1. How can one minimize the risk of complications associated with a tummy tuck?

Potential complications of abdominoplasty ("tummy tuck") are similar for allmajor Plastic Surgery procedures, and include complications related toanesthesia, early complications of surgery, and later complications ofhealing.

In addition to the standard concerns, abdominoplasty has a few specificpotential complications. As a large area of the anterior abdominal wall(skin and fat of the abdomen, down to the muscle fascia - the lining overtop of the rectus abdominis muscles) is elevated, there is an extensivespace where wound fluid will be produced and may accumulate beneath theskin. This is known as a "seroma". For this reason, drains are always usedin a tummy tuck to avoid seroma fluid from pooling beneath the skin andpreventing healing or promoting infection. Expect the abdominal drains tobe in place for 1-2 weeks after surgery.

An abdominal binder is also often used for gentle compression over the areaof surgery. It supports your front, supports your back, and helps toencourage resolution of swelling and skin contraction, especially ifliposuction was added to the procedure. The binder is worn for 3-6 weeksafter surgery, initially 23 hours a day (with a break to shower and changeclothes), and eventually during activities such as standing, bending andtwisting (after a month).

If a seroma were to occur, it is usually drained by way of a needle and asyringe in your surgeon' s office. This is done through a scar or an areawhere you are numb, and does not hurt. Occasionally, if you have a verylarge seroma or have recurrent accumulation of fluid, repeat needleaspiration (sucking out fluid) may be needed, and infrequently insertion ofa new drain. Seroma is most common in individuals who are obese orfollowing massive weight loss.

Prophylactic (preventative) antibiotics are used to prevent infection, andare started right when the incision is made and continued for a few days toa week or two after surgery. Unlike after breast augmentation, showering ispermitted in my patients when their abdominal drains are in place. The riskof infection is naturally very low, and a shower makes anyone feel like amillion bucks after surgery!

Numbness of the skin of the abdomen is very common for months after surgery.This is more of an expected long-term result than a complication. I counselmy patients that "nerves are like tree roots, they always want to regrow"and find their way. Nerves are "bruised" during surgery and stop workingtemporarily. They start to "wake up" at around 10 days post-op, withspontaneous "zinger" sensations that may feel like electric shocks, an itchyou cannot scratch, sharp pains, itching or burning. This does not meananything is wrong. Nerves regenerate slowly up to an inch a month,and start to recover from the sides inwards. It may take a full year ormore for sensation to completely recur in the lower abdomen. There isnothing that you can do to speed up nerve recovery - just be a patientpatient!

The best ways to prevent complications of any plastic surgical procedure areto maintain a positive attitude, keep a healthy and nutritious diet, regularexercise, get lots of sleep, and ensure you have the physical and emotionalsupport of your immediate family members and friends both before and aftersurgery. An abdominoplasty is a major surgical procedure that affects your"core", needed for any upright activity. You will not be able to performall the activities you are used to doing for at least 4-6 weeks aftersurgery.

Individuals who are athletic and whose bodies are used to being stressedphysically in a healthy manner with regular exercise respond better tosurgery, with a smoother recovery. "Couch potatoes" who normally do notask more of their body than strolling or sedentary activities can bephysically overwhelmed by surgery, particularly a tummy tuck.


2. How does abdominal liposuction differ from a "tummy tuck"?

Liposuction is a procedure whose goal is to permanently remove excess fatfrom an area of persistent deposition, despite efforts to become asphysically fit as possible and to achieve your ideal weight. Liposuction isfor body contouring only in areas of stubborn fat deposits. Common areastreated include the lower abdomen, hips, flanks (sides, or "spare tire"area), inner or outer thighs, chin, or the area below the buttocks.

An abdominoplasty achieves some unique results that other procedures likeliposuction do not address: (1) Excess skin and fat of the lower abdomen issurgically excised (removed), including some stretch marks below the bellybutton; (2) The muscles of the abdominal wall (rectus abdominis muscles) are"corseted" back together in the midline; and (3) The abdominal wall istightened, creating a flat contour to the belly.

After pregnancy, the muscles of the abdominal wall become separated from oneanother in the midline. This is known as "rectus diastasis". When therectus abdominis muscles are separated from one another, the abdominal wallis less strong, the abdomen can bulge out of proportion to the body, andmuscle function is less efficient. Even though the muscles individually canbe very strong, their activity is less efficient because they are notworking together as a unit to keep the abdominal wall flat and to supportthe back.

Spending hours and hours at the gym to strengthen the abdominal muscles willnot recreate their normal position; many of my patients are personaltrainers and fitness instructors. Even professionally fit women sometimesneed help to get their pre-pregnancy bodies back!

An incision is usually also required around the belly button ("umbilicus")to enable the skin of the entire abdomen, from the xiphoid process to thepubic bone, to be pulled downwards and redraped. The belly button remainsin the same location in relation to the body (in the midline, across fromthe hipbone), but it comes out through a new opening.


3. What are the advantages of a tummy tuck (compared to liposuction)?

Only a tummy tuck will achieve the specific goals of bringing the rectusabdominis muscles of the abdominal wall back together and reconstructingyour normal anatomy after pregnancy, excision of excess skin and fat of thelower abdomen, and recontouring your abdomen to become firmer, flatter andmore toned.

Liposuction alone will just debulk areas of excess fat deposition.Liposuction will not tighten the muscles of the abdominal wall; it will notcorrect excess crepe-like skin or remove stretch marks.


4. What are the disadvantages of a tummy tuck?

Potential risks and complications of a tummy tuck specifically includecreation of a long scar that travels hipbone to hipbone, in the naturalcrease just above your pubic hair. Many women already have a scar in thislocation if they have had a C-section in the past. This scar would beexcised (removed), and a new longer scar would be created in its place.This scar is hidden in your underwear and bikini bottoms, and fades withtime. All scars require at least one year to "mature" - this means tobecome softer, flatter, less red and raised.

A tummy tuck requires significantly more downtime than liposuction alone.At least 6 weeks are needed for healing before exercise, lifting more than 5pounds, and twisting/turning of the trunk is allowed. Fatigue is the mostcommon complaint after an abdominoplasty. You will not have your usualenergy to function at a normal capacity both physically and emotionallyafter surgery for up to two months. Most Moms say that is the mostfrustrating part of recovery - the inability to care for their children theway they are used to. For this reason, it is very important to have otheradults around to help you with the normal activities of daily living and toassist you with carrying your children, driving, errands, and housework.

In addition to these special potential disadvantages, a tummy tuck also hasthe usual possible complications of a surgical procedure under generalanesthesia (risks related to anesthesia, early complications such asbleeding, infection, and late complications like poor scar formation,numbness and asymmetry).


5. When is liposuction sufficient and when is a tummy tuck necessary?

If you have not had a pregnancy yet, or if you truly do not have rectusdiastasis, you may be a candidate for liposuction only. Good candidates forliposuction are individuals with good skin tone and elasticity, withoutsignificant abdominal muscle laxity (loosening) and without excess skin frompregnancy or massive weight loss. A good test is to pinch your own skin ofthe abdomen - if it retracts back quickly without an excess fold, then youmay be a candidate for liposuction if you also have excess fat of theabdominal wall.

Liposuction will NOT address intra-abdominal fat. Contract your abdominalmuscles and grab the skin and fat of your lower abdomen - this is the fatthat can be removed with liposuction.

If you also have excess droopy or crepe-like skin in your abdominal region,many stretch marks and bulging of your abdomen that you cannot correct withregular exercise and a healthy diet, then a tummy tuck may be a moreappropriate procedure for you.

Be sure to visit a Board-Certified Plastic Surgeon for a full consultation,including a complete history and physical exam, to learn about which optionis best to address your concerns, and for your unique body situation.


6. If liposuction is safer, what are the reasons for doing a tummy tuck?

I would not necessarily agree that liposuction is safer. Any surgicalprocedure has its unique set of risks and benefits, alternative and expectedoutcomes. Be sure to fully educate yourself about the safety of anysurgical procedure you are considering, including any specific risks thatapply to you because of your personal health history or body details.

Liposuction alone will just debulk areas of excess fat deposition.Liposuction will not tighten the muscles of the abdominal wall, it will notcorrect excess crepe-like skin or remove stretch marks, like a tummy tuckwill. Many women find their abdomens have permanent changes followingpregnancy, including stretch marks, loss of abdominal tone, excess skin andextra fat deposits that have accumulated since having babies. Most mothersdo not have complete recovery of their bodies after children.

Consultation with a Plastic Surgeon with extensive experience in theprocedure(s) you are seeking will help to determine which operations maybest achieve your goals.


7. Are tummy tucks covered by insurance?

A tummy tuck is always considered cosmetic and is not covered by insurance.Occasionally, if an umbilical or ventral hernia (bulging of the intestinesthrough the abdominal wall in the midline) exists that requires surgicalrepair, a portion of the procedure may be covered by your insurance.However, you will still be responsible for the majority of the surgicalfees, operating room and anesthesia time, and possibly an overnight stay inhospital.