Silhouette cosmetic surgery
Abdominoplasty (tummy tuck)

Some life events promote the distension of the abdominal skin (pregnancy, weight changes). They result in an unsightly excess of skin that may make it difficult to wear clothes

The tummy tuck (or abdominoplasty or abdominal dermolipectomy) is a procedure designed to remove excess abdominal skin. The treatment of subcutaneous excess fat can be performed at the same time. We differentiate between the umbilical abdominoplasty and subumbilical abdominoplasty ("mini-tummy tucks"). Circular abdominoplasty ("body lift") is covered in a separate chapter.

Full abdominoplasty

cicatrice abdominoplastie classique

With this procedure, all the skin between the navel and the pubis is removed. The remaining skin is peeled back, stretched and spread over the entire abdomen.

The inevitable long scar extends along the entire width of the abdomen. However, the scar is located just above the pubic bone, allowing it to be hidden by wearing underwear or swimwear.

The umbilicus or navel can be preserved and remain in its original position (tummy tuck with transposition of the umbilicus) or can be removed and rebuilt. The desire to keep your own navel is valid but will result in scarring around it: this is the standard method offered by most plastic surgeons. In some cases, Dr. Laveaux will offer an optional alternative technique for patients who don’t wish to preserve their navel.  This option has the advantage of not causing scarring around the navel, the only scar visible from this operation when wearing underwear.

In all situations, Dr. Laveaux uses the “High Superior Tension" technique that provides the best cosmetic results and can significantly reduce the risk of hematoma, seroma and skin necrosis.

Associated procedures

  • Liposuction is systematically associated with this procedure for two reasons :
  • to allow the preservation of the lymph vessels and to reduce excess abdominal fat and narrow the hips ;
  • liposuction and pubic tuck are necessary if the pubis is prominent. This leads to an additional vertical scar in pubic hair area ;
  • tightening of the abdominal muscles can be combined if necessary (Diastasis recti/abdominal treatment). The opportunity to perform this procedure is determined during the examination of the abdomen in consultation ;
  • In case of an incisional hernia or associated ruptures a digestion surgeon specialised in this type of procedure will assist during the operation to complete their treatment.

Principle of the Full Tummy Tuck

The procedure is performed under general anesthesia and takes between an hour and a half and 3 hours depending on the amount work to be done. Hospitalisation ranges from 24 to 72 hours.  The insertion of drains is not systematic.  If they are necessary, they will be removed before the release.

Post-operative effects

Pain is variable, generally mild and mainly due to liposuction. The pain is more intense for the treatment of diastasis or hernias.

The patient may return to work between 5-10 days after surgery depending on the job.

Resuming sporting activities varies between 6 weeks and 4 months in the case of diastasis or hernia treatment.

Sometimes a daily anticoagulant therapy may be prescribed for 8 to 10 days to reduce the risk of developing complications. 

Complete healing is achieved within 2 to 3 weeks.

The dressings are semi-permeable, therefore showers are allowed. Special dressings will need to be applied to the scars, even after healing, for 2-3 months to improve their appearance.

Wearing a compression belt is recommended 24 hours a day for 1 month (required for 3 months for treatment of diastasis or hernia).

Outcome

The result is often impressive given the amount of skin removed, both in aesthetic terms and in terms of comfort. However, the patient should wait about one year before the scar is fully developed and thus more discreet.

Risk of complications

As with any surgery, a number of complications can occur. But the likelihood of these complications is reduced in the hands of a qualified plastic surgeon and in the presence of a competent anesthetist. The patient’s compliance to instructions given by the surgeon is also essential and include :

  • stopping smoking 1 month before and after the procedure (reduction of all risks) ;
  • stopping the pill two months before and after the procedure (reducing the risk of phlebitis and pulmonary embolism) ;
  • not taking aspirin for 10 days before and after the procedure (reduced risk of hematoma) ;
  • When applicable, respecting the target weight your surgeon has determined before surgery, (reduced risk of phlebitis and pulmonary embolism and the risk of a poor cosmetic outcome).

Fortunately, postoperative effects are generally manageable following an abdominoplasty that has been carried out properly, so serious complications are rare.

In spite of the fact that complications are so rare you must be aware of the following problems :

Haematomas are quite rare but can occur. They can be evacuated.

Infection : this is extremely rare when the procedure is carried out in sterile environment.

Seroma : lymph collection under the skin that can be evacuated and that will dry up rapidly without sequelae.

Thrombo-embolic accidents (blood clots in the veins of the legs, pulmonary embolism) are rare and can be prevented by strict prophylactic measures (standing and walking as soon as possible after surgery, wearing compression stockings, or heparin therapy).

Numbness of the skin may be observed. It is usually transient and most patients recover normal nipple feeling after 6 to 18 months.

In case of a complications, your surgeon will treat them successfully if necessary.

In practice, the vast majority of cases take place without any problem and the patients are satisfied with the result.

Health insurance coverage

As this procedure is considered purely for aesthetic purposes, no coverage is provided by health insurance.

In some cases (sagging abdominal skin that partially covers the pubis, post-bariatric surgery) a partial reimbursement of the cost of the procedure may be considered upon prior agreement. Your health insurance fund’s medical advisor will need to examine you in this case.

In case of agreement, you will be responsible for the additional surgeon and anesthesiologist fees which will be redeemable in whole or in part by your health insurance.

Subumbilical abdominoplasty ("mini-tummy tucks").

This procedure aims to remove a variable amount of skin beneath the navel. The scar is located in the same place as an umbilical abdominoplasty but it is shorter.

Usually the navel remains in its original place. Sometimes it is lowered a few centimetres. In any case, there is never a scar around the umbilicus, which is preserved.

This procedure often complements an abdominal liposuction when there is too much excess skin to hope for sufficient retraction of the skin but not enough excess skin for an umbilical abdominoplasty to be performed.

The procedure is performed either under assisted local anesthesia as an outpatient or rarely during hospitalisation for 24 hours under general anesthesia. The duration of the procedure varies between 45 and 60 minutes.

Postoperative effects

The after effects are more manageable than after a full abdominoplasty and the risk of complications is lower.  No drain is inserted.  Preventive doses of anticoagulants are not systematic.

Health insurance coverage

As this procedure is considered purely for aesthetic purposes, no coverage is provided by health insurance.

 

Author:
Specialist in aesthetic surgery - Antibes
Updated: 16-08-2015

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