk of surgical complications and can have an impact on the surgical strategy and technique. In case of a suspected hernia a CT or ultrasound is usually recommended to assess its size and extent.

We ask you to provide as much detailed information on your past medical history as possible when you come for your preoperative consultation so we can coordinate any necessary tests with your GP.

Do I need to stop smoking before surgery?

We seriously recommend stopping all nicotine consumption, including smoking at least 6 weeks before any surgical procedure. One of the most common complications following any type of surgery is delayed wound healing or wound breakdown. The main cause of this is usually bad blood circulation to the skin and tissues in the operated area. Nicotine is a chemical substance, which causes blood vessels in the body to constrict (narrow). This lowers the blood circulation to the wound and significantly increases the risk of complications.

Why is it necessary to cut out and reposition the navel for a full abdominoplasty?

In order to tighten the skin and soft tissues of the abdomen they must be pulled downwards. A full abdominoplasty usually involves removing most or all the skin and fatty tissue below the navel. If the navel were not repositioned it would come to lie just above your pubic area, which would look very strange.

What happens if my navel dies off?

The navel is actually merely a thick strand of scar tissue going from the skin down to the muscle fascia. It is a leftover from your umbilical chord and serves no function after birth. Especially in people with a very thick layer of fatty tissue this strand can be quite long so that when the navel is cut out from the skin around it and a large part of its blood supply is removed. The remaining blood supply running along the strand itself may then not be enough to keep it alive. In the rare occasion that the navel does die off completely it will have to be removed and the skin closed over it directly. If desired a new navel can be reconstructed at a later date.

Can the repair/tightening of the muscle fascia tear and is that dangerous?

When the fascia is tightened with sutures over a period of 6-12 weeks a strong scar is formed in that area. This scar is actually what holds the repair together long-term and not the sutures. Overexertion of the abdominal muscles in the first few weeks after surgery when the scar has not fully formed can lead to the sutures pulling out and the repair failing. This is certainly not dangerous and does not need any urgent treatment, however the cosmetic and functional outcome of the operation may be compromised.

What happens if I become pregnant after an abdominoplasty with tightening of the muscle fascia?

Carrying out a full term pregnancy is usually not a problem after an abdominoplasty as the tissues outside of where the fascia was tightened can stretch with the growing baby just as they would normally. We do however not recommend undergoing an abdominoplasty if you plan on having (more) children as the surgically tightened soft tissues will get stretched again and may reverse the cosmetic result.

I have an umbilical or other type of hernia. Can I still have an abdominoplasty?

Yes. The size, location and extent of any abdominal wall hernia must be examined either with an ultrasound or preferably with a CT scan prior to surgery. Small umbilical hernias will have no impact on the surgery, however larger more complicated hernias may require involving a specialist abdominal surgeon. This of course can be done at the same time as the abdominoplasty, but will have an impact on the planning and scheduling.

Are there any activities I won’t be able to do after surgery?

It is usually recommended not to engage in any activities straining the upper body for 4-6 weeks after surgery. These include lifting heavy objects (greater than 20kg) and physical activities such as jogging. Once the healing period is over there are no restrictions.

I have already had an abdominoplasty but I have regained some excess tissue. Can I have a further abdominoplasty?

In most cases this is indeed possible. It is however essential for your surgeon to know the surgical details and the technique of your previous surgery. The risk of complications such as wound breakdown, necrosis of the navel and  bad scarring are significantly higher in any repeat surgery.

I have had previous abdominal surgery and have a long scar on my abdomen. Can I still have an abdominoplasty?

This depends on the location and course of the scar. The surgical technique may have to be modified as not to risk extensive tissue necrosis. The decision whether or not it is possible at all would have to be made individually.

I have had a cesarean section. Can I still have an abdominoplasty?

Yes you can. The cesarean scar can be incorporated into the abdominoplasty skin incision so you won’t have any additional scars.

What happens when I develop a seroma?

A Seroma is a fairly common complication after any operation involving a large wound cavity. The seroma merely a collection of wound secretions and is not dangerous. It can however be quite uncomfortable and cumbersome. Small amounts of fluid can just be left alone until your body absorbs them by it self. Larger fluid collections may need to be drained with a needle. This can be done during a regular consultation and is usually painless. In some cases repeated drainages over a period of a couple of weeks are necessary until the fluid build up stops completely.  Kompression garments or an abdominal binder can reduce the risk of seroma formation.

I would also like a mastopexy or breast enlargement. Can this be done at the same surgery as the abdominoplasty?

Yes. Breast procedures can be performed together with an abdominoplasty under the same anaesthetic. However the operation time, risk of complications and recovery time will be significantly increased.

How long before I can go back to work after surgery?

This depends on your work. Light duties, such as office jobs can usually be resumed after about 2 weeks. Lifting heavy objects and activities that strain the abdominal muscles should be refrained from for at least 6 weeks.

Especially if you have small children it is important for you to plan and ensure enough support for their care other household chores during your recovery period.

Will I get a sick certificate for the time I am off work?

Only if the procedure is medically indicated and covered by your health insurance.

You will need to take annual leave for the entire period that you are absent from work it is a purely aesthetic procedure.

Will my health insurance cover the costs for the surgery?

Usually not. If you have a proven abdominal wall hernia or significant symptomatic separation of the abdominal muscles your health insurance may pay for at least part of the procedure. The correction of large excesses of soft tissue, particulary after massive weight loss following bariatric surgery (e.g. gastric bypass or band) are sometimes covered by health insurance. Written confirmation of guaranteed payment by your insurance company must be sought by a medical professional prior to surgery.

Will my health insurance cover the costs of treatment if I develop any complications requiring medical treatment, hospitalization or even further surgery?

Yes, provided the complication is purely medical, e.g. an infection.

Corrections of aesthetic complications are not covered.