Faster Recovery After Abdominoplasty

Richard A. Baxter, M.D., F.A.C.S.

by Richard A. Baxter, M.D., F.A.C.S. | August 10, 2010 @ 09:00AM

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Abdominoplasty, or "tummy tuck," is often the best choice for improving the appearance of the abdominal area after the skin and muscle wall have been stretched from pregnancy or changes in weight. There is simply no amount of exercise that can restore and tighten loose skin. And although there are some methods of minimizing stretch marks, they are permanent. If the only problem is localized fat, and the skin tone is good, then a liposuction procedure would be preferred over an abdominoplasty.

A standard abdominoplasty involves removal of the skin and fat from about the level of the "belly button" to just above the pubic area; the skin from above is undermined and stretched down to the pubic area where it is sewn to the skin edge there. This tightens the whole front of the abdominal area. The "belly button" is brought up through an opening in the undermined skin, which has been pulled over it, so that the navel is in the same location. In addition to tightening the skin in this fashion, the excess fat under the skin in this area is usually removed.

Because the whole front of the abdominal area has been undermined in order to accomplish the necessary skin and fat removal, there is normally a tendency for fluid to accumulate underneath the skin. Traditionally, this requires placement of a drainage tube, which may need to be left in place for up to three weeks. However, a new technique called "anchor sutures" or "progressive tension sutures" nearly eliminates the fluid buildup, so that the drainage tube to be removed in a day or two in many cases. Without the inconvenience and discomfort of managing the drainage tube, recovery and return to normal activities are much more rapid.

It turns out that the anchor suture technique has other benefits as well. (These sutures are on the inside, from the inner surface of the skin flap to the outer surface of the muscle lining that forms the "wall" of the abdomen.) The anchor sutures can also be used to create attractive contours, such as a subtle groove down the midline. A final benefit is that because the skin flap is anchored down, there is less tension on the edges of the skin where it is sewn together. Less tension means a better scar, and less chance that the scar will shift position as it heals.

While the quality of the scar is important, the location and orientation of the scar also matters. If it doesn't angle up toward the hips on the sides, it may be exposed in many types of swimwear, thereby offsetting some of the benefits of having the operation in the first place! It may also be a problem if the scar pulls up in the middle section, elevating the pubic area more than desirable. This portion of the scar looks best when it is fairly straight, and located just at the top of the pubic area. Anchor sutures also help to optimize this.

So what should the intelligent consumer ask when considering abdominoplasty? First, make sure that it is the right operation for your concerns. It is not a substitute for diet and exercise, but it may be the solution to the problems you can't correct on your own. Smoking increases the risk of complications, so be prepared to do your part on that issue. Ask your plastic surgeon how long you will need a drain after surgery, and what your recovery period is expected to be. If your procedure is to be done in an office-based facility, does the doctor have hospital privileges for abdominoplasty in a nearby hospital? If not, you may have no way of knowing whether the surgeon's training and performance has been reviewed and approved by his or her peers.

A tummy tuck is definitely one operation where looking at "before" and "after" pictures is helpful. There are several variations in technique and scar configuration, and some of the more traditional methods may leave a scar exposed in the type of swimwear you prefer. The most up-to-date methods give the surgeon precise control of the scar location, and allow for aesthetically pleasing contouring of the abdomen while minimizing recovery time.

This article provided by Richard A. Baxter, M.D., F.A.C.S.

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