Dr Lisa Friederich

1300 375 472

Abdominoplasty

Abdominoplasty, commonly referred to as a ‘tummy tuck’, is a surgical procedure designed to reshape and tighten the abdomen. This is a procedure best suited to those who have excess abdominal skin due to weightloss, pregnancy or other causes.

The aim of an abdominoplasty is to remove excess skin from the abdomen and tighten the fascia of the rectus muscles if they have become separated. Liposuction can be be performed as an adjunct to abdominoplasty to remove stubborn areas of fat not included in the resected tissue. 

The result is a flatter, firmer and more attractive looking abdomen. Tightening the abdominal muscles improves their function and may improve core stength. There is evidence this improves back pain and continence.

Types of Abdominoplasty

Traditional aka Radical or Full Abdominoplasty

This is the most commonly performed type of abdominoplasty. The skin and fat layer of the abdomen are elevated up to the lower border of the rib cage. The rectus muscle fascia is stitched together to correct any separation. The overlying skin and fat is then pulled down and the excess is removed. Usually, all of the skin between the belly button and the lower incision is able to be removed. This necessitates the belly button being relocated to a new position. To do this, it is cut from the surrounding skin and kept attached to the abdominal wall. After the excess skin has been removed a small hole is cut in overlying skin like a button hole and it is sutured in place.  

The scar for this usually runs from hip to hip. The hospital stay is usually 3-5 days. It is uncomfortable to begin with as the tummy will be tight and getting out of bed can be challenging. A urinary catheter is placed before the operation and removed once you are able to get out of bed by yourself.

Mini-Abdominoplasty

An option for those who only have laxity in the lower abdomen and no significant muscle separation. The skin and fat below the belly button is elevated, the excess is removed and the incisions closed. The length of the incision is significantly smaller and the skin removed does not necessitate repositioning of the belly button. 

Extended Abdominoplasty

Essentially the same operation as the Full abdominoplasty, but with an extension of the incision  such that allows for the removal of  more skin. For those with significant laxity after  massive weight loss.

*Liposuction Only

This is a viable option for younger patients with good skin tone and stubborn pockets of fat that exercise and diet won’t touch. It won’t remove loose skin, but may exacerbate it in some once fat has been removed.

 

The procedure

The procedure is performed in a Fully accredited hospital under General Anaesthesia.

Hospital stay is between 3-5 days for a full abdominoplasty. Mini abdominoplasties may go home the same day, but usually stay at least one night.

The Anaesthetist and Hospital will contact you the week of surgery to discuss your admission and fasting time.

When you arrive at the hospital you will be admitted and given a hospital gown to change into.

When it is time for your operation you will be brought up to the operating theatres and checked in by nursing staff.

Dr Lisa will see you in the waiting bay to mark you up and then the anaesthetist will have a quick chat before you are taken into the operating theatre.

You will have an IV inserted and monitoring attached. We will warm you up with a hot air blanket and give you some oxygen before you go off to sleep.

Once asleep you will have a urinary catheter inserted. Calf pumps and a diathermy plate are put on before proceeding to prepping and draping.

Markings

Preoperative markings are drawn prior to surgery. These include landmarks such as the midline and the lower incision line. The position and symmetry of this is checked with you before finishing.

Incisions

Once you are off to sleep, a catheter is inserted and you are prepped and draped. The lower incision skin is cut with a scalpel and elevated from the underlying abdominal wall with a diathermy tip. When close to the belly button, this is incised free from the skin flap.

Elevation of Skin

The light grey area shows the extend of elevation of the skin and fat of the abdomen. The blood supply comes in obliquely from the sides, so minimal elevation is performed in this region.

Rectus Fascia repair

Once the skin flap is elevated, the underlying abdominal wall is revealed and rectus separation is able to be directly assessed. The edges of the overlying fascia are marked and sutured together. This is done with a permanent suture in 2 layers.

Completed repair

After suturing of the rectus fascia, the muscle bellies resume their anatomical alignment. The belly button is secured to the abdominal wall. In those with a long stretched stalk it is hitched up or tethered down to shorten it.

Skin Excision

The skin flap is often split in the midline up to the belly button during elevation to allow for easier access for the muscle repair. Once the work on the abdominal wall is complete the bed is flexed to take the tension off the abdominal skin and it is pulled downwards and towards the midline. The excess skin is removed. Drains are placed on each side.

Closure

The wound is closed progressively in layers, starting with Scarpa's fascia, a strong fascial layer that holds the majority of wound tension. The skin is then closed in 2 further layers. All of the sutures used for this closure are dissolvable and not visible on the ourside of the wound. The belly button is inset by locating it's position and cutting a small hole in the overlying skin flap. The edges of this are closed with sutures. Finally wound dressings are applied and an abdominal binder fitted.

After the procedure

When the operation is finished you will be woken from anaesthesia and taken to the recovery area. You will be sitting in a ‘banana’ position, with your hips flexed and your knees bent. This position takes tension off of the tummy skin and wound closure. Your tummy will feel tight and you will probably have some pain. The nurses looking after you will help you whilst you wake up and give you pain medications as needed. Once you are fully awake and stable you will be taken back to your hospital bed on the ward. 

You may rest in bed for the rest of this day, but on the following day you must get up and out of bed. Initially you may need to walk hunched over as your tummy will feel tight, but you will soon be able to walk upright as the skin settles. As soon as you can get up by yourself your catheter can be removed. The earlier this is out the better. Mobilising as soon as you can is essential in decreasing the risk of deep vein thrombosis and chest infections.

You may shower as soon as you are able as all dressings are waterproof.

The drains will be kept in until you have mobilised and taken out when there is minimal drainage coming out. They are almost always able to be removed before you go home.

Risks and complications

Surgery is generally very safe, but there is the potential for risks and complications to occur. Knowing potential risks enables preventative measures to be taken. Note that Smoking and Obesity increase the rate of ALL risks and complication.

Some risks and complications associated with abdominoplasty may include:

  • Pain and swelling – this is normal and to be expected
  • Bleeding – intraopertively / postoperatively
  • Haematoma – When blood accumulates within the surgical site. This will usually require a return to theatre for evacuation
  • Bruisingmay occur. It is much more common when liposuction is performed as part of the procedure
  • Altered sensation and numbness, usually temporary and resolves with time. 
  • Delayed healing, wound breakdown, skin necrosis
  • Stitch abscess
  • Belly button healing delay or loss
  • Infection
  • DVT / PE (Deep Vein Thrombosis/ Pulmonary embolus)
  • Seroma (tissue fluid collection)
  • Dog ears
  • Longer scar than expected, high riding scar or asymmetric scar
  • Poor quality scar- thickened, stretched, keloid
  • Belly button malposition
  • Pubis / Mons disproportion or malposition
  • Residual fat or skin
  • Prolonged swelling. It usually takes at least 3 months for the swelling to resolve completely. The main reason for this is the disruption in the lymphatic drainage of the upper abdominal flap.
  • Fat necrosis or lumpiness with liposuction
  • Anaesthetic problems
  • Reoperation /revision

Dr Lisa will discuss all of this in more detail with you during your consultation.

 

Costs of surgery

Costs associated with abdominoplasty usually include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests

Health fund cover

Health funds will cover the hospital fees (bar any hospital excess) and contribute a small rebate if a Medicare item number can be applied. In regards to abdominoplasty there is only a Medicare item number available for patients who meet the following criteria:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

Would you like to know more?

Please let us know if you would like further information or to book a consultation. You are  welcome to send photographs to Dr Lisa using the form below to see if you are a suitable candidate. All such images are treated confidentially.

Abdominoplasty

Abdominoplasty, commonly referred to as a ‘tummy tuck’, is a surgical procedure designed to reshape and tighten the abdomen. This is a procedure best suited to those who have excess abdominal skin due to weightloss, pregnancy or other causes.

The aim of an abdominoplasty is to remove excess skin from the abdomen and tighten the fascia of the rectus muscles if they have become separated. Liposuction can be be performed as an adjunct to abdominoplasty to remove stubborn areas of fat not included in the resected tissue. 

The result is a flatter, firmer and more attractive looking abdomen. Tightening the abdominal muscles improves their function and may improve core stength. There is evidence this improves back pain and continence.

Types of Abdominoplasty

Traditional aka Radical or Full Abdominoplasty. 

This is the most commonly performed type of abdominoplasty. The skin and fat layer of the abdomen are elevated up to the lower border of the rib cage. The rectus muscle fascia is stitched together to correct any separation. The overlying skin and fat is then pulled down and the excess is removed. Usually, all of the skin between the belly button and the lower incision is able to be removed. This necessitates the belly button being relocated to a new position. To do this, it is cut from the surrounding skin and kept attached to the abdominal wall. After the excess skin has been removed a small hole is cut in overlying skin like a button hole and it is sutured in place.  

The scar for this usually runs from hip to hip. The hospital stay is usually 3-5 days. It is uncomfortable to begin with as the tummy will be tight and getting out of bed can be challenging. A urinary catheter is placed before the operation and removed once you are able to get out of bed by yourself.

Mini-Abdominoplasty

An option for those who only have laxity in the lower abdomen and no significant muscle separation. The skin and fat below the belly button is elevated, the excess is removed and the incisions closed. The length of the incision is significantly smaller and the skin removed does not necessitate repositioning of the belly button. 

Extended Abdominoplasty

Essentially the same operation as the Full abdominoplasty, but with an extension of the incision  such that allows for the removal of  more skin. For those with significant laxity after  massive weight loss.

*Liposuction Only

This is a viable option for younger patients with good skin tone and stubborn pockets of fat that exercise and diet won’t touch. It won’t remove loose skin, but may exacerbate it in some once fat has been removed.

The procedure

The procedure is performed in a Fully accredited hospital under General Anaesthesia.

Hospital stay is between 3-5 days for a full abdominoplasty. Mini abdominoplasties may go home the same day, but usually stay at least one night.

The Anaesthetist and Hospital will contact you the week of surgery to discuss your admission and fasting time.

When you arrive at the hospital you will be admitted and given a hospital gown to change into.

When it is time for your operation you will be brought up to the operating theatres and checked in by nursing staff.

Dr Lisa will see you in the waiting bay to mark you up and then the anaesthetist will have a quick chat before you are taken into the operating theatre.

You will have an IV inserted and monitoring attached. We will warm you up with a hot air blanket and give you some oxygen before you go off to sleep.

Once asleep you will have a urinary catheter inserted. Calf pumps and a diathermy plate are put on before proceeding to prepping and draping.

Markings

Preoperative markings are drawn prior to surgery. These include landmarks such as the midline and the lower incision line. The position and symmetry of this is checked with you before finishing.

Incisions

Once you are off to sleep, a catheter is inserted and you are prepped and draped. The lower incision skin is cut with a scalpel and elevated from the underlying abdominal wall with a diathermy tip. When close to the belly button, this is incised free from the skin flap.

Elevation of Skin

The light grey area shows the extend of elevation of the skin and fat of the abdomen. The blood supply comes in obliquely from the sides, so minimal elevation is performed in this region.

Rectus Fascia repair

Once the skin flap is elevated, the underlying abdominal wall is revealed and rectus separation is able to be directly assessed. The edges of the overlying fascia are marked and sutured together. This is done with a permanent suture in 2 layers.

Completed repair

After suturing of the rectus fascia, the muscle bellies resume their anatomical alignment. The belly button is secured to the abdominal wall. In those with a long stretched stalk it is hitched up or tethered down to shorten it.

Skin Excision

The skin flap is often split in the midline up to the belly button during elevation to allow for easier access for the muscle repair. Once the work on the abdominal wall is complete the bed is flexed to take the tension off the abdominal skin and it is pulled downwards and towards the midline. The excess skin is removed. Drains are placed on each side.

Closure

The wound is closed progressively in layers, starting with Scarpa's fascia, a strong fascial layer that holds the majority of wound tension. The skin is then closed in 2 further layers. All of the sutures used for this closure are dissolvable and not visible on the ourside of the wound. The belly button is inset by locating it's position and cutting a small hole in the overlying skin flap. The edges of this are closed with sutures. Finally wound dressings are applied and an abdominal binder fitted.

After the procedure

When the operation is finished you will be woken from anaesthesia and taken to the recovery area. You will be sitting in a ‘banana’ position, with your hips flexed and your knees bent. This position takes tension off of the tummy skin and wound closure. Your tummy will feel tight and you will probably have some pain. The nurses looking after you will help you whilst you wake up and give you pain medications as needed. Once you are fully awake and stable you will be taken back to your hospital bed on the ward. 

You may rest in bed for the rest of this day, but on the following day you must get up and out of bed. Initially you may need to walk hunched over as your tummy will feel tight, but you will soon be able to walk upright as the skin settles. As soon as you can get up by yourself your catheter can be removed. The earlier this is out the better. Mobilising as soon as you can is essential in decreasing the risk of deep vein thrombosis and chest infections.

You may shower as soon as you are able as all dressings are waterproof.

The drains will be kept in until you have mobilised and taken out when there is minimal drainage coming out. They are almost always able to be removed before you go home.

Risks and complications

Surgery is generally very safe, but there is the potential for risks and complications to occur. Knowing potential risks enables preventative measures to be taken. Note that Smoking and Obesity increase the rate of ALL risks and complication.

Some risks and complications associated with abdominoplasty may include:

  • Pain and swelling – this is normal and to be expected
  • Bleeding – intraopertively / postoperatively
  • Haematoma – When blood accumulates within the surgical site. This will usually require a return to theatre for evacuation
  • Bruisingmay occur. It is much more common when liposuction is performed as part of the procedure
  • Altered sensation and numbness, usually temporary and resolves with time. 
  • Delayed healing, wound breakdown, skin necrosis
  • Stitch abscess
  • Belly button healing delay or loss
  • Infection
  • DVT / PE (Deep Vein Thrombosis/ Pulmonary embolus)
  • Seroma (tissue fluid collection)
  • Dog ears
  • Longer scar than expected, high riding scar or asymmetric scar
  • Poor quality scar- thickened, stretched, keloid
  • Belly button malposition
  • Pubis / Mons disproportion or malposition
  • Residual fat or skin
  • Prolonged swelling. It usually takes at least 3 months for the swelling to resolve completely. The main reason for this is the disruption in the lymphatic drainage of the upper abdominal flap.
  • Fat necrosis or lumpiness with liposuction
  • Anaesthetic problems
  • Reoperation /revision

Dr Lisa will discuss all of this in more detail with you during your consultation.

 

Costs of surgery

Costs associated with abdominoplasty usually include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests

Health fund cover

Health funds will cover the hospital fees (bar any hospital excess) and contribute a small rebate if a Medicare item number can be applied. In regards to abdominoplasty there is only a Medicare item number available for patients who meet the following criteria:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

Would you like to know more?

Please let us know if you would like further information or to book a consultation. You are  welcome to send photographs to Dr Lisa using the form below to see if you are a suitable candidate. All such images are treated confidentially.

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