Abdominoplasty

Abdominoplasty achieves a flatter, firmer abdomen and a narrower waist. An abdominoplasty is done using general anaesthesia, performing an incision above the pubic hair which is extended to the hips. The skin of the abdomen is loosened and, if necessary, the abdominal muscles are reinforced using stitches. The excess skin is stretched downwards and removed.

After the abdominoplasty, the patient will be wearing a special corset, reinforced with bandages, depending on each particular case. The scars surrounding the belly button will improve over time. However, in some cases it’s necessary to perform a scar revision using local anaesthesia. More than with any other aesthetic surgery, the skin of each patient reacts differently to the stitches.

It should be mentioned, as a possible yet rare complication, that a loss of vitality (necrosis) of the skin located above the pubic area can occur, if this happens, a longer postoperative treatment can be required. Besides that, seromes and bruises can appear, these also need to be treated.

What is abdominoplasty?

Abdominoplasty is amajor surgical procedure whose purpose is to remove the excess of skin and fat in the middle and lower part of the abdomen, as well as reinforcing the muscles of the abdominal wall. This procedure can drastically reduce the abdomen’s appearance (colloquially known as “belly”). In exchange, a permanent scar is left which, depending on the extent of the original problem and the surgery performed for its correction, can be longer or shorter.

Previous to the abdominoplasty: the incision is done
above the pubic area to allow
the removal of the excess skin and fat.

Who is the ideal candidate for undergoing an abdominoplasty?

The ideal candidates for an abdominoplasty are both women and men who have a relatively good silhouette, but are still worried about fat accumulations or a skin excess in the abdomen area area that don’t improve despite a diet or physical exercise.

Abdominoplasty is especially useful in women who have gone through multiple pregnancies, after which the skin and the muscles of the abdomen relaxed and didn’t regain their original tone. It can also improve the loss of skin elasticity in older people, a situation that’s often linked to a moderate obesity. Those patients who want to lose a lot of weight need to postpone the surgery, the same goes for women who are planning on going through future pregnancies, as the vertical muscles of the abdomen are stretched during the surgery and might loosen again throughout a pregnancy. If there are any previous scars in the abdomen, this surgery might be contraindicated or the scars may change their position. In other cases, this surgery helps removing them.

What is the preparation for the intervention like?

During the initial consultation, the plastic surgeon will evaluate the health state of the patient, he will also determine the extension of the fat accumulation within the abdomen area and the skin tone. The patient will have to explain whether he is a smoker, and if he is taking any kind of medication or vitamins. The patient needs to expose his expectations clearly and in an honest way, in order for the surgeon to be able to explain the alternatives to the problem, including the risks and limitations of each one. If for example the patient only shows a fat accumulation in the area beneath the belly button, it might be enough performing a less complex procedure called mini-abdominoplasty, which requires a shorter stay in the clinic and is performed in less time. In other cases, regardless of whether a complete abdominoplasty or a mini-abdominoplasty is going to be performed, a liposuction in the hip area can be combined with the abdominoplasty to improve the body contour more harmonically. Some cases can even be solved by only doing a liposuction of the abdomen.

Anyway, the surgeon will value which one is the optimal procedure to provide you a more appropriate body contour. During the assessment, the patient will be informed on what type of anaesthesia is going to be used, whether a hospitalisation is necessary or not and the cost of the intervention.

Where is the surgery performed?

The abdominoplasty and the mini-abdominoplasty are always performed in an operating room, either at a clinic or a hospital. These procedures must not be performed at a medical office. A liposuction also needs to be done at the operating room, following strict aseptic conditions.

What kind of anaesthesia is applied?

The most commonly used type of anaesthesia for an abdominoplasty is general anaesthesia, during which the patient will be asleep until the surgery finishes. In some cases, especially when doing a mini-abdominoplasty and in the case of an abdomen liposuction, local anaesthesia plus sedation can be used, this way the patient will be awake but also completely relaxed during the intervention, and the abdomen will be completely insensitive to pain.

What does an abdominoplasty consist in?

A complete abdominoplasty usually lasts between 2 and 3 hours, depending on the amount of correction needed. A mini-abdominoplasty last between 1 and 2 hours. The abdominoplasty intervention is performed through a long incision from one hip to the other, right above the pubic area. A second incision is done around the belly button in order to be able to separate it from the surrounding tissues.

During the mini-abdominoplasty, a much smaller incision is used, also located above the pubic area, and the incision around the belly button area is not necessary, in some cases the belly button can be moved downwards while the skin is stretched.

After that, the skin is detached upwards from the abdomen until reaching the ribs, leaving the abdominal muscles exposed. These muscles are tightened and connected in the middle line, providing a firm abdominal wall as well as a narrower waist. The detached skin is stretched towards the pubic area, and the excess skin removed; the belly button is placed in its new position. Lastly, the stitches are done and a bandage is placed, as well as a temporary drainage tube to avoid the accumulation of fluids within the treated area. Doing a mini-abdominoplasty, the skin is only detached between the incision and the belly button, the excess skin is removed and the stitches are placed.

The skin is detached from the abdominal wall, up to the ribs	The muscles and tissues of the abdominal wall are approached to achieve a narrower and longer waist	The excess skin is removed; in case of a complete abdominoplasty, the belly button is relocated

What is the postoperative period like?

During the first few days, the abdomen is usually a bit swollen, and a slight discomfort, as well as pain that can be treated with medication. Depending on the extension of the surgery, the patient will stay in the clinic for 1 or 2 days. Despite the fact that in the beginning you mustn’t stretch your body completely, the patient should start walking as soon as it’s possible. The outer stitches on the skin will be removed after 5 to 7 days; the inner stitches, whose ends stick out of the incision edges, after 2 or 3 weeks. The patient will have to wear an abdominal corset during a month (day and night), which will help reducing the inflammation of the abdomen.

Returning back to normal after the intervention

The patient might take some weeks or even a few months until feeling the way he did before the intervention. If his physical condition previous to the surgery is good, including strong abdominal muscles, the recovery after the abdominoplasty will be faster. Some people return to work after about 2 weeks, while others need 3 or 4 weeks of resting and recovering. Physical exercise helps with recovery. Even people who don’t do sport previous to the moment of the treatment needs to perform a program consisting of exercises, this needs to be done to reduce the inflammation, reduce the possibility of a venous thrombus forming, and tone the muscles. However, strong physical exercises should be avoided until the patient feels comfortable. The scars may seem to be getting worse during the first 3 to 6 months while they are in the healing period; this is normal. The patient needs to wait between 9 months and 1 year for the scar to flatten and lighten its colour. Despite the scars never disappearing completely, they won’t be visible, even when wearing a bikini or swimsuit.

Are there any risks? Are there guarantees?

Every year, hundreds of abdominoplasties are performed successfully. When performed by a qualified plastic surgeon, the results are usually very good. Even so, every time a surgery is performed there are risks, as well as the complications related to this specific treatment. The complication after the surgery, like an infection or a venous thrombus can occur, but are rather rare. An infection can be treated with antibiotics and drainage. A venous thrombus can be prevented by moving your legs and standing up as soon as the surgery allows it. A bad scarring can produce a low quality scar which sometimes requires a second surgery. Smokers must quit smoking a few weeks before the surgery, and need to be warned that smoking increases the chance of complications showing up and slows down the scarring process. The risk of complications appearing can be decreased by meticulously following the instructions of your plastic surgeon, both before and after the surgery, especially those regarding the continuation of physical exercise.

What are the results of an abdominoplasty?

An abdominoplasty, no matter a complete or a mini abdominoplasty, provides excellent results for patients whose abdominal muscles are weakened and who have an excess of skin and fat. In most cases the results are permanent, as long as paired with a balanced diet and periodic physical exercise. If the patient has realistic expectations and is able to tolerate the presence of a permanent abdominal scar, even if it can be disguised, and a long recovery period, abdominoplasty can be suitable for this person.