Minimally Invasive Whole Body Procedure
Abdominoplasty
Procedure:
Flatten abdomen by removing excess fat, skin & tightening muscles of abdominal wall. Combined with liposuction for best contouring. (Insurance if hernia is present, may be applicable.)
LENGTH:
2 to 4 hours.
ANESTHESIA:
General In/Outpatient: Either depending on individual circumstances & extent of surgery, or combined surgery.
SIDE EFFECTS:
Temporary pain. Swelling, soreness, numbness of abdominal skin, bruising, tiredness for several weeks or months.
RISK:
Blood clots. Infection. Bleeding under the skin flap. Poor healing resulting in conspicuous scarring or skin irregularity. Need for further surgery.
EXERCISE:
1/3 Intensity at 3weeks, 2/3 Intensity at 6weeks. Full Intensity at 8 weeks.
BRUISING:
2 to 4 weeks.
FADING & SCAR IMPROVEMENT:
6 to 24 months.
SWELLING:
Moderate/Significant Up to 4 weeks, Subtle (Mild) 2 to 3 months, all of which are dependent upon extent of procedure(s).
DURATION of RESULTS:
Permanent.
OFFICE VISITS:
1st 3 to 5 days / 2nd Visit 7 to 10 days. Anticipated office visits 3 to 5 the first 3 months then yearly.
GARMENT WORN:
3 to 4 weeks.
PAIN MEDS:
Ibuprofen or Narcotics as needed.
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More Information About Abdominoplasty
— Reconstruction of the abdominal wall
with removal of excess skin and fat.
The front portion of the abdominal wall is composed of a thin inner lining, a thicker and more substantial layer of muscles and a variable thickness layer of fat covered by abdominal skin. Several factors affect the shape and consistency of the abdominal wall. Since the muscular layer provides most support to prevent outward bulging of abdominal contents, the tone or quality of these muscles is important. With increasing age, unless exercise levels are kept very high, looseness or laxity of the abdominal musculature usually progresses, allowing bulging in the lower portion of the abdomen. This bulging is made worse by excessive weight gain, since this increases the amount of fat both within the abdomen and in the fat layer of the abdominal wall. Excess fat within the abdomen pushes against the muscles, increasing the bulging, and excess fat between the muscle and skin causes both a visible bulging as well as a stretching effect on the skin envelope.
In addition to the information contained here, during your consultation and examination, we will review specific factors which pertain to your individual case. (As you review this information, please write questions in the margins that we can address during your consultation.)
During pregnancy, enlargement of the uterus within the abdomen produces a marked stretching and separation of the rectus abdominus muscles (the vertical muscles near the midline of the abdomen) as well as other abdominal muscles. Following delivery, or after a substantial amount of weight loss, the degree to which the muscles regain their tone or the tissues regain their original shape and position depends on several factors:
the individual's age, quality of tissues, overall physical condition, amount of exercise, weight stability, nutritional status, and hereditary or inherited tendencies.
Despite all efforts, age, multiple pregnancies, and the effects of marked weight gain and subsequent loss frequently produce deformities of the abdominal wall which cannot be corrected by exercise alone. Proper exercise and conditioning are essential ingredients to obtain and preserve body shape, contour and stability. Proper amount of weight loss and maintenance of stable weight are equally important. When deformities persist after proper weight level has been stabilized and an exercise program carried out, then and only then do surgical procedures play a role in further correction of deformities.
Although a considerable amount of tissue may be removed during Abdominoplasty, the actual weight of this tissue, even in extreme circumstances, is rarely over three to five pounds; therefore, surgical procedures are neither intended for nor accomplish the goal of weight loss. THE ROLE OF ABDOMINOPLASTY AND SIMILAR PROCEDURES IS TO REPOSITION STRUCTURES WHICH MAY HAVE BEEN STRETCHED OR DISPLACED, TIGHTEN THOSE WHICH HAVE BECOME LOOSENED, REMOVE EXCESSES WHERE POSSIBLE AND PROVIDE AN OVERALL IMPROVEMENT IN CONTOUR OF THE ABDOMEN.
The surgical procedure of Abdominoplasty is often referred to in lay publications as tummy tuck. Unfortunately, the glib use of this term implies a relatively minor surgical procedure. MINOR OR LIMITED SURGICAL PROCEDURES IN THIS AREA PRODUCE PREDICTABLY LIMITED RESULTS. Unless underlying muscular structures are first repositioned and tightened, removal of a small amount of skin and fat from the abdominal wall will not produce a very long lasting change. The bulging intra-abdominal contents will rapidly restretch the skin. A PROPERLY PERFORMED ABDOMINOPLASTY FIRST ADDRESSES THE UNDERLYING FRAMEWORK BY REPOSITIONING AND TIGHTENING ABDOMINAL MUSCLES. In order to approach these muscles, it is necessary to lift the fat and skin off the abdominal wall, from the pubic hairline area up to and slightly over the lower margin of the rib cage. After muscles are tightened and repositioned, the large apron of abdominal skin and fat is then tightly pulled downward, removing the excess, thinning or removing fat underlying the flap, and repositioning the umbilicus (belly button) when appropriate. Abdominoplasty, therefore, is a procedure involving major reconstruction of the abdominal wall, and is certainly not a minor type operation as may be implied by the term tummy tuck.
IF THERE ARE ISOLATED OR LOCALIZED DEPOSITS OF FAT, AND THERE IS NO SIGNIFICANT LAXITY OF EITHER THE UNDERLYING MUSCLES OR THE OVERLYING SKIN, THIS FAT IN SOME INSTANCES MAY BE REMOVED BY A TECHNIQUE CALLED SUCTION LIPOPLASTY. This involves applying a strong suction with small metal cannulas through small incisions in order to remove the localized fat deposits. The suction procedure, however, is totally unsuccessful if the underlying musculature or overlying skin has excessive looseness or laxity. The excessive laxity of abdominal muscles and skin must first be corrected, and this usually requires tightening of the muscles and removal of some of the skin. The suction technique may be combined with Abdominoplasty in many instances to help limit the length of necessary incisions, as well as contour areas difficult to reach through the Abdominoplasty approach.
Properly performed, Abdominoplasty can produce a marked improvement in contour and appearance of the abdomen. By correcting bulging or overhang in the lower abdomen, it can provide you with increased versatility in the types and sizes of clothing you wear. In order to complete the procedure a fairly long incision is necessary, in some instances extending from hip to hip. The incision is obviously placed as low as possible near the pubic hairline and within the lines of moderately brief underwear. Nevertheless, you must be aware and consider the balance between improvement in abdominal contour, and the necessary presence of a rather large scar on the lower abdomen.
Previous scars or stretch marks on the abdomen are usually partially but not completely removed by the Abdominoplasty procedure. Depending on the amount of tissue which can be removed from the lower abdomen, scars or stretch marks which are present in the tissue to be removed will obviously be absent following the operation. Those stretch marks or scars in the upper and mid-portion of the abdomen are usually not completely removed, but are seldom made worse.
In general, abdominoplasty surgery is performed under a light general anesthetic. I believe (as do our board certified anesthesia colleagues) that this is a better and safer approach than local anesthesia alone or local anesthesia under sedation with intravenous drugs.
Abdominoplasty can sometimes be combined with other surgical procedures, usually producing slightly greater, but nevertheless acceptable risks. A decision in this regard must be strictly individualized, depending on the type of other surgical procedures being performed as well as other medical and surgical factors.
The purpose of all types of cosmetic surgery is to improve your appearance as much as possible. This change will hopefully improve your quality of life by improving your self image in a very positive way. By addressing and improving those specific areas which detract from your appearance, leaving the positive aspects of your appearance undisturbed, this type of surgery results in an overall improvement in your appearance. Cosmetic surgical procedures are not magic. They are detailed procedures designed to improve specific aspects of your appearance. They can do no more than that. Whether you are happy with the results of cosmetic surgery will depend largely on how well you communicate to us which specific aspects of your appearance you are unhappy with and how well we communicate to you what a surgical procedure can and cannot do toward alleviating the problem. Plastic surgery does not perform transforming miracles. A combination of art and science, plastic surgery is not an exact science. Some of the factors involved in producing the result (such as your healing characteristics) are not totally within your or our control, and therefore, it is impossible to warrant or guarantee the results of your surgery.
After talking with you and examining you, I will make every effort to clearly and precisely give an opinion about whether a specific surgical procedure can significantly improve your areas of concern with a high degree of reliability and a minimal level of risk. All cosmetic surgical procedures involve some trade-offs. I will try to outline these clearly for you and answer any questions you might have. The final decision regarding having the surgery is yours, and I encourage you to consider it carefully and deliberately.
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AT YOUR INITIAL CONSULTATION VISIT:
When I visit with you in the office, I will review your past medical history, as well as your desires regarding Abdominoplasty. Age is not a limiting factor in determining who can have an Abdominoplasty, as long as your general health is good. We will review extensively the information contained here, as well as more specific information with respect to your specific needs. After examining your torso, I can much more precisely define recommendations for you.
In this consultation, I would expect you to be frank in discussing your expectations with me. Do not hesitate to ask any questions that you may have. I will be equally frank with you, explaining the factors that could influence the procedure and the results.
I cannot make the decision for you regarding whether to undergo surgery or not. I can only advise you regarding the surgical options and anticipated outcomes I would expect for you based upon your individual anatomy, desires, and realistic expectations. I will define goals in a surgical plan at this initial consultation. Follow up appointments will include time to ask further questions or review the procedure so that you are comfortable with its nature and implications. I will educate you and define the operative scenarios and choices available to you, but you must make the final decision regarding the surgical procedure.
When a decision is made to proceed with surgery, preoperative photographs will be taken. These photographs are essential to the planning, execution, and follow-up of your procedure. They are taken with you in the standing position (the position in which you are most often seen). You are lying down during the procedure and I refer to these photographs frequently as your tissues appear very differently than when you are standing.
Surgical fees for Abdominoplasty vary and depend on the extent and nature of your specific operation. We will discuss surgical fees during your consultation. A variable portion of the Abdominoplasty procedure may be covered by your medical insurance if an abdominal hernia is present. Following your examination, if appropriate, we will be happy to contact your insurance carrier by letter regarding their degree of coverage under the terms of your policy. If they can confirm coverage before surgery, we ask that you pay only a deposit of the amount not covered by the policy. If they cannot confirm coverage, surgical fees are payable prior to surgery. Following surgery, if appropriate for the abdominal hernia, we will file your insurance claim and provide all medical record information applicable to your case.
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BEFORE YOUR ABDOMINOPLASTY:
Our nurse and office manager will make all arrangements regarding scheduling of your surgery and will give you specific instructions as well as reconfirm these with you by telephone and/or letter. Since both of our schedules must be coordinated with the surgical facility and anesthesia schedules, please allow our personnel a reasonable amount of time to make these arrangements. They will make every attempt to accommodate your requests.
Good general health is mandatory for a problem free and predictable recovery from any surgical procedure. Wellness and good general health result from proper diet, regular exercise and appropriately timed medical evaluations focused on preventative medicine. Good nutrition, vitamin and herbal supplements, as well as adherence to holistic health principles are important concepts in maintaining wellness. Certain supplements, although generally beneficial, may have adverse effects during surgery. Please advise us about all your medications and supplements, so we may advise you regarding their safety in regard to your surgical procedure.
We believe that good nutrition is an important component to excellent surgical outcomes. Multiple studies show that most Americans aren't getting the recommended daily intake of necessary vitamins and minerals, much less the optimal amount. These suboptimal levels of nutrients have been linked with major diseases from heart disease to cancer.
We use a three phase healing program with nutritional supplements to help you recover more quickly and with less downtime. We have you start this a week or so ahead of time to ensure that you are boosting your body's immune system and removing anything that could interfere with anesthesia or increase bleeding. Immediately following surgery we give you nutrients that help reduce pain and inflammation and detoxify the anesthesia and other medications. The third phase has additional healing nutrients to support your recovery.
Routine laboratory tests including blood counts and blood chemistries, a pregnancy test when applicable, and an electrocardiogram if you are over 50 years old, will be performed prior to surgery. These tests are performed routinely to screen for any abnormalities, which might complicate your anesthesia or surgery.
Nicotine causes constriction of blood vessels, and can impair circulation to tissues following any surgical procedure, especially those of the skin. Smoking should be discontinued prior to the procedure for a minimum of 2 weeks. You should cease smoking for a minimum of 4 weeks following your procedure.
Do not take aspirin or any drug containing aspirin for at least two weeks prior to your surgery. Aspirin may retard platelet function, a blood component that is important to normal blood clotting mechanisms. There are many drugs which contain aspirin. Before taking any drug, check the label carefully to assure that it contains no aspirin.
Do not eat or drink anything 8 hours prior to surgery. Safety in the administration of anesthesia or sedation requires that your stomach be absolutely empty for this interval of time before surgery.
Shower or bathe normally the evening prior to surgery.
You should wear loose fitting, comfortable clothing the day of surgery. A loose fitting shirt with buttons in front is preferable to any type of clothing which must be put on over the head. Pleases be sure that you have all of your questions answered prior to going into the surgical facility. I prefer that you make an additional appointment in the office if necessary to answer questions regarding your surgery. On the day of surgery, I will visit with you briefly immediately prior to surgery. Any final questions will be answered at that time.
Arrange for someone to drive you home at the appropriate time following your procedure, and arrange for someone to stay with you the night of surgery.
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THE DAY OF SURGERY:
I usually prescribe sedation or premedication prior to your being brought to the operating room. In order to minimize total necessary doses of drugs, sedation is best administered through an intravenous line rather than given in shot form into your muscle. It is normal to be slightly excited or apprehensive immediately prior to the surgery, and this will be alleviated quickly once your intravenous line is inserted. Our anesthesiologist will speak with you and answer all of your questions regarding your anesthetic.
Prior to moving to the operating room, I will ask you to sit and stand briefly so that I can mark your surgical site to use as guidelines during your surgery. Once in the operating room, you will then be positioned comfortably, and will have no recall of further events during your surgery.
The operation is performed using a general anesthetic. In addition, the medications have a profound amnesic effect, and you will have no recall of any events during the procedure. Actual surgical time usually ranges from 2 � hours to 3 � hours depending on the technique chosen.
After you are asleep, a small drainage tube may be placed into your bladder to monitor your urine output and provide bladder drainage, since the procedure can sometimes take an extended period of time and may irritate bladder emptying slightly.
Through the lower abdominal incision mentioned previously, the skin and fat overlying the abdominal muscles are lifted over a variable surface of the abdominal wall. An incision may be made around the umbilicus (belly button), and the umbilicus left attached via a stalk of tissue carrying its blood supply from the underlying abdominal wall. The muscles of the abdominal wall are then repositioned and tightened using many rows of sutures (stitches) which are reinforced in multiple layers. The flap or apron of skin and fat which has been elevated is then stretched downward where it overlaps the lower abdominal incision. The excess or overlapping portion is removed. The belly button may be repositioned according to lines drawn down the midline of your body to precisely reposition it. A small opening is then made through the elevated flap or apron to receive the repositioned umbilicus. Suction lipoplasty contouring is many times performed in areas of thickened fat not removed with the skin flap removal in the lower abdomen. This procedure is especially helpful in the upper abdomen and waist. Small silicone rubber drains are then placed which exit through the edges of the lower abdominal incision, and all incisions are then closed using multiple layers of sutures. Drains are usually removed within 5-14 days depending on the amount and character of the drainage.
At the completion of your operation, you will be transferred to the appropriate recovery area where you will remain until you awaken. I purposely like for you to remain drowsy, since you will be much more comfortable. After an appropriate interval of observation, usually a few hours, you will be allowed to leave with someone to drive you home and stay with you the evening of the surgery.
You will have been given prescriptions for pain medication and antibiotics with instructions for each at your preoperative visit.
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POSTOPERATIVE HEALING:
Postoperative healing requires some mandatory down time as part of the surgical recovery process. Post surgical healing requires the body to repair the surgical wound (whether in the skin, fat, muscle or bone) with scar tissue. The bruise and tissue fluid in the wound are gradually replaced by stronger scar or fibrous tissue over a period of 6-8 weeks. Until the time that the healing area is strong enough to maintain tissue integrity, the wound is held together by the sutures (stitches) placed at the time of surgery. Too much wound tension (stress) before the strength of the healing tissue is satisfactory, can cause disruption of the incision. I place sutures very precisely to account for these healing characteristics to maximize your postoperative activity, comfort, and safety. However, your inherent healing characteristics significantly dictate these parameters. Stretching, movement, massage, and return to normal activities of daily living in the early postoperative recovery allow for the optimal return to your full normal life style.
After the initial burst of high energy healing and the bulking up of scar tissue, the wound enters a maturation phase, and the scar tissue becomes thinner, less red, and stronger. The maturing and stabilization of scar tissue occur over a period of 6 to12 months. Long-term changes tend to be more subtle, slower, and less evident than short-term changes that occur in the first 6 to 8 weeks.
There are no absolute parameters regarding return to postoperative activities and one must adjust for variation in pain tolerance, invasiveness of surgery and healing variations.
In general, you cannot speed up the healing process, only slow it down by too much activity too soon. Overexertion can lengthen the period of time for pain to decrease, swelling and bruising to resolve, and the final surgical results to be evident. Healing occurs for up to one (1) year, sometimes longer. The latter changes tend to be subtle and gradual, and therefore not nearly as dramatic as in the initial 6 to 8 weeks.
Please be patient with your own healing. Any change in your appearance affects your perception of self-image and requires an adjustment period of days to weeks. It is normal to have mild feelings of doubt or a low mood during this period in the first 1 to 3 weeks following surgery. These feelings are then rapidly replaced by positive feelings as healing progresses and you adjust to your improved appearance.
Should you develop any of the following symptoms, please call our office:
- Elevation of temperature to or above 101 degrees, b) extreme swelling or tenderness c) any prolonged or significant bleeding from incision lines (slight drainage for 24 hours is normal), d) redness along the incision lines or elevation of temperature.
If you should have any other questions or problems, please contact our office at (303) 443-2277.
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LIMITATIONS, RISKS, AND POSSIBLE
COMPLICATIONS OF ABDOMINOPLASTY:
I have previously discussed the necessity of a rather long lower abdominal scar in order to perform this procedure. All scars require between six months to one year to mature, and during this period the scar initially may be a very fine line and then may become red and slightly raised. Over a period of months, the redness gradually disappears or decreases and firmness which you may feel in the area of the incision also decreases. If the scar widens excessively, it may be necessary in the future to revise it by removing it and closing it again when there is not as much stretch on the tissue.
It is possible to have untoward side effects to any drug which is administered during surgery. Severe side effects are extremely rare, but can be life threatening. It is for this reason that I insist on performing your surgery in an optimal setting where all conceivable equipment and medical backup are available should you have an unexpected reaction. Anesthetic or sedation risks are extremely minimal. Many cases have been vastly over publicized by the media, and most have occurred in settings where less than optimal facilities, equipment and personnel are present.
Infection can occur in any surgical wound, but occurs very rarely. You will be given antibiotics immediately before and after your Abdominoplasty as an additional preventive measure, but this does not totally eliminate the chance of infection.
Bleeding which was not present at the time of surgery can occur following surgery, usually in the first 24 hours, but may occur later. If significant bleeding occurs, you will notice a marked bulging usually associated with some discomfort beneath the skin. We will go back to the operating room and stop the bleeding. Excessive bleeding occurs in less than 1% of cases.
Because we are lifting the skin and fat off the underlying muscles, we force the lifted tissues to receive blood supply only from the area of the lower rib margin and sides of the abdomen. Before lifting, these tissues received additional blood supply from the underlying muscles. Tightly stretching the tissues to achieve the desired result causes some further compromise of blood supply. These factors combined in less than 5% cases may produce small areas of skin loss. This usually appears as a small crusted area along the border of the lower abdominal incision, but rarely may involve larger areas. In most cases, keeping the area clean and allowing it to heal underneath the small crust is all that is required. Occasionally, a secondary scar revision procedure may also be necessary should this unusual complication occur.
The possibility of blood clots forming in the legs and passing to the lungs, a dangerous and sometimes life threatening problem, is possible. This problem may occur in 1-2% of cases, and is the reason I encourage early mobility and ambulation.
Prior to your operation, I very carefully outlined the midline of your abdomen using bony landmarks at the neck level, middle portion of the rib margins, and the midline between the labia. The umbilicus is repositioned exactly along this line when your incisions are closed. As the stretched skin/fat flap loosens, and as healing and scar maturation progress, scar contraction or flap movement may shift the umbilicus slightly off the midline. Additionally, a small scar will be visible around the outline of the umbilicus. We try to minimize this by appropriate design of the incisions and closures.
The quality and characteristics of your scars are to some degree beyond our control. Despite meticulous and careful closure, you may form scars which have an unsatisfactory appearance. Unfortunately, I have no way of predicting this in advance. Scar revision may be needed for unsatisfactory scars.
Due to the amount of stretch necessary to achieve a satisfactory result with Abdominoplasty, sudden violent movements or other complications may result in areas of wound dehiscence (opening of the wound). With these rare occurrences, the openings are usually small and are treated conservatively, but may require an additional surgical procedure should they occur.
With current techniques, we rarely have enough blood loss with Abdominoplasty to require transfusion.
All of the above mentioned complications of Abdominoplasty are unusual, but occur occasionally despite the most vigorous standards of surgical practice. They are listed not to alarm, but simply to adequately inform you prior to your surgery.
CONCLUSION:
Abdominoplasty or major reconstruction of the abdominal wall with removal of excess fat and skin is a major surgical procedure. When properly performed in appropriate patients, it can provide a marked improvement in appearance and configuration of the abdomen and gives much more versatility in types of clothing which can be worn. Although it is a significant surgical procedure with some risks, it offers advantages not available by any other method and can be extremely rewarding for you.
During your office consultation, additional and more detailed information regarding all of the areas mentioned in this information sheet will be provided you as well as an opportunity for you to ask in-depth questions. Please review this sheet carefully, and write down any questions you may have.
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