Abdominoplasty (Tummy Tuck)

A traditional full abdominoplasty elevates large areas of skin from your lower abdomen to your ribs and pulls this skin tightly to remove the excess. Not only does this leave a large potential space to collect fluid/blood, but it can compromise the blood supply to the skin and divides the muscle attachments, which give us a “6-pack” and good waist definition.

Large drains must be used to ensure that fluid does not collect and these need to be removed on the ward when the drainage has slowed down.

Lipo-abdominoplasty: This technique uses liposuction to remove fat deposits and establish a plane. As the liposuction cannula passes into the tissue, it preserves the perforating blood vessels so that the skin is not completely undermined. By keeping these attachments, the ‘6-pack shape’ and definition of the waist is maintained. There is no large empty space so that drains are only required for a short time.

Lipo-abdominoplasty involves an incision from hip to hip, near the pubic hairline. If you already have a scar (such as a Caesarean section scar), then I will remove this, thereby avoiding a new scar. A separate incision is made around the navel (belly button).

If your muscles have stretched apart, they will be pulled together and stitched in the correct place, to tighten your abdomen. Once the underlying tissues have been tightened, the skin is pulled down thus allowing the excess skin to be removed. A small hole is made so that your navel can be stitched in its new position.

Mini-abdominoplasty: This is similar to a lipo-abdominoplasty, but it requires a much smaller incision and leaves the navel intact. It is only suitable for those who only have excess skin below the navel.

Umbilical float abdominoplasty: This is similar to a mini-abdominoplasty but it includes dividing the stalk of the umbilicus within the abdomen to enable skin above and below the umbilicus to be tightened without an additional scar around the umbilicus

Fleur de Lys abdominoplasty:  This method is used for patients who have laxity in all directions and have lost a considerable amount of weight.

Skin is excised through a horizontal incision from hip to hip, just above the pubic hairline. A longitudinal incision is added vertically down the mid-line of the abdomen and a new opening is made for the umbilicus.

Please note that the scarring is more extensive than with a standard abdominoplasty technique, but it allows excellent tightening of the skin.

Reverse abdominoplasty: This technique allows for tightening of laxity in the upper abdomen via an incision underneath the breasts. It is used in patients who have laxity confined to the upper abdomen, or for massive weight loss patients, who have already had a lower abdominoplasty.

Corset abdominoplasty: This is a combination of a Fleur de Lys abdominoplasty with a reverse abdominoplasty. It allows for maximum tightening of the abdomen with excision of skin in the lower abdomen, under the breasts and in the middle of the abdomen. It is mainly used for massive weight loss patients. The incision under the breasts allows the addition of procedures to enhance or tighten the breasts

A rectus diastasis: This is a split in the rectus muscle that commonly occurs after pregnancy or weight gain as the abdomen stretches. A diastasis results in a gap in the abdominal wall, which is often seen as a visible bulge after eating and there is a vertical split in the contour of the abdomen. As the muscles have split apart, they sit in an abnormal position and the core abdominal strength is weaker. This can cause back ache and postural problems.

A diastasis repair can be performed as part of any abdominoplasty technique or as a sole procedure. If it is a sole procedure, a limited incision is used just above the pubic hairline and the base of the umbilical stalk is divided at the level of the muscle, to access the upper and lower abdomen to repair the split. This is hidden under the skin so there is no visible scar around the navel. The umbilical stalk is then re-sutured in the correct position.

Abdominoplasty procedures are usually carried out under general anaesthetic (you will be fully unconscious) and take between 2 to 3 hours to perform. I use a long-acting local anaesthetic block during the surgery, which reduces post-operative pain so you should only need simple painkillers when you go home. You are likely to stay in the hospital for one night.

The incisions are closed with dissolvable sutures that do not require removal. They are often hidden under the skin, so you will not see them and will dissolve naturally over a period of approximately 4 weeks, when the incisions are strong enough to support themselves.

I use transparent glue and tape dressings (Prineo®), which are waterproof and can be peeled off approximately 2 to 3 weeks after surgery, when they start to lift at the corners.

You can shower as soon as you like after surgery and do not require any dressing changes.

You should wear a compression garment for 4 weeks following your surgery. You will be measured for this prior to your procedure and the garments can be purchased from the hospital. I recommend that you obtain 2 garments, as you will want one to wash and one to wear.

Having cosmetic surgery should be a very positive experience. Complications are infrequent and usually minor. However, all surgery is not without risk, and it is important that you are aware of possible complications. All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss them. Decisions about this surgery should never be rushed.

Risks with this surgery can be divided into those specific to the surgery and those that relate to the anaesthesia.

General Anaesthetic risks: An anaesthetic is very safe, however, should a complication arise, the relevant medical expertise is immediately available to deal with this.

The risks increase if you have certain medical problems, which will be discussed at length during the consultation. The risks include:

• Unintended intraoperative awareness, which is very rare.
• Dizziness and nausea.
• Sore throat.
• Damage to teeth or mouth.
• Nerve injury due to body positioning.
• Allergic reaction or anaphylaxis.
• Malignant hyperthermia, which is a rare life-threatening condition.

The anaesthetist will go through these risks, and others, in more detail prior to your surgery.

Scars: Scars tend to settle remarkably well. However, some patients heal with thickened scars, and this can make them more noticeable.

Bruising and swelling: This is very common and may take approximately 3 weeks to resolve.

Haematoma:  This is clotted blood that collects under the skin. If a haematoma develops, it is likely to do so within 4 to 6 hours post-surgery. Any increase in swelling or pain should be reported immediately so that treatment can be given. Sometimes patients need to have this collection of blood removed with another short operation. This does not normally delay your recovery or change the cosmetic result.

Infection:  This is rare, but you may require antibiotics if there are any concerns.

Numbness, reduced sensation or oversensitivity:  A reduction in sensation occurs in most patients around the abdomen and possibly the upper thigh. This is usually temporary, but occasionally these changes can remain to some degree.

Wound healing problems: These healing difficulties can range from minor problems, such as small scabs or areas of wound separation, to major issues, such as skin loss. Although very rare, this situation may require a skin graft to close the wound, meaning more surgery.

Patients who have diabetes, smoke, are obese or elderly are at increased risk of delayed healing.

Seroma: This is a collection of clear fluid under the skin, which sits in a pocket. This normally reabsorbs spontaneously over the course of a couple of weeks, although it can be drained with a needle if it feels tight. Vary rarely a surgical procedure may be required if it does not reabsorb.

Dog-ears: These are soft tissue prominences where the scar stops. In most cases these settle over the course of 3 months. A small local anaesthetic procedure may be required to remove any excess that remains.

Contour abnormalities: It is possible to have a bulge or depression after surgery and occasionally a small amount of liposuction is needed to correct this, thus requiring further surgery.

Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE): Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and travel to your lungs. If the blood clot is large enough, it could prove fatal.

The overall risk for cosmetic surgery is less than 1%, but to reduce any risks of a DVT/PE, you will be provided with special stockings to wear in bed together with a blood thinning injection, if you are not mobile or have previously had a DVT or PE.

All the risks outlined above will be discussed in detail at your consultation with me. However, if you have further questions or concerns, please do not hesitate to ask.

Decisions about cosmetic surgery should never be rushed.

When you wake following your surgery, there will be pillows under your knees to take the tension off your abdomen. The tension will relax over the course of one week, when it will feel less tight. I recommend continuing to place pillows under your knees for the first week after surgery.

I will also apply a supportive compression corset around your abdomen in theatre to reduce post-operative swelling. This should stay in place and needs to be worn day and night, for the first 4 weeks. It can be removed for washing, showering and for short periods during the day.

The transparent glue and tape dressings (Prineo®) are are waterproof and can be peeled off approximately 2 to 3 weeks after surgery, when they start to lift at the corners.

You can shower as soon as you like after surgery and do not require any dressing changes.

The garment needs to be worn day and night but if you find it uncomfortable then you can swap to lycra shorts which offer gentler compression. You will need to purchase this before your surgery, and I will guide you in the clinic. Details can also be found in the compression garment guide.

Your abdomen will feel tight and uncomfortable for the first few days. You will be given pain relieving medicines to make you feel more comfortable. You should expect to be in hospital overnight for monitoring.

Before you are discharged from hospital you will be given a follow up appointment to see the nurse one week post-operatively to check your incisions. I will normally see you in clinic approximately 2 weeks following your procedure.
You will not be able to drive yourself home from hospital. Ideally, you should have someone to stay with you for the first few days to assist you. If you have any concerns during this period, please contact the clinic for advice.

Scar advice:

Once the dressings are removed, I recommend that you massage the incisions, using small circular motions at least twice a day for a few minutes. You can use any moisturising cream of your choice and apply firm pressure until it blanches.

The scars will also benefit from Silicone scar gel (ScarAway or Kelo-cote) twice a day, which will soften and fade them, as well as applying sunblock for 12 months to provide sun protection.

ScarAway can be purchased from Healthcare Pharmacy at Governors Square in Grand Cayman.

When you return home, you should take it easy for the first week or so. Most patients take around 2 to 3 weeks off from work. You should be able to drive from 2 weeks, commence gentle exercise at around 4 weeks and return to sit ups and normal activities at around 6 weeks.

This surgery is very rarely covered by health-insurers. For self-funding patients, surgical fees are a combination of the hospital costs, the surgeon, anaesthetic fees and any consumables. I do not charge additional fees for post-op appointments. The fees are based on the surgical time taken to perform the surgery, rather than procedure itself. This means that the costs are calculated fairly.

You will be given a quotation for surgery approximately 48 hours following your consultation.

Abdominoplasty Compression Garments

Abdominoplasty - Nicotine and Surgery

Pre-Operation Instrutions for Abdominoplasty Procedures

Abdominoplasty - Post-Op Instructions

Dermabond™ Prineo™