Abdominoplasty

Generality

The abdominoplasty is the cosmetic surgery operation, aimed at the removal of adipose tissue and excess skin; it serves to improve the appearance of the abdomen, but is not a treatment for weight control.

Abdominoplasty is indicated for women who have been involved in numerous pregnancies and for all those who have the after-effects of a drastic weight loss diet, implemented to treat severe obesity.
There are three main types of abdominoplasty: complete abdominoplasty, partial abdominoplasty (or mini-abdominoplasty) and extended abdominoplasty.
Abdominoplasty is a major surgery, so it has risks and complications.
The complete recovery from an abdominoplasty mainly depends on the modalities of intervention.
Generally, the results satisfy the patients.

What is abdominoplasty?

Abdominoplasty is the cosmetic surgery that removes the accumulations of abdominal adipose tissue associated with excess skin and relaxation of the abdominal muscle wall.
The goal of abdominoplasty is to improve the appearance of the abdomen, eliminating part of the so-called "imperfections" and trying to make the muscles located here stand out more.

WHAT IS IT NOT?

Contrary to what some people may think, abdominoplasty is not a surgical treatment for weight control.
In other words, if those who undergo abdominoplasty do not adopt a healthy lifestyle and do not eat in a balanced way, they will recover the abdominal appearance they had before the operation.
Therefore, in order for abdominoplasty to provide permanent results, it is essential that operated people control their caloric intake and keep fit with healthy physical exercise.

Uses

The ideal candidates for abdominoplasty are:

  • Women who have been the protagonists of numerous pregnancies and who, because of this, have an abdomen with accumulations of adipose tissue, extremely relaxed and with excess skin that is difficult to eliminate with physical exercise. In general, women with these problems also present a condition known as abdominal diastasis Abdominal diastasis is the pathological separation of the right rectus abdominis muscle from the left rectus abdominis muscle.
    The "abdominoplasty" is an operation indicated also for the resolution of severe episodes of abdominal diastasis;
  • Men and women who have the after-effects of a drastic weight loss diet, implemented to cure "severe obesity. The after-effects consist of deposits of abdominal fat that are difficult to eliminate, excess skin at the abdominal level, unsightly abdominal folds, etc.

WHO IS IT NOT APPROPRIATE FOR?

Abdominoplasty is not an intervention to cure obesity. The treatments for the latter are other, starting with: the constant practice of physical activity and the control of nutrition (appropriate diet).

Preparation

The abdominoplasty is a major surgery, therefore it requires special preparation.
First, the future patient must:

  • Stop smoking if you are a smoker. Cigarette smoke promotes the onset of infections in the surgical wounds, resulting from future abdominoplasty. It also alters the blood supply to the skin and this slows down the healing process of the aforementioned surgical wounds.
    Generally, doctors recommend to stop smoking at least two weeks before the operation and, if the patient wants to start again, to start again only after two weeks after the operation;
  • Lose weight and reach the body weight considered ideal by the doctor who will perform the surgery;
  • Stop taking the contraceptive pill. Clearly, this pre-operative indication applies if the patient is a woman and uses the aforementioned method of contraception. The contraceptive pill favors thrombosis episodes; stopping its use reduces the risk thrombosis;
  • Discontinue any intake of antiplatelet drugs (aspirin) and anticoagulants (warfarin). This pre-operative indication is explained by the fact that the aforementioned drugs dilute the blood and therefore represent a factor favoring bleeding.
    From the abdominoplasty wounds a loss of blood is expected, which, if the aforementioned drugs are taken, can be conspicuous and dangerous for the patient's health;
  • Warn the medical staff of any allergies to all those drugs (painkillers, sedatives, anesthetics, etc.), which could be used during abdominoplasty.

Abdominoplasty is an operation that requires, just before its execution, the practice of general anesthesia.

In order for general anesthesia to not lead to complications, it is essential that the patient, on the day of the operation, has had a complete fast for at least the previous evening. By complete fasting, we mean the abstention from food and drinks other than water; the latter is allowed up to a few hours after the procedure.


What are the main implications of general anesthesia?

The task of an anesthetist, the practice of general anesthesia involves:

  • The patient falling asleep for the duration of the procedure;
  • Continuous monitoring of the patient's vital parameters (heart rate, blood pressure, body temperature, oxygen level in the blood, etc.), through "appropriate instrumentation.

Typically, the sleep anesthetic takes effect within 10-15 minutes; its administration lasts for the entire duration of the operation. Awakening occurs at the end of the procedure and when the anesthetist stops the injection of the anesthetic.

PRE-OPERATOR EXAMS

Normally about a week before the operation, the patient must go to the hospital, where the operation will take place, to undergo a series of clinical examinations.
These clinical examinations of assessment - also known as pre-operative examinations - are used by the operating surgeon to ensure that there are no contraindications to the operation. The classic pre-operative tests include: blood tests, urinalysis, electrocardiograms and blood pressure measurements.

PRE-OPERATIVE CONSULTATION

The preparatory phase for an "operation such as abdominoplasty also includes a consultative meeting between the operating doctor and the future patient, during which the first explains the method of intervention (from how the procedure is performed to possible complications) and the second has the "opportunity to remove any doubts on procedural aspects that are still unclear.

Procedure

There are various types of abdominoplasty. Some types are ideal for eliminating large amounts of excess fat and skin; other types, on the other hand, are suitable for the removal of moderate / limited accumulations of fat and excess skin.
The main types of abdominoplasty are:

  • The complete or standard abdominoplasty;
  • L "partial abdominoplasty or mini-abdominoplasty;
  • The extended abdominoplasty.

WHAT DOES THE CHOICE OF ABDOMINOPLASTY DEPEND ON?

The choice of which type of abdominoplasty to practice is up to the operating surgeon and it depends, quite intuitively, on the quantity and location of abdominal fat and excess skin in this area.

COMPLETE OR STANDARD ABDOMINOPLASTY

The complete abdominoplasty is suitable for the removal of large quantities of adipose tissue and skin; moreover, it guarantees the possibility of remodeling the abdominal muscle wall more easily and with good results.
From a strictly technical-operational point of view, complete abdominoplasty includes:

  • The incision of the abdomen from side to side and just above the pubic area. Com "it is easy to imagine, it is an" engraving of important dimensions;
  • A second incision around the "navel, in such a way as to" free "the latter from the surrounding skin;
  • The detachment of the skin and adipose tissue from the abdominal muscle wall;
  • The removal of skin and adipose tissue deemed to be too much. In this phase of the operation, the surgeon also repairs the abdominal muscle wall, if the latter presents anomalies or is, in some way, altered;
  • The relocation of the navel and the suture of the latter to the parts of skin resulting after the previous step;
  • The suture of the first large surgical incision;
  • The application of a protective bandage, which covers the entire surgical wound.

A "complete abdominoplasty" is an operation that can last up to 5 hours; on average, it lasts 3.

PARTIAL ABDOMINOPLASTICS OR MINI-ABDOMINOPLASTICS

Partial abdominoplasty is suitable for those who need to remove small amounts of excess adipose tissue and / or skin.
From a strictly technical-operational point of view, partial abdominoplasty involves:

  • The execution of a curved incision on the abdomen, precisely a little higher than the pubic area;
  • The detachment of the skin and adipose tissue from the abdominal muscle wall, located just below the navel;
  • The removal of the skin and adipose tissue detached from the abdominal muscle wall located just below the navel. In this phase of the procedure, the surgeon also repairs the abdominal muscle wall, if the latter presents abnormalities or is, in some way , altered;
  • The suture of the incision;
  • The application of a protective bandage, which covers the entire surgical wound.

As readers will surely have noticed, there is no incision of the navel, which remains in its original position for the entire duration of the operation.
Partial abdominoplasty is an operation that usually lasts a couple of hours at the most.

EXTENDED ABDOMINOPLASTY

The extended abdominoplasty is suitable for the removal of large quantities of adipose tissue and skin located on the abdomen, hips and part of the back. In fact, it corresponds to a complete abdominoplasty, plus the removal of adipose tissue from the hips and from the lumbar area closest to the hips.
From a strictly technical-operational point of view, partial abdominoplasty involves:

  • The execution of a large incision, which includes the entire abdominal pubic area, the two sides and the lumbar region immediately after the sides of the body;
  • A second incision around the "navel, in such a way as to" free "the latter from the surrounding skin;
  • The detachment of the skin and adipose tissue from the underlying muscle walls. This part of the procedure obviously concerns all the anatomical areas from which the doctor wants to remove excess fat and skin;
  • The removal of skin and adipose tissue deemed to be too much. In this phase of the operation, the surgeon also repairs the abdominal muscle wall, if the latter presents anomalies or is, in some way, altered;
  • The relocation of the navel and the suture of the latter to the parts of skin resulting after the previous step;
  • The suture of the first large surgical incision;
  • The application of a protective bandage, which covers the entire surgical wound.

Extended abdominoplasty is an operation that can last from 3 to 5 hours.

Post-operative phase

At the end of the abdominoplasty and upon awakening from general anesthesia, hospitalization is always provided.

The length of hospitalization varies according to the type of abdominoplasty: for example, for extensive abdominoplasty operations - which are quite invasive - the hospitalization can last up to 4 days; while, for partial abdominoplasty operations - which are less invasive than the previous ones - hospitalization lasts a maximum of a couple of days.
During the entire period of hospitalization, the medical staff periodically monitors the patient's vital parameters; moreover, they provide for the continuous drainage of blood and other fluids from the surgical wound, through a special tube. The removal of this tube takes place shortly before discharge. .
For discharge and especially for returning home, the patient should ask for the support of a relative or a close friend.

POST-OPERATIVE FEELING

It is quite normal that, after abdominoplasty, the patient feels:

  • Pain in the operated area. This feeling usually resolves within a few days. If it persists or is particularly acute, it is advisable to use painkillers (eg ibuprofen or paracetamol);
  • Confusion and lightheadedness. These are effects due to general anesthesia. They resolve within a maximum of 24 hours;
  • Sense of tiredness. Abdominoplasty is an operation that takes away a lot of energy from patients, who need a few days to recover in an acceptable way.

POST-OPERATIVE RECOMMENDATIONS

The most important medical recommendations relating to the post-operative phase include:

  • The observance of a period of rest from any tiring activity (lifting weights, intense physical exercise, etc.). Doctors consider it necessary to follow this recommendation for at least 6 weeks;
  • The cleaning of the wound and the protective bandage, which the operating doctor applied at the end of the operation;
  • Don't smoke for at least a couple of weeks. The effects of smoking have already been widely discussed above.

Frequently asked questions about resuming daily activities:

D: When is it advisable to return to work?
A: In case of not particularly tiring work, the resumption of the activity can take place after 4 weeks; in case of very heavy work, it is better to wait at least a couple of more weeks.

D: When is it possible to resume the practice of physical activities of modest intensity, without risk of complications?
A: After 10-20 days.

REMOVAL OF STITCHES

The sutures applied during the final phase of the abdominoplasty can be resorbable or non-resorbable.
If the sutures are resorbable, their removal occurs spontaneously, without the patient having to go to the operating surgeon in the days following discharge. If, on the other hand, the sutures are non-resorbable, their removal requires the intervention of the treating surgeon; in general, it is the latter who establishes an appropriate date for the removal of the so-called "sutures".

Recovery

The duration of recovery from abdominoplasty depends on the type of procedure the plastic surgeon used. For complex operations, such as those of extended abdominoplasty, the recovery phase can take from 3 to 6 months; for simpler operations, such as partial abdominoplasty, however, it can take 6 weeks or so.
It should not be forgotten that the age of the patient, the attention he pays to pre- and post-operative recommendations, etc. also affect recovery times.
Despite recent advances in plastic surgery, the surgical incision, made during abdominoplasty, still leaves a scar.

Risks and complications

Abdominoplasty is a major surgery, therefore, like any operation of this kind, it presents some risks and can lead to complications, sometimes even very serious ones.

ADVERSE EFFECTS

By adverse effects, doctors mean minor issues.
In the case of abdominoplasty, the main adverse effects consist of:

  • Acute and protracted pain for longer than normal;
  • Appearance of large hematomas in the operated area;
  • Swelling at the level of the intervention area;
  • Presence of a very noticeable scar.

COMPLICATIONS

By complications, doctors mean problems of some clinical significance.
Complications of an "abdominoplasty include:

  • Episodes of infection;
  • Episodes of subcutaneous bleeding;
  • Episodes of seroma;
  • Permanent sense of numbness
  • Obvious redness of the scar, resulting from the surgical incision;
  • Formation of a blood clot in the pulmonary arteries and one of their branches (pulmonary embolism)
  • Slow healing of the surgical wound

Contraindications

The abdominoplasty has some contraindications.
In fact, it is unsuitable for:

  • People with heart disease (so-called heart patients);
  • People with diabetes;
  • People suffering from severe obesity;
  • Women of childbearing age who want to have a child. If all the conditions of intervention are met, the subjects in question can undergo abdominoplasty once the desired pregnancy or pregnancies have been completed.

Related and alternative interventions

Sometimes, women who need a tummy tuck are also candidates for alternative interventions: liposuction, body contouring surgery (or lifting body), a reduction mammoplasty, a lifting breast and / or a "hysterectomy.
Among the aforementioned surgical procedures, liposuction deserves particular attention. The latter can be not only an intervention related to abdominoplasty, but also an alternative; much depends on the elasticity of the patient's skin.


Liposuction is the surgical procedure of elimination, by aspiration, of fat deposits resistant to the slimming action of a diet or physical exercise.

Results

Generally, patients undergoing abdominoplasty are satisfied with the results obtained thanks to the operation. It is quite rare that some individuals are not happy with their final appearance or find it difficult to recognize themselves (since, in some cases, the physical change is really profound ).
To maintain the results of the abdominoplasty, it is essential to adopt a balanced diet and exercise.


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