The Ideal Candidate
Tummy Tuck surgery is ideally suited to the woman who has had several pregnancies (or gained and lost a great deal of weight with just one) and has developed laxity in the abdominal wall musculature (sometimes referred to as Diastasis Recti) and/or skin excess. A Flap of excess skin (sometimes referred to as a Pannus) can sometimes hang over the pubes. In the presence of these conditions, the alternative (abdominal liposuction) surgery offers far less potential improvement than an abdominoplasty.
The Operation and More On Risk
The operation can be more or less extensive depending upon the problem being addressed. A "Mini" is less of a big deal than a Standard or "High Cut." Each of these operations is more serious than simple liposuction. The tightening of the abdominal wall, while it allows for a more radical contour improvement, can make breathing a little more difficult. This is almost never significant unless the patient already has impaired breathing (such as in those with Severe Emphysema or Obstructive Pulmonary disease). Therefore in patients looking to have this procedure, a look into that patient's overall health is indicated.
Post-operatively, I almost always (except in "Mini" procedures in young people) insist upon some sort of aftercare arrangement. This constitutes an overnight stay (at least) in a facility with nursing available. The first few times out of bed may take a little help. Although the patient may not want to get up, it is important to do so soon after surgery. Family members tend to think the patient should be in bed. A skilled nurse knows better.
When patients do go home, it might be a few weeks until they are back to regular activity. I recommend no heavy exercise for six to eight weeks. Each case is judged individually. I do however like the patient up and walking taking deep breaths from the morning after surgery.
The operation, recovery and risks of abdominoplasty surgery are much more involved than those of liposuction. There is always a scar after an abdominoplasty, generally a scar that extends from one side of the abdomen to the other. Plastic surgeons are skilled in making these scars less apparent than other surgeons, but the surgeon cannot do the healing for the patient. Patient healing varies from person to person as do the resultant scars following abdominoplasty surgery.
Wound healing can be delayed following abdominoplasty surgery especially in the larger cases, as the operative design involves reducing the blood supply to the large flap of skin that is mobilized, reduced and moved from the top of the abdomen to the bottom. It is this mobilization that allows a great portion of the skin and fat (the pannus) to be removed. At times patches of skin can be lost (Skin necrosis) leaving an open wound that can take some time to heal. In these cases, a revisional operation six months to a year down the line is frequently desired to improve the result. This risk warrants measures to minimize its occurrence. Patients that smoke or have diabetes or take steroid medications are at higher risk. Withholding cigarette smoking, controlling diabetes and minimizing the use of steroids (if possible) can improve the odds.
More rare complications (really the complications of a large operation) include venous thrombosis (the development of vein clots in the legs). This is one reason it makes sense not to be still in bed as these clots tend to develop in patients at rest. The are also more likely in those that smoke. Rarely, these clots can break off from the veins and result in serious problems. They occur in less than 2% of patients.
