Posted by Dr. Hardesty

Abdominoplasty (“Tummy Tuck”): Pre- and Postoperative Recovery Protocol/Instructions

The following is what I give all my abdominoplasty, or “tummy tuck” patients prior to surgery.

I believe you will find this information helpful as you prepare for and recover from your abdominoplasty. If you have any questions after reading, please do not hesitate to ask us.

I. Pre-Operative

A. 30 Days Before

1. Start iron pills — 325 miligrams (mgm); can purchase directly over-the counter) per day to build up blood (may turn stools black and cause constipation).
2. Start a multivitamin to gain nutrients for healing — no mega E (can cause bleeding).
3. Stop any hormonal birth control or post-menopausal female hormones (increased risk of blood clots).
4. Stop any over-the-counter supplements (can cause unknown problems).
5. If you have had bariatric surgery (weight-loss surgery), start on 100 grams of protein per day
6. Stop smoking. No exceptions.
7. If you are over age 45 or have medical issues, our surgery center recommends a preoperative clearance by your primary care physician with basic laboratory data.

B. 14 Days Before

1. If you are over age 45 or have medical issues, provide a preoperative clearance letter with laboratory data for your surgeon.
2. Make a preoperative appointment with Dr. Hardesty and his physician assistant who will provide prescriptions (for before and after surgery), counseling and educational materials. Discuss what medications are okay to continue or stop. Bring a list of questions.
3. Complete final payment for procedure prior to leaving the office after the preoperative appointment has concluded.
4. Stop shaving around the pubic area; razor blade shaving causes small cutsthat can harbor bacteria and increase infection rate).
5. NO aspirin, Aleve or Motrin (can interfere with normal clotting) — use only plain Tylenol (will not interfere with normal clotting) or pain medication prescribed by your regular provider.
6. Make arrangements for drop-off, pick-up and child care.

C. Four Days Before 

1. Start Bromelain and Arnica as directed (for anti-bruising and swelling).
2. Purchase two large bags of frozen peas or corn (Costco size). Can have one in a pillow case and place over your abdomen, then change out with thesecond one (in freezer) when the first thaws.
3. Purchase any needed food and supplies, and verify with your postoperative support team your and their schedule.
4. No hair removal of pubic area (can increase infection rate); the operating staff will clip pubic hair if needed.

D. Three Days Before

1. Start anti-bacterial decolonization showers.
2. Topical antibiotics (prescription will be given) to be applied in ear canal, nostrils and umbilicus (tummy button).

E.  The Day Before

1. Have ALL prescriptions filled.
2. Have bed, recliner, pillows and foam wedges etc. ready.
3. Make sure you know the location of the surgicenter, and see if you can obtain any of the surgicenter’s required preoperative paperwork to fill out prior to arriving the day of surgery.
4. Call the surgicenter for your expected time of arrival.
5. Have or purchase a bell to ring (if you need assistance after surgery) to notify your present support.

F. The Night Before

1. Make out a list of any last-minute questions, your needs, wants, desires and expectations of the surgery.Complete a preoperative enema (decreases fecal load) for postoperative constipation (from pain meds) and potentially reduces risk of blood clots (hard stool pressing on intra-abdominal veins during tightening of the muscles).
2. Take a shower with antiseptic solution and scrub entire body well.
3. No alcohol-containing drinks.
4. Nothing by mouth after midnight or eight hours prior to surgery (unless instructed so by your surgicenter).

II. Operative Day

1. Wake up and take a second shower, and scrub the surgical area.
2. Check your list (bring model photos demonstrating your desires).
3. Place anti-nausea patch behind ear.
4. Take all necessary medications with sips of water.
5. If anxiety begins, may take 5 mgm of Valium with a sip of water.
6. Remove all piercings, jewelry and hair pins from body/hair.
7. Do not wear make-up and remove nail polish (for intraoperative monitoring).
8. Wear a button down or zipper shirt/blouse and sweat pants or stretchable pants.
9. Go over your list with your plastic surgeon and anesthesia provider.
10. Reaffirm with the surgicenter when your postoperative care provider should be at the surgicenter for postoperative education and instructions.
11. To prevent deep vein thrombosis (DVT) you will be given a 5,000 units heparin injection, thrombo embolic device (TED) hose, and sequential compression device (before, during and after surgery).

III. Postoperative

A. Immediate

1. Communicate with your recovery room nurse about pain, nausea, etc.
2. Do what you are asked to do.
3. Your doctor will provide an abdominal binder; adjust tightness to comfort.

B. Discharge

1. Anti DVT (blood clot in leg) program: leg/foot exercises, TED hose and (you will be sent home with) a portable sequential compression device (SCD)
2. to be used for two weeks after surgery. Get out of bed and walk around house every 1-2 hours while not sleeping. Leave SCD on while sleeping or resting for the next two weeks.
3. Incentive spirometer every hour after surgery (improves breathing) after general anesthesia.If drains used, a measuring cup and chart will be used for recording out put as directed.
4. Foley catheter: doctor will insert into patient prior to leaving the surgericenter and have patient remove it six hours after surgery (some
5. patients develop urinary retention while general anesthesia wears off and will require re-catheterization).
6. The doctor will provide a loaner walker for walking in a hunched over position. A “lazy boy” bed position is best (use a recliner, hospital bed or pillows/foam wedges).
7. Keep diet progressive to prevent nausea: clear liquids (Gatorade, broth, tea) for first eight hours, a liquid diet the next eight hours (soups, pudding, yogurt) and a soft diet for next eight hours (well-cooked oatmeal or pasta); after 24 hours, try a regular diet. Start stool softeners and anti-constipation program.
8. Pain management: The doctor will inject long-acting local pain reducers into the surgical area and provide a postoperative non-narcotic pain pump reliever that lasts several days. It’s okay to start using aspirin, Motrin or Aleve AFTER surgery and alternate with oral narcotics. Do not take pain medications on an empty stomach; crackers before and after medications will prevent nausea and an upset stomach.
9. 9.  An incentive spirometer will help open up the small breathing units found within the lungs that collapse during general anesthesia. Use once an hour while awake until you are able to obtain preoperative values.

C. First Four Postoperative Days

1. Wear SCDs 24 hours a day and do anti DVT exercises every hour.
2. Use the incentive spirometer (opens up small breathing units in lungs) once an hour until you reach your preoperative values.Walk hunched over (use walker provided) and sleep in the fetal position using a recliner, adjustable bed or wedges/pillows.If unable to have a bowel movement, start over-the-counter laxatives and stool softeners.

D. The fifth day to two weeks postoperative

1. No restrictions in sleeping position or standing up straight. Use walker only as needed.
2. Non-narcotic pain-pump to be removed.
3. May shower but keep incision and drain exit sites dry; let shower spray back side and sponge bath front side of body. May remove SCD during ambulation (walking upright) but wear at all times when not.Progressively walk upright and stretch to point of pain and fatigue.
4. Wean off narcotic pain pills and replace with Tylenol, Motrin, Aleve or aspirin like over-the-counter medications.
5. May drive as tolerated (must be off narcotics).
6. May switch from provided binder to Spanks-like garment for comfort and support.May return to work as tolerated.

E. After two weeks

1. Exercise to point of pain or fatigue.
2. SCD not required (may continue).
3. Report to office when individual drainage less than 25 cc’s in a 24-hour period for serial removal. May shower without restrictions when drains are all removed.
4. Start anti-scar programs: Embrace and silicone-gel strips.

F. After six weeks

1. No restriction on exercise (use good judgement).
2. Continue to wear Spanks-like garment for support and swelling (only as needed).
3. It will take two to three months for the majority of the swelling to be gone.
4. It will take nine-plus months for the scars to “mature” (soften and lighten) Enjoy your new body!

The Staff of Imagine Plastic Surgery serving many of the communities of the greater Inland Empire including but limited to Riverside, CA and Inland Empire, Redlands, Rancho Cucamonga, Ontario, Corona, Upland, and Chino Hills.