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Abdominoplasty

Pregnancy and increases in intra-abdominal fat leads to a loss of abdominal contour and shape. An increase in abdominal volume leads to stretching of the skin and causes the abdominal muscles to separate along the midline. Unfortunately, after delivery or weight loss, the skin does not retract and the abdominal muscles do not return to their midline position, which permanently changes the contour of the abdomen and flanks. An abdominoplasty, also referred to as a tummy tuck, returns the muscles to the midline (muscle plication), removes the excess skin, and moves the belly button to allow contouring of the upper and lower abdomen. This results in flattening of the abdomen, a decrease in the overall circumference, and tapering of the waist inward above the hips to restore curves.  At Froedtert South Plastic Surgery the cost of a full abdominoplasty is $6,600, which includes anesthesia, all surgical fees, and follow-up care. A mini-abdominoplasty is a variation of an abdominoplasty where only some portions of the procedure are used to achieve a pleasant abdominal contour.

Indications for surgery

An abdominoplasty is an elective, cosmetic procedure used to improve the contour of the abdomen after pregnancy and weight loss. The procedure removes excess skin and tightens the abdominal musculature by repairing the separation that develops between the rectus abdominis muscles (rectus diastasis). An abdominoplasty is not considered a weight loss procedure but instead is typically reserved for patients who have reached, or are near, their goal weight. Unfortunately, despite claims on the internet, special exercises, special diets, and special supplements cannot tighten the skin and muscle or restore the abdominal contour.

Types of Abdominoplasties 

​There are two broad categories of abdominoplasties: full abdominoplasty and mini-abdominoplasty. A full abdominoplasty involves a lower incision from one hip bone to the other crossing through the pubic area. The second, upper incision, curves above the belly button. A full abdominoplasty addresses the entire abdominal area, tightening the muscles and removing excess skin both above and below the belly button. A mini-abdominoplasty typically involves a shorter lower incision and an upper incision that is below the belly button. A mini-abdominoplasty focuses more on the lower abdomen when the rectus diastasis does not extend above the belly button. 

Recovery

Immediately following surgery, it is not uncommon for patients to experience swelling, bruising, and tightness from the muscle plication. Maintaining compression across the abdomen with an abdominal binder is an essential part of the initial healing process.  This compression is typically worn for four to six weeks after surgery and helps to minimize swelling and promote healing of the surgical surfaces created after removing the excess tissue.  Drains are typically used, temporarily, to prevent the collection of fluid beneath the skin. These drains are removed one to two weeks after surgery. For the first one to two weeks, lifting is limited to 5-10lbs, and patients typically walk with a hunched posture. Sleeping with the head of the bed elevated for one to two weeks is also recommended. Light cardio exercises can be started at three weeks, if tolerated. Core strengthening, like sit-ups and crunches, are avoided until at least 10-12 weeks after surgery. Final results will become visible over several months, but subtle changes will continue to occur for 6-9 months after surgery.  Maturation and lightening of the scar typically take 9-12 months but fortunately is hidden beneath clothing.

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©2020 by Brian Hill, MD - Plastic Surgeon.

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