HOW TO MINIMIZE RISKS AND COMPLICATIONS OF A TUMMY TUCK (ABDOMINOPLASTY)

Posted by Dr. Hardesty

Tummy tuck is also known as Abdominoplasty. When liposuction is added as part of the standard procedure, it is referred to as Lipo-Abdominoplasty. There are variations of the standard or basic tummy tuck referred to as a mini or extended abdominoplasty. Thus tummy tucks of any variations has a high satisfaction rate. According to RealSelf 97% of patients voted “its worth it”. However just as in living “life happens” and untoward events can happen despite careful planning, patient compliance and “doing everything correctly”. Fortunately most are minor challenges and rarely some can be serious. The purpose of this writing is to present on how we as patients and Plastic Surgeons can take steps in minimizing and prevention of such untoward events.

WHAT IS A TUMMY TUCK OR ABDOMINOPLASTY PROCEDURE?

First to better understand the potential challenges one needs to understand the basics of the tummy tuck or abdominoplasty. The classic or standard tummy tuck (abdominoplasty) procedure usually includes:

• removing lower abdominal excess skin and fat, resulting in a smoother and flatter contour
• reapproximating separated central abdominal muscles (diastasis rectus)
• intraoperative injection of long acting local anesthesia.
• I also insert a non narcotic pain pump that automatically drips in long acting local pain medication often precluding use of post operative narcotics for pain relief.

Commonly associated procedures:

• liposuction of the flanks
• repair of any hernias (umbilical and inguinal if present)
• insertion of temporary (usually 3 days) non narcotic pain pump

Common risks/complications & Preventative Steps

1. Bleeding, hematoma or fluid collection.

PREVENTION:

• no Aspirin, Celebrex, Aleve, Motrin mega vitamin E,or a diet high in omega 3’s 2 weeks prior to surgery
• all supplements
• any prescription medications (check with your doctor on how to compensate for)to thin your blood at least 2 weeks prior to surgery.)
• If you do have any headaches or pain I prefer plain Tylenol.

2. Blood clots, deep vein thrombosis (DVT) and pumonary embolus.

PREVENTION:

• no alcohol night before (can dehydrate)
• fleets enema night before. Removes hard feces that may occlude internal abdominal veins when muscles re/approximated thus increasing infra abdominal pressure.
• temporary and calculated administration of anti coagulant by injection just prior to surgery
• use sequential compression devices both pre, intra and postoperatively. In fact we send all abdominoplasty patients home with portable and rechargeable SCD units that are be used for the first two weeks after surgery.
• Early walking, calf compressions and ankleflexing is associated with prevention of DVT’s

3. Pneumonia/wound Infection

PREVENTION:

• 3 days before surgery: take a shower morning and evening with antiseptic solutions and place mucopurien (prescription only) topical antibiotic in the nasal opening, umbilicus (tummy button) and external ear canal.
• IV antibiotics will be given preoperatively just before surgery
• all patients receive a device called a incentive spirometer that encourages deep breathing.
• It is also important for patients to start walking as soon as possible after surgery.

4. Anesthesia.

PREVENTION:

• Age/significant medical history
• if over age 45 or any significant health issues a preoperative evaluation and lab work will required your by primary care physician.
• Where Surgery is performed: a fully accredited and certified Ambulatory Surgical Center such as Riverside Outpatient Surgical Institute (ROSI)

5. Skin-vascular insufficiency resulting in skin incision separation and possible skin loss.

PREVENTION:

• No smoking or second hand smoking for two before surgery and 1 month after surgery.
• For the first four days walking in the bent over position(we loan you a walker for the first 4-7 days).
• Sleeping in the lawn chair position or fetal/curled position for the first 4 days after surgery.

6. Temporary Urinary retention.

The general anesthesia side affects is also puts the nerves to the bladder asleep resulting in a high incidence of urinary retention in the first several hours after surgery after abdominal surgery

PREVENTION:

• The general anesthesia also puts the nerves to the bladder asleep resulting in a high incidence of urinary retention in the first several hours after surgery. Thus, a bladder catheter is inserted (while your asleep) and removed 6-8 hours after surgery.

7. Fluid accumulation (seroma). This a a collection of swelling fluid that can accumulate unerring the skin and above the muscle.

PREVENTION:

• During surgery “quilting sutures” are placed as well as temporary drainage tubes that are removed when drainage is resolved.

8. Poor wound healing, asymmetry of the incision and unfavorable scar formation

• NO smoking! Smoking and second hand smoking is the number one problem of poor wound healing and unsightly wide scars.
• We here at Imagine Plastic Surgery have a comprehensive preventative and anti scar program including m: Embrace, silicone gel sheeting, lasers and injections.
• Some times the incision heals in a unanticipated way and can be revised under local anesthesia if necessary

9. Skin discoloration and/or prolonged swelling.

PREVENTION:

• individual genetics plays a large role in the color of the final scar and amount of swelling.
• We strongly believe in using sun block over all unctions and avoidance of direct sunlight or tanning booths for the first 6 months over all incisions.
• A compression garment like “spanks” usually removes abnormal and persistent swelling.

10. Recurrent looseness of skin.

PREVENTION:

• As we age we naturally loose collagen and elastic fibers of the skin. The amount is genetically related. However after pregnancy or massive weight loss the skin actually permanently decrease it “viscoelastic properties which means the skin will again stretch. Anticipating and compensating this we perform the surgery in the “lawn chair position” and actually have you walk and sleep in the hunched over position for the first 4 days after surgery.

11. Fatty tissue found deep in the skin might die (fat necrosis.)

This is a rare and usually occurrence and included for completeness.

PREVENTION:

• Gentle and precise liposuction and skin excision is always completed. However if a firm lump does not resolve injections are first used to dissolve the lump and rarely need a secondary procedure.

12. Suboptimal aesthetic result, asymmetric scars and “dog ears” resulting in need of a possible revisional surgery.

PREVENTION:

• As in life, even with careful and precise surgery, unusual healing occasionally occurs. Fortunately most revisions when needed are completed using only local anesthesia in the minor room suite.

COST/FEES

The tummy tuck costs are based on the anesthesia used (local vs sedation or general anesthesia), the facility (minor surgical suite, outpatient operating room or hospital setting) and if combined with other procedures. All pre and post operative care is included. Some preoperative laboratory analysis may be required (usually covered by your medical insurance).

SUMMARY

The most important factor to consider is seeking the opinion and services of a skilled, experienced and Board Certified Plastic Surgeon who are experts in tummy tuck (abdominoplasty and Lipo abdominoplasty techniques.) The Imagine Plastic Surgery team uniquely provides the full array of both non surgical and surgical alternatives to thus filling our motto of “One Goal, Many Options”. For more information, call and schedule a consultation.