Tummy Tuck (Abdominoplasty) Toronto
Having a toned abdomen is one of the most common patient requests. The abdomen is one of the first sites to show signs of weight gain for many individuals. Excess skin and fatty tissue often develop at this site due to the effects of aging, pregnancies, and weight gain. The skin gradually loses elasticity and is stretched beyond its ability to contract following weight loss. Stretch marks commonly develop.
Patients often present with abdominal wall weakness and a central bulge as well, due to separation between the abdominal wall muscles following pregnancies or significant weight fluctuation. This muscle gap is often more pronounced following multiple pregnancies, multiple births, and large birth weight babies. It can be frustrating for many patients that the abdomen may be unresponsive to diet and exercise due to these changes.
A tummy tuck may be performed to improve abdominal contour, correct excess abdominal skin and subcutaneous tissue, and often to repair the rectus diastasis (gapping between the rectus – “six-pack” – muscles) that commonly results after pregnancy or significant fluctuations in body weight.
The surgery is performed through an incision on the lower abdomen, from hip to hip and a small incision around the umbilicus (belly button). Excess skin and subcutaneous tissue is removed and the abdominal muscles are repaired and tightened in the midline. The transverse abdominal scar may be concealed by swimwear. Certain patients with a lesser degree of abdominal skin laxity and subcutaneous tissue limited to the lower abdomen may be candidates for a mini-tummy tuck (abdominoplasty). This procedure requires less undermining and does not alter the abdominal wall above the umbilicus. Additionally, there is no scar around the umbilicus.
Although tummy tuck is a major cosmetic surgery, it may dramatically improve the appearance of the abdomen by tightening abdominal wall muscles and removing excess skin and fat. Patients often inquire regarding a less invasive option – for example, liposuction – to address excess abdominal skin and fatty tissue. Unfortunately this is not an option for most patients following pregnancies or significant weight fluctuation given that the skin has lost elasticity. If excess fat was suctioned in these cases, the skin would not contract adequately afterwards. This would increase the amount of redundant skin and negatively affect the appearance of the abdomen.
A tummy tuck is performed under general anesthetic and patients are generally admitted to the overnight facility at 199 Avenue Road until the following morning for observation and pain control. Two drains will be in place immediately following surgery to prevent fluid from accumulating at the surgical site, which could lead to wound healing complications or infection. These drains will be removed in clinic within the first week based on how much drainage occurs.
Patients are generally able to return to work within 1-2 weeks. Dr. Power will make specific recommendations based on each patient’s job and household requirements. It is necessary to refrain from strenuous activity or heavy lifting for 4-6 weeks post-operatively and to wear an abdominal binder for support during this time period. The abdominal garment may be concealed under clothing.
What are common concerns of patients considering a tummy tuck (abdominoplasty)?
Patients considering a tummy tuck are generally interested in improving their abdominal contour
History of pregnancy or significant weight fluctuation often leads to the development of excess subcutaneous tissue (fatty tissue or fullness), decreased elasticity, and redundancy of skin resulting in skin folds and abdominal striae (stretch marks). In addition to these skin and soft tissue changes, a rectus diastasis (gapping between the rectus abdominus muscles) commonly develops which may reduce core strength and lead to abdominal bulging Abdominoplasty or tummy tuck surgery addresses these concerns by resecting excess skin and subcutaneous tissue from the abdomen as well as tightening and reinforcing the rectus muscles in the midline.
Who is a suitable candidate for a tummy tuck (abdominoplasty)?
As for anyone considering elective cosmetic surgery, patients with well-defined concerns regarding their appearance and achievable goals are good candidates for this procedure.
During initial consultation, a detailed medical history and examination will be performed to rule out contraindications to surgery and to determine if any pre-existing conditions may require optimization prior to elective surgery. Due to the extent of surgery and skin flap elevation, smoking cessation is essential at least 4 weeks pre- and post-operatively to lower risk of complications:
Smoking is associated with higher incidence of infection and partial flap necrosis (loss of skin), which may result in a large region to heal secondarily through delayed wound healing. Body weight, weight history, and pregnancy history are also important considerations. The recommended body mass index (BMI) for patients considering abdominoplasty is less than 30, ideally closer to or less than 25, and stable for at least 6 months pre-operatively. If significant weight loss occurs after a tummy tuck, this may result in further skin and soft tissue redundancy and results may be less predictable. It is also recommended for women to have completed pregnancies before proceeding with tummy tuck surgery. Although it is possible to carry a full-term pregnancy following abdominoplasty, this would place significant tension on the rectus plication (muscle repair site) and further stretches the abdominal soft tissues. Revision procedure may be required following significant weight loss or pregnancy after abdominoplasty has been performed.
What are different types of tummy tuck (abdominoplasty) surgery?
The three most common types are the standard tummy tuck, a mini-tummy tuck, and a circumferential tummy tuck. The extent of abdominal skin laxity will be carefully assessed during clinical examination to determine the most appropriate technique to achieve your goals.
If the skin redundancy extends onto your back – which commonly affects patients following bariatric surgery and significant weight loss – a circumferential tummy tuck may be recommended
The excision is carried around the body onto the lower back to address redundant tissue in this region, which improves overall contour
A mini-tummy tuck may be recommended for patients with skin redundancy limited to the region below the umbilicus
This is performed through a shorter incision and does not place a scar around the umbilicus
A standard tummy tuck is the most common technique performed to address skin redundancy of both the anterior abdomen – including the upper abdomen – and rectus diastasis
What to expect after a tummy tuck (abdominoplasty)?
Patients are generally admitted overnight following surgery for monitoring in a recovery suite at 199 Avenue Road
Close observation is performed to ensure that there is no significant bleeding and that patients are tolerating oral pain medication and beginning to ambulate short distances prior to discharge home
Two drains are typically placed to lower the risk of fluid accumulation under the abdominal flap
You will be instructed on how to care for and measure drain output at home. I generally remove the drains within the first week of surgery once output has decreased to an appropriate amount
I recommend patients to begin showering daily starting the day after the procedure and to change the gauze underneath the abdominal binder
The abdominal binder should be worn for 6 weeks following surgery
It provides additional support for the muscle repair during early healing and lowers the risk of fluid accumulation
Small pieces of surgical tape will be placed over the incisions for the first 1-2 weeks post-operatively
What is the anticipated recovery after tummy tuck (abdominoplasty)?
Patients are generally able to resume office work (paperwork equivalent) within 1-2 weeks following a tummy tuck
Pain medication is usually required for the first few days following surgery
I also prescribe a short course of antibiotics to lower risk of infection while the drains are in place
Specific recommendations for activity modifications will be made for you based on your job activity level and requirements
Patients may resume exercising 6 weeks post-operatively, which ensures that the muscle repair site has healed well by this stage
How much should I weigh before considering tummy tuck surgery?
It is recommended for patients to achieve a healthy body mass index (BMI) prior to surgery. This will lower the risk of surgical and anesthetic complications and also result in a better aesthetic outcome. Ideally a BMI less than 25 is recommended pre-operatively. Tummy tuck is not an effective surgery for weight loss. It is performed to improve abdominal contour. At higher body mass index (BMI), patients often present with increased fatty tissue within the abdomen, deep to the abdominal wall. This is called visceral fat. It surrounds body organs and is not addressed by a tummy tuck. It is also the type of fat linked with increased risk of cardiovascular disease, diabetes, and other systemic illnesses. If abdominoplasty is performed on a patient with significant visceral fat, the abdominal contour may still be rotund post-operatively.
When can I exercise after tummy tuck
Exercise may be resumed 6 weeks post-operatively. This time frame will lower the risk of delayed bleeding given the large surface area that is operated on during tummy tuck. Although bleeding is controlled at time of surgery, delayed bleeding may occur during early healing if heart rate or blood pressure increase. The muscle repair also has little strength during early healing. Abdominal exercises, if performed during the early post-operative phase, may lead to breakdown at the muscle repair site. If the stitches break or pull through these fragile tissues, the rectus diastasis may recur.
How painful is tummy tuck surgery?
Patients often report discomfort for a few days post-operatively, generally related to the muscle repair site. The muscle sheath (outer layer) is injected with long-acting local anesthetic towards the end of surgery. This provides a bridge as the oral pain medication takes effect. It is recommended to walk short distances around your home during early healing to lower risk of venous thromboembolism (blood clots). Walking with your waist slightly flexed over the first few days may also reduce discomfort. Within a few days patients are able to wean prescription pain medication by taking Tylenol extra-strength or plain and then discontinuing all analgesia when able. It is recommended to avoid anti-inflammatories for one month post-operatively to lower risk of bleeding.
When should I have a tummy tuck if considering more pregnancies?
Although tummy tuck is not a contraindication to future pregnancies, it is recommended to delay surgery until you have completed childbearing. If pregnancy occurred followed tummy tuck, revision surgery may be required in the future given that the muscle repair site would likely develop recurrent separation. Redundant skin and soft tissue may also recur following pregnancy. Waiting approximately 6 months following delivery is recommended to achieve a stable weight.
How long should my weight be stable before tummy tuck?
It is generally recommended to maintain a stable weight at healthy BMI for 3-6 months prior to abdominoplasty to increase the likelihood of achieving a stable and satisfactory aesthetic outcome.
Should I have a mini or full tummy tuck?
Few patients are candidates for a mini tummy tuck if a rectus diastasis (muscle separation) is present. A mini tummy tuck may be an option for a slender patient with very minimal skin and soft tissue excess limited to the lower abdomen only. It does not address the abdominal wall above the level of the umbilicus.
What is the purpose of drains after tummy tuck?
Drains are generally used to lower the risk of developing a fluid collection (seroma) below the skin flap. Whether drains are necessary is an area of debate within the plastic surgery literature. Dr. Power generally inserts two drains following tummy tuck surgery which exit through the transverse abdominal incision. This avoids additional scars at the drain sites. Patients are instructed how to shower with the drains in place beginning the day after surgery. The drains are removed when they taper to a consistently low amount of drainage over a 24-hour period. This is generally within one week of surgery.
How long should I wear the abdominal binder after tummy tuck?
The abdominal binder is recommended for 6 weeks post-operatively. This provides support to the muscle repair site, decreases swelling, and may lower the risk of seroma (fluid accumulation).
Are the effects of tummy tuck long-lasting?
Yes, as long as one maintains a healthy diet and exercise regimen post-operatively.
What are potential complications of a tummy tuck (abdominoplasty)?
It is important to understand potential complications – both local and systemic – of a tummy tuck
Hematoma (collection of blood or ongoing bleeding deep to the abdominal flap)
Seroma (fluid collection)
Delayed wound healing
Dehiscence (wound separation)
Partial skin flap or umbilical necrosis
Failure of the plication sutures
Hypertrophic or widened scarring
Thromboembolism – deep venous thrombosis (DVT)
Pulmonary embolism (PE)
Potential complications related to general anesthetic
Precautions are taken to lower risk of these associated complications. Patients are stratified pre-operatively based on risk factors for thromboembolism development. For patients at low risk, thromboembolic deterrent (TED) stockings and sequential compression devices (SCDs) are applied before induction of general anesthetic. SCDs intermittently tighten around the lower extremity throughout surgery and during early recovery until patients are mobilizing well. Through this pumping mechanism, SCDs increase venous return to the heart and decrease blood pooling in the lower extremities, which lowers the risk of DVT formation. Patients are also encouraged to begin early ambulation following abdominoplasty. Those at higher risk for thromboembolic events may require anticoagulant, which lowers risk of DVT or PE formation by decreasing blood viscosity.
Despite the potential complications of a tummy tuck, appropriate patient selection and optimization pre-operatively, through investigations and consultation with other medical services as needed, make a tummy tuck a well-tolerated surgery with high patient satisfaction.