• 02 May 2016

Abdominoplasty, popularly known as ‘tummy tuck’ is the ultimate love handle and muffin top buster that helps in getting rid of the excess fat and loose skin in the belly area. This surgery procedure comes to the rescue for people in MIami with sagging skin following a massive weight reduction or pregnancy.


Women win the race of statistics here. According to American Society for Aesthetic Plastic Surgery, the procedure has made it to the list of top 5 most practiced invasive cosmetic procedures. This increase in the number of the surgeries would definitely make one wonder about the miraculous results it must be giving. No doubt about that! However, before the statistics misguide you into taking it as an easy-peasy task, let me make it clear, it is one of the most serious cosmetic procedures which if not performed properly or taken lightly may lead to complications. If you’re about to undergo abdominoplasty you may have gotten a heads up from your doctor about all the associated risks and complications but we’re here to zero in on the  most important and overlooked recovery issues that you probably know about but haven’t taken seriously. Don’t fret! We’ll tell you how to cope up with them too. Let’s get started.

To make it easier for you, we have come up with a short checklist of questions that you should ask your surgeon before a Tummy Tuck.
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A Muzzy Start!

Don’t panic if you can’t recall most of the first post-operative day events of your hospital stay (for some it might be up to two) because you’re very much going to be groggy thanks to the anesthesia. You may have a blurry picture of someone disturbing your peaceful sleep by calling out your name repeatedly, which by the way is the recovery room’s nurse trying to get you through the third stage of anesthesia (recovery). Feel free to expect;

  • Confusion
  • Nausea and vomiting
  • Mouth dryness
  • Shivering
  • Sleepiness
  • Sore throat
  • Headache
  • Dizziness
  • Muscle aches
  • Pain (dull mostly)

With first half of the day gone, you would feel physically and mentally enervated and thirsty, really thirsty! But unfortunately, you won’t be allowed a sip of water for some time. Yeah, you read that right, that post midnight fasting state prior to surgery won’t end so soon. This is for your own safety because presence of food before and immediately after surgery is risky. Why? Well, anesthesia tends to make movement of food pipe sluggish and there are fair chances of whatever you sip/eat going into the wind pipe. Hang on! You won’t be starved. Your IV line will be maintained supplying you with the fluids and energy needed constantly in order to prevent any electrolyte or glucose imbalance and most importantly, keep you hydrated and alive! Tip: A cotton ball dipped in normal saline or maybe water can be rubbed on lips to assuage dryness. Take lots of rest! Like you have an option? But, seriously rest as much as possible. You will soon get over the foggy anesthesia phase as well as side effects. Bottom line: Expect light headedness, sleepiness and the feeling of weighing a ton! Those are anesthesia side effects kicking in.  All of these will soon wear off.

Don’t Expect an Immediate Transformation

A Tummy Tuck is meant to get rid of the excess fat and it  ends up getting you all swollen up. Kinda kills the purpose of getting the procedure done in the first place, right? Well, you were informed about the swelling and bruising, but it’s been 3 weeks and it still hasn’t gone away. Is it going to stay the same way? Like it or not, you’ll have to be really patient before you get to see the final results. There is no such thing as an immediate change and make sure you discuss this aspect pretty well during your initial consultations with your surgeon. Once the concept sinks in, then proceed with the surgery. In my opinion, ‘Please be Patient’ should top the list of counseling and post-operative instructions. Swelling may take anywhere between 1-6 months to resolve, after which you can enjoy the results completely. While the actual and final look varies from patient to patient, some clients reported the ultimate look to be revealed a year later too. So be ready to wait a little (more)if needed. In case you’re curious to know the reasons behind swelling (for the sake of general knowledge or simply to have an answer when others ask), let me list them for you;

  • Soft tissue swelling- is the kind which takes several weeks to resolve and aggravates with activity. It is a consequence of interruption of venous and lymphatic vessels as a part of the tummy tuck procedure. Take as much rest as possible because this will take time.
  • Accumulation of fluid between abdominal wall and skin- the fluid accumulated could be blood (hematoma formation) or serum (seroma). Seroma formation is the most common complication of Abdominoplasty [1]. The incidence of the complication ranges between 1-38% and both the types can be very well picked up on an ultrasound. Factors that affect seroma formation include;
  • Patient obesity
  • Use of sharp liposuction cannulas
  • Wide undermining
  • Weight of skin excised
  • Extensive use of cautery dissection

 Treatment options for this type may involve several episodes of aspiration and drain catheter placement. However, if both options fail, open surgical excision of the cavity becomes the definitive treatment.

  • Separation of the abdominal wall muscle may produce a bulge that looks like a swelling- The procedure involves bringing together of the rectus muscle (plication/reapproximation), resulting in tightening of the abdominal wall. Your physician may spot this by examining you in various positions
  • Residual adipose tissue- again picked up easily on examination and requires another session of liposuction.

To assess swelling on a weekly (monthly to be more appropriate) basis, try observing the impressions of elastic clothing on your tummy and compare it with those of flanks (there won’t be much of a difference though). With the passage of time you’ll see improvement and this monitoring would give you an idea of how fast the swelling is resolving. Apart from monitoring, few techniques and measures have reported (without any scientific evidence though) an improvement generally. These include;

  • Wearing compression garments or abdominal binders. They compress the abdomen and help a lot in controlling swelling. Make sure you get 2-3 of each such pieces. Abdominal binders are easily available in pharmacies and are of different sizes and widths.
  • A bit of exercise helps (seek permission from your doctor first!) by reducing swelling, toning muscles and most importantly preventing formation of blood clots. Simply walking around may help a lot. In which phase of recovery should it be started depends on your doctor.
  • Lymphatic drainage massage treatment is also recommended. It should be extremely gentle though.

Bottom line: Most of the swelling goes away in 2-3 months. Rest resolves alot of the swelling with time. You will have to be very patient.  However, make sure you consult your surgeon if you experience any unusual symptoms. Also, discuss other options to deal with swelling.

The Much Dreaded Scarring

As they say, things get worse before they get better. Try not to fret when you see abdominoplasty scars and please try with all your heart because scars go through a number of changes during recovery and healing process. While an experienced surgeon will make every possible effort to hide the scars in natural creases, they could still look worst around 3 months post surgery. Scar formation tends to be affected by a number of factors;

  • Genetics
  • Illness (slows the healing as well as changes the wound healing)
  • Vitamins (zinc and vitamin C speed up the process)
  • Smoking
  • Blood supply of the affected area
  • Skin quality
  • Skin color (dark skinned people are prone to keloid formation)

The initial stage in which you see the scar is all red and inflamed marks the inflammatory stage, which is characterized by an increased blood supply. You may also see a scab formed over the scar (protects the scar). Then you may notice your scar is a bit raised and redder than before, congratulations it has now entered the proliferative stage marked by growth of collagen and tiny blood vessels. A heads-up, an overactive proliferative stage may result in formation of keloids characterized by;

  • Redness
  • Itchiness
  • Pain
  • Unusual sensations

Next is the remodeling stage that lasts between a few weeks to years and is marked by thinning and fading of scar, at times barely to a noticeable line. Tips: You can surely try a number of things to flatten your scars and make them fade away before time. A couple of people who underwent the surgery recommended silicon sheeting (after wound closure). However, doctors at times recommend;

  • Steri-Strips (can be used over suture material  and open incisions)
  • Massaging over the wound (15-30 seconds) three times a day after it has healed completely helps in breaking down collagen giving a smoother appearance of scar tissue
  • Avoiding exposure to sun as not only does it slow the healing but also activate melanocytes (pigmentation agents/cells) causing discoloration of skin
  • Applying vitamin E oil after the wound has healed and sutures removed. The benefits of powerful anti-oxidants include;
  • Prevention of free radical molecules from attacking skin tissue
  • Stimulation of health cell growth that reduces the need of collagen
  • Applying topical antibiotic ointment prescribed regularly
  • Covering the wound just as explained. Keeping wound uncovered may increase the healing time.

Bottom line: tummy tuck is not a scar-free surgery. Expect scarring and again be patient through the process of healing, which may take its time. You may speed up the process, make it better, but may not be able to prevent it. Nevertheless, discuss scar reducing techniques with your surgeon and confirm the credibility of any information or remedy you come across.

The Troublesome Constipation

One thing you’d frequently bump into during the tummy tuck surgery is constipation. And trust me this time round the feeling of being constipated is going to take you to a level where you’ll just become exhaustipated. Constipation could be a sudden reduction in frequency with respect to your normal habits (could be down to zero), an increased need of straining, rectal pain, abdominal pain, hard stools, bloating and a fuller feeling. You can experience relative constipation (no stool only gas) or absolute constipation (no stool no gas). If truth be told, you won’t be able to prevent it completely but with the appropriate measures (discussed later) you can lessen the intensity and duration. But first, let us list the culprits.

  • Anesthesia! This one’s the deadliest. The first few days are a mental torture (personal experience). Under the effect of anesthesia, intestines become sluggish and refuse to move an inch even, leading to a reduction in bowel movements and eventually constipation.
  • Electrolyte, glucose or fluid imbalance
  • Prolonged inactivity
  • Dietary changes (especially lack of fiber)
  • Pain killers (narcotics especially)

The matter gets out of hands especially when you know you can’t strain hard! Obviously you don’t want your tummy to be opened again. Managing constipation becomes extremely important when you realize that the doctors won’t let you go before your bowel movements get normal (at least till you have the very first one). Well, then how to deal with it? Our tips will definitely answer this burning question!

  • Limit the post-operative pain killer intake! But, don’t let the pain kill you. If the pain is unbearable, go for the medicines.
  • Walking around helps (not for first few weeks)
  • Take stool softeners and insist on getting a suppository inserted, laxatives or enema. You don’t want to strain with that kind of soreness in your belly.
  • Get an elevated toilet seat! Doesn’t help in getting rid of constipation, but does make sitting and standing up easy! (irrelevant, but a pearl of wisdom)
  • A good diet! High fiber diet especially with lots of fluids before surgery is going to make things easy for you. Include prune or prune juice in your post-surgical diet.
  • Become active as soon as possible (after surgery)
  • Ask for a carminative

Even after you’re discharged, make sure you don’t make constipation a part of your tummy tuck recovery and immediately seek medical attention if there is;

  • Anal fissure
  • Rectal prolapse
  • Fecal impaction
  • Hemorrhoids
  • Rectal pain
  • Rectal bleeding
  • Pain not related to abdominal surgery

Bottom line: there’s no way you can avoid bumping into this menace. But, prepare yourself mentally as well as with all the above mentioned tips to win the battle against constipation. Do keep a tab on the red flag signs and symptoms though. While you will have to experience all these recovery issues to a certain extent, you can definitely lessen the intensity or at least be mentally prepared so that they don’t hit you so hard. This is where a board certified, experienced and skilled plastic surgeon steps in. People believe that a surgeon has the responsibility of only carrying out the procedure and knowing the technicalities. Well, that is one aspect of surgery (the most important one) but undergoing a surgery, especially a cosmetic procedure has a huge psychological impact too, which makes pre-operative and post-operative counseling a vital part of the surgery. Only a proper surgeon qualified in cosmetic procedures would know how body shaping procedures shape one’s lifestyle and mindsets. If you want to learn more about how a board certified surgeon stands out with his matchless results, feel free to visit us and we’ll tell you the difference it makes when you choose an experienced board certified surgeon for your purpose.

References

[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827279/