Abdominoplasty: Straight Talk to Help You Decide if it's Right for You

Abdominoplasty, otherwise known as the "tummy-tuck," is an elective cosmetic surgical procedure. It is major invasive surgery, which removes excess skin and fat from the middle and lower abdomen. It also tightens the muscles of the abdominal wall. The procedure can dramatically reduce the appearance of a protruding abdomen. However it does produce a permanent large scar, which can extend from hip to hip, depending upon the extent of the procedure. If you are considering abdominoplasty, this article will give you a basic understanding of when it can help, who it can help, how it is performed, and the results that you can expect.

The Best Candidates
The best candidates for abdominoplasty are emotionally stable men and women who are in relatively good shape, close to their ideal body weight, who have good overall skin elasticity, but who are bothered by a large fat deposit or loose abdominal skin that won't respond to diet or exercise. The surgery is particularly helpful to women who have lost elasticity in the muscles and skin of the abdomen due to multiple pregnancies. Loss of skin elasticity in older patients, due to weight loss, can also be improved.

The Cost
This is expensive surgery. The average cost of Abdominoplasty ranges from $5,000 to $9,000. If a surgery costs $6,200, the cost would be broken down to $5,000 for the surgeon, $500 for the anesthesiologist, and $700 for the facility. Liposuction might be an additional $2,700. According to the American Academy of Cosmetic Surgery's 2005 Procedural Census, 32.4 percent of their member surgeons performed abdominoplasties. The "tummy-tuck" lies just about in the middle of preferred invasive plastic surgery procedures, and since liposuction is number one, that would make abdominoplasty near the top plastic surgery procedure when combined with liposuction.

Who Should Not Consider Abdominoplasty?
Abdominoplasty is not a "one size fits all" procedure. A lot depends upon the collaborative decisions made by the patient and his or her surgeon. Patients who plan to lose a lot of weight should postpone surgery until they have achieved their desired weight. Young women who plan future pregnancies should also wait, since vertical muscles in the abdomen, which are tightened during surgery, can separate again during pregnancy. If you have heavy scarring from previous abdominal surgeries, your doctor may advise against an abdominoplasty, due to the possibility of unusually prominent scars.

Finding the Right Surgeon
Before you elect to have abdominoplasty, you must find a qualified surgeon who is board certified. Be wary of the doctor who identifies him or herself as simply "board certified." You must understand exactly what "board certification" means. In the United States there are several plastic surgery certifications: the American Society of Plastic Surgeons; the American Board of Plastic Surgery; and the American Society for Aesthetic Plastic Surgery. In Canada, make certain that the surgeon is certified by the Royal College of Physicians and Surgeons of Canada. Claims of board certification can be verified by the American Board of Medical Specialties. Ask for a list of certified doctors in your area.

What Are the Risks?
When performed by a qualified plastic surgeon who is trained in body contouring, the results are usually more than satisfactory. However, as in all surgeries, there are some risks associated with abdominoplasty, and there are specific complications associated with the procedure. These include infection, blood clots, and poor healing, which can result in heavy scaring. Infection is treated with antibiotics and drainage, while the risk of blood clots can be minimized by moving around as soon after surgery as is possible. Poor healing and scaring may require additional surgery. Smoking can increase the risk of complications and delay healing. Following your surgeon's instructions carefully, before and after surgery, can significantly reduce your risk of complications.

The Consultation
Many plastic surgeons do not charge a fee for the initial consultation. The surgeon will evaluate your medical history and ask about your health habits. This is the time for absolute honesty. Be specific about what you want done. If your plastic surgeon fully understands your expectation, he'll be able to determine whether your goals are realistic. Be certain to tell the surgeon if you smoke, have diabetes, or if you have any secondary medical considerations or conditions. He will ask you about you family medical history, especially your parents and siblings. Your surgeon may want to do some tests, to rule out certain diseases. In any case your surgeon will work with you to recommend the procedure that is right for you.

Types of Abdominoplasty
There are two types of abdominoplasties: the "mini-abdominoplasty" and the more invasive "abdominoplasty." Both of these surgeries may involve liposuction. In both surgeries skin and fat are cut away from the abdomen. In a mini-abdominoplasty, an incision is made just above the pubic area, and fat and excess skin are removed from the middle and lower abdomen. The navel is pulled lower to compensate for the stretching and removing of skin. Minimal or no abdominal tightening will be required. Recovery time is usually very quick.

The full abdominoplasty requires a much larger incision. Skin is then separated from the abdominal wall all the way up to the ribs, and the muscles are sewn together to tighten them, and much skin is removed, requiring the patient to be bent over for 10 to 14 days. Usually in two to three weeks the patient may resume normal activity, except for lifting. There must be no lifting whatsoever for up to two months.

The Surgery
Complete abdominoplasty usually takes two to five hours, depending upon the extent of the work needed. The surgeon will make a long incision from hipbone to hipbone, just above the pubic area. A second incision is made to free the navel from surrounding tissue. The surgeon then separates the skin from the abdominal wall, lifting a large skin flap to expose the abdominal muscles. The muscles are then sewn together to firm the abdominal wall and narrow the waistline. The skin flap is stretched, and excess skin is removed. A new hole is cut for the navel, which is then stitched in place. Incisions will then be stitched closed, dressings will be applied, and a temporary tube may be inserted to drain off excess fluid.

Partial abdominoplasty may take an hour or two. The incision is much shorter, and the naval usually does not have to be removed, although it may be pulled into an unnatural shape when the skin is tightened and stitched. Both surgeries may require liposuction.

Both types of surgery can be performed with either general anesthesia, in which you will be asleep, or local anesthesia, where you will be awake, but sedated. With the local, you will be relaxed and pain free, although you may feel some tugging or pulling. Depending upon your doctor your surgery may be performed in a hospital or in an outpatient surgical center.

After Surgery
After the surgery you may be swollen and in pain, which can be controlled by medication. Depending upon the type of surgery, you may be released within a few hours, or you may remain hospitalized for up to three days. Your doctor will give you instructions in your post-operative care, and though you may not be able to stand up straight, you should start walking as soon as possible. Surface stitches will be removed within a week, and deeper sutures that protrude through the skin will come out in two to three weeks. The dressing on your incision may be replaced by a support garment.

It may take weeks, even months to fully recover from abdominoplasty. The better your physical condition is before surgery, the shorter will be your recovery time. Some people return to work in a couple of weeks; in someone else recovery can take up to a month. A low-impact exercise program, such as yoga, will help you heal faster, reduce swelling, tone the muscles, and lower your chances of blood clots.

The Down Side
Your scars may actually appear to worsen during the first three to six months, as they heal. This is normal. Expect it to take months or up to a year for the scars to flatten out and lighten in color. While scars will not be noticeable under clothing, even a bathing suit, they will not go away completely. Although abdominoplasty, whether partial or complete, produces dramatic results for patients with weakened abdominal muscles or excess skin, it is not a substitute for a healthy diet and regular exercise.

In Conclusion
In most cases the results of abdominoplasty are long lasting, if you maintain a healthy lifestyle. If you are realistic in your expectations, and you are prepared for the consequences of a permanent scar and a lengthy recovery, abdominoplasty just may be the right choice for you. You must decide.

To find a plastic surgeon who performs this procedure, visit the online referral service of the American Society of Plastic Surgeons (ASPS). The ASPS was founded in 1931, and it is the largest plastic surgery organization in the world. It is also the foremost authority on cosmetic and reconstructive plastic surgery. All ASPS physicians are certified by the American Board of Plastic Surgery (ABPS) or the Royal College of Physicians and Surgeons of Canada.