Abdominoplasty

Overview

Abdominoplasty is a surgical procedure that addresses the appearance of the abdomen. During this procedure, excess skin and fat are removed from the abdomen. Connective tissue in the abdomen (fascia) is tightened with sutures.

This procedure may be considered if you have excess skin or fat around the area of your belly button or a weakened lower abdominal wall. Some patients may meet criteria for this procedure using their private health insurance.

Factors That May Lead to Considering Abdominoplasty

There are a number of reasons you might have excess fat, reduced elasticity of the skin or weakened connective tissue in your abdomen. These include:

Significant changes in weight
Pregnancy
Abdominal surgery, such as a C-section
Aging
Your natural body type

Abdominoplasty can remove loose, excess skin and fat, and tighten weak fascia. The procedure may also remove stretch marks and excess skin in the lower abdomen below the bellybutton. However, it won’t address stretch marks outside of this area.

If you’ve previously had a C-section, your plastic surgeon might be able to incorporate your existing C-section scar into your abdominoplasty scar.

Abdominoplasty can also be performed in combination with other surgical procedures. If you’ve had liposuction of your abdomen, you may consider abdominoplasty as liposuction removes tissue just under the skin and fat but not any excess skin.

Abdominoplasty isn’t suitable for everyone. Your doctor might advise against this procedure if you:

Plan to lose a significant amount of weight
Might consider pregnancy in the future
Have a severe chronic condition, such as heart disease or diabetes
Have a body mass index that’s greater than 30
Smoke
Have had a previous abdominal surgery that caused significant scar tissue

Risks

Abdominoplasty poses various risks, including:

Fluid accumulation beneath the skin (seroma). Drainage tubes left in place after surgery can help reduce the risk of excess fluid. Your doctor might also remove fluid after surgery using a needle and syringe.
Poor wound healing. Sometimes areas along the incision line heal poorly or begin to separate. You might be given antibiotics during and after surgery to prevent an infection.
Scarring. The incision scar from abdominoplasty is permanent, but it’s typically placed along the bikini line. The length and visibility of the scar varies from person to person.
Tissue damage. During abdominoplasty, fatty tissue deep within your skin in the abdominal area might get damaged or die. Smoking increases the risk of tissue damage. Depending on the size of the area, tissue might heal on its own or require a surgical touch-up procedure.
Changes in skin sensation. During abdominoplasty, the repositioning of your abdominal tissues can affect the nerves in the abdominal area, and infrequently, in the upper thighs. You’ll likely feel some reduced sensation or numbness. This usually diminishes in the months after the procedure.

Like any other type of major surgery, abdominoplasty poses a risk of bleeding, infection and an adverse reaction to anesthesia.

How You Prepare

You’ll consult with a plastic surgeon about abdominoplasty. During your first visit, the surgeon will likely:

Review your medical history. Be prepared to answer questions about current and past medical conditions. Talk about any medications you’re taking or have taken recently, as well as any surgeries you’ve had. Tell your doctor if you are allergic to any medications. If your consideration of abdominoplasty is related to weight loss, your doctor will likely ask detailed questions about your weight gain and loss.
Do a physical exam. To determine your treatment options, the doctor will examine your abdomen. The doctor might also take pictures of your abdomen for your medical record.
Discuss your expectations. Explain why you’re considering abdominoplasty, and what you’re hoping for in terms of appearance after the procedure. Make sure you understand the benefits and risks of the procedure, including scarring. Keep in mind that previous abdominal surgery might limit your results.

Before abdominoplasty you might also need to:

Stop smoking. Smoking decreases blood flow in the skin and can slow the healing process. In addition, smoking increases the risk of tissue damage. If you smoke, your doctor will recommend that you stop smoking before surgery and during recovery.
Avoid certain medications. You’ll likely need to avoid taking aspirin, anti-inflammatory drugs and herbal supplements, which can increase bleeding.
Maintain a stable weight. Ideally, you’ll maintain a stable weight for at least 12 months before having abdominoplasty. If you’re severely overweight, your doctor will recommend that you lose weight before the procedure. Significant weight loss after the procedure can affect your results.
Arrange for help during recovery. Make plans for someone to drive you home after you leave the hospital and stay with you for at least the first night of your recovery at home.

What You Can Expect

Abdominoplasty is performed in a hospital or an outpatient surgical facility. During the procedure, you’ll be under general anesthesia — which makes you completely unconscious and unable to feel pain. In some cases, you might be given a pain-relieving medication and be moderately sedated (partially asleep).

During the Procedure

There are a number of different approaches for abdominoplasty, depending on your specific situation and the surgeon’s assessment. During a typical procedure, the surgeon will make incisions to remove most of the skin and fat between your bellybutton and pubic hair in a horizontal oval or elliptical shape. Connective tissue (fascia) that lies over the abdominal muscles is then tightened with permanent sutures.

The amount of excess skin removed and the type of procedure you have will determine the shape and length of the incision. The incision above the pubic hair will be stitched together and will leave a scar that falls along the natural crease within the bikini line.

The surgeon will also reposition the skin around your bellybutton. Your bellybutton will be brought out through a small incision and sutured in its normal position.

During the procedure you might be given an antibiotic to prevent infection.

The procedure typically takes about two to three hours.

After the Procedure

After abdominoplasty, your abdominal incision and bellybutton will likely be covered with surgical dressing. Small tubes might be placed along the incision site to drain any excess blood or fluid.

Members of your health care team will help you walk as early as the first day after the procedure to help prevent the formation of blood clots.

You’ll likely be given pain medication. It’s normal to have swelling in the surgical area.

Drains might be left in place for several days after surgery. Your doctor or another member of your health care team will show you how to empty and care for your drains. You might need to continue taking an antibiotic as long as the drains are in place.

Your surgeon might also prescribe a blood-thinning medication for a short time after your abdominoplasty.

You’ll wear a supportive abdominal garment (abdominal binder) for about six weeks after your procedure. This helps prevent fluid buildup and provides abdominal support while you heal. Your doctor will explain how to care for your scar.

For the first six weeks after abdominoplasty, you’ll need to be careful when moving around. You’ll also need to avoid positions that strain your incision line — such as quickly bending at the waist — to prevent the reopening of the wound.

You’ll need to schedule regular follow-up visits with your surgeon.