Tummy Tuck

We are all born with a finite amount of fat cells. As we gain weight they increase in size and when we lose weight they decrease in size.

Thus, once removed fat will no longer be able to be stored in the area of fat removal. However, weight gain will be in other areas of the body where the fat was not removed.

Yes! By performing liposuction first (fat removal only) will not preclude having a tummy tuck (abdominoplasty) at a later date.  A tummy tuck will remove any additional unwanted fat and the excess and stretched skin as well as repair the stretched or separated (diastasis recti) abdominal muscles usually found after pregnancy or significant weight loss.

Both remove unwanted fat but in different ways.

Liposuction will remove fat by extracting the fat through a cylindrical tube (cannulae) with negative pressure (suction). It will not affect, or repair separated abdominal muscles (after pregnancy or significant weight loss) nor will it reduce excess skin or loose skin. In fact, the skin may become looser after liposuction because of the “deflation” of fat and volume loss. Thus, is why we include Vellashape III (a skin shrinking device) with all our liposuction procedures.

Tummy Tuck (abdominoplasty) surgically removes the excess fat directly from the abdominal AND:

1. Tightens/repairs the stretched and separated muscles after pregnancy or significant weight loss.
2. Dr. Hardesty includes flank liposuction and a non-narcotic pain pump with each tummy tuck.

Nothing substitutes for a personal evaluation and a face to face discussion of your options.  Unfortunately without a examination I can advise you in general terms, however I hope you will find them helpful.

In general it’s best to be a your goal weight prior to surgery:

1) your abdomen (and other parts of your body) often will change size with weight fluctuations.

2) we all have internal fat (fat on our internal organs that pushes out the abdominal wall and not accessible to liposuction or abdominoplasty) and external fat (fat that we can pinch between our fingers that can be liposuctioned or surgically removed during abdominoplasty). Weight loss effects both and thus when you attain your goal weight  we can optimally tighen your muscles and remove the excess fat and hanging skin.

3)Body Mass Index  (BMI) over 30 and greater is associated with progressively slightly increased complications.

I would perform two stages for safety, pain control and overall I feel better long term result.

First Stage:

1)Extended abdominoplasty: removing all skin and fat between your pubic hair line (or lower) and your umbilicus (tummy button) which would remove most if not all of your rolls of abdominal skin.

2)tighenting your presumed separated muscles.

3)Liposuctioning your flank areas4)insertion non-narcotic paint pump for post op pain control

Second Stage (3-6 month latter)

1)lateral thigh and buttock lift

2)aggressive liposuction of abdomen, thighs and back

3)insertion non-narcotic paint pump for post op pain control

I believe you are a reasonably good candidate and will be very satisfied with your extended  “tummy tuck” and its components as stated in above.

Sensation usually returns after liposuction. You most likely will have a area of decreased sensation just above your central abdominal incision (Similar to women after c-section).

I suggest you make out a list of your questions and select several nude “model” photos of what your desired goals/look would be and then schedule several different consultative appointments with experienced Plastic Surgeons who are Certified by the American Board of Plastic Surgery and who are ideally members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

Unfortunately without a examination or photos  I can only advise you in general terms, however I hope you will find them helpful.

Liposuction is often incorporated/included but not always necessary with a abdominoplasty to enhance the results.

Based on my experience I always offer complimentary liposuction of the flanks to better create a optimal contour of your tummy.

However it is not advised to perform liposuction of the upper abdomen at the time of abdominoplasty for fear of injuring the blood vessels that supply the lower abdominal tissue. This liposuction can often be completed under local anesthesia several months after healing of the abdominal incision.

Every Plastic Surgeon will perform a abdominoplasty a little differently depending on the patients anatomy and desires.

There are four types of abdominoplasties.
A-C All have horizontal
incisions and D has a significant vertical compotent.
A) mini- muscle tightened below umbilicus to pubic bone
B) standard- muscle tightened from breast bone to pubic bone
C) extended as in standard but incision longer to excise excess skin/fat in outer thigh area
D) fleur de lis- same as standard but in addition excess skin/fat excised in a vertical direction.

Please make a follow up a appt. with your Plastic Surgeon to address any and all of your questions.

I trust your Plastic Surgeons is Certified by the American Board of Plastic Surgery and is ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

The following document  is what I give all my Abdominioplasty patients prior to surgery.

Please find below information that I believe you will find helpful as you prepare for and recovery from your Abdominioplasty.

I. PREOPERATIVE
a. 30 Days Before
1) Start iron pills  325 mgm (can purchase directly over the counter) start taking a day (builds up blood). May turn stools black and cause constipation.
2) Start a multivitamin (provides nutrients for healing) no mega E; it 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 over age of 45 or medical issues our surgery center recommends a preoperative clearance by your primary care physician with basic laboratory data.

b. 14 Days Before
1) If over the age 45 or medical issues, provide preoperative clearance letter with laboratory data for your surgeon.
2) 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 ok to continue or stop. Bring list of questions.
3) Complete final payment of procedure prior to leaving the office after the pre-operative appointment is concluded.
4) Stop shaving around pubic area (razor blade shaving causes small cuts that can harbor bacteria and increase infection rate).
5) NO aspirin, Aleve, 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, pickup and child care.

c. 4 Days Before
1) Start bromelain and arnica as directed (anti bruising and swelling).
2) Purchase 2 large bags of frozen peas or corn (Costco size). Can have one in pillow case and place over abdomen and change out with second one (in freezer) when thawed.
3) Purchase any needed food, supplies and verify with your postoperative support team yours/their schedule.
4) No shaving of pubic area (can increase infection rate) Operating Staff will clip pubic hair if needed.

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

f. Night Before
1) Make out a list of any “last minute” questions, your needs, wants desires and expectations of the surgery.
2) 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).
3) Take a shower with antiseptic solution and scrub entire body well.
4) No alcohol containing drinks.
5) Nothing by mouth after midnight or 8 hours prior to surgery (unless instructed so by surgicenter).

II Operative Day

1) Awake and take second shower and scrub the surgical area
2) Check your list (bring model photos demonstrating your desires).
3) Place anti-nausea patch behind ear (prevents nausea).
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, “bobbie pins” from hair and body.
7) No make-up and remove nail polish (intraoperative monitoring).
8) Button down or zipper blouse/shirt, sweat pants or stretchable pants.
9) Go over your list with Plastic Surgeon and Anesthesia provider.
10) Reaffirm with 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 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 (pain, nausea, etc.).
2) Do what you are asked to do.
3) 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) portable Sequential Compression Device (SCD) 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 next two weeks.
2) Incentive spirometer every hour after surgery (improves breathing) after general anesthesia.
3) If drains used measuring cup and chart for recording out-put as directed.
4) Foley catheter: doctor will insert into patient prior to leaving surgericenter and have patient remove 6 hours after surgery (some patients develop urinary retention while general anesthesia wears off and will require re-catheterization.
5) Walking in hunched over position. Doctor will provide a “loaner” walker for patient.
6) Bed position “lazy boy” position (use recliner, hospital bed or pillows/foam wedges).
7) Diet progressive to prevent nausea: clear liquids (Gatorade, broth, tea) for first 8 hours, liquid diet next 8 hours (soups, pudding, and yogurt), and soft diet for next 8 hours (well-cooked oatmeal or pasta) after 24 hours regular diet.
Start stool softeners and anti-constipation program.
8) Pain management: 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 is ok to start using aspirin, Aleve, Motrin AFTER surgery and alternate with oral narcotics. Do not take pain medications on an empty stomach. Crackers before and after medications (to prevent nausea and upset stomach).
9)  Incentive spirometer: helps 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 SCD’s 24 hours a day, anti DVT exercises every hour.
2) Use incentive spirometer (it opens up small breathing units in your lungs) once an hour until you reach your preoperative values
3) Walk  hunched over (use walker provided) and sleep in the “fetal position” using recliner or wedges/pillows.
4) If unable to have a bowel movement; start over the counter laxatives and stool softeners.

d) 5th 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.
4) May remove SCD during ambulation (walking upright) but wear at all times when not.
5) Progressive ambulation (walking upright) and stretching to point of pain and fatigue.
6) Wean off narcotic pain pills and replace with Tylenol, Motrin or Aspirin like over the counter medications.
7) May drive as tolerated (must be off narcotics).
8) May switch from provided binder to “spanks” like garment for comfort and support.
9) 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 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 2-3 months for the majority of the swelling to be gone.
4) It will take 9 + months for the scars to “mature” (soften and lighten)
5) Enjoy your new body.

I trust you have chosen a Plastic Surgeon who is experienced and Certified by the American Board of Plastic Surgery. In addition ideally a members  of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).