Surgery of the Abdomen Abdominoplasty

Abdominoplasty is designed to firm and smooth the abdomen. This procedure removes excess skin and fat from the abdomen and fat from the abdomen and also tightens the muscles of the abdominal wall. The result is a flatter, tighter abdominal profile. Abdominoplasty is best suited for women and men who are in relatively good shape, but have loose abdominal skin and/or a significant amount of abdominal fat that won’t respond to dieting or exercise. Women who have had children can especially benefit from abdominoplasty.

You may be a good candidate for abdominoplasty if you have one or more of the following conditions:
*excess or loose, sagging abdominal skin
*an abdomen that protrudes and is out of proportion to the rest of the body
*abdominal muscles that have been weakened by pregnancy or aging
*excess fat that is concentrated beneath the abdominal skin

Dr. Pledger does not recommend this procedure for you if you plan on becoming pregnant in the future. If you have had a Cesarean section or other type of abdominal surgery the scar may limit the results of an abdominoplasty. Quite often the existing scar can be used for the new incision, as is often the case.

Consultation

During your consultation Dr. Pledger will evaluate the quality of your abdominal skin, the location of any existing scars, the amount and location of any excess fat, and the status of your underlying muscles. Dr. Pledger will then determine the type of abdominoplasty that is needed. There are four different types of abdominoplasty procedures. All of these techniques include liposuction of the abdomen, hips and pubic area. They are horizontal, horizontal with belt lipectomy, vertical and mini-abdominoplasty.

Horizontal
This is the most common technique used. A horizontal incision will be placed just within or above the pubic area. The length of the incision varies by patient depending on the amount of skin to be removed. A second incision will be made around the navel. Excess skin above the navel is separated from the deeper tissues so it can be pulled downward and removed. The muscles of the abdomen are tightened.

Horizontal with belt lipectomy
The same technique as the horizontal abdominoplasty is used, but an additional incision is made around to the back. This removes the excess skin over the hips.

Vertical
This technique is used if you have a vertical scar running the length of your abdomen. Dr. Pledger will use this incision as part of the abdominoplasty. This incision can be used to remove some of the skin circumferentially around the waistline.

Mini-abdominoplasty
This technique requires only a short horizontal incision and naval incision. This procedure may benefit you if you are primarily dissatisfied with the appearance of the abdominal area below the naval. It will not correct loose skin above the navel. The muscle below the navel is tightened. Liposuction of the entire abdomen is also done.

Dr. Pledger may also recommend liposuction on additional areas, other than the flanks and pubic area which are included with the abdominoplasty, to get the best result possible.

Surgery

Abdominoplasty is done under general anesthesia at a surgical facility. It usually requires an overnight stay at the facility. Prior to surgery Dr. Pledger will meet you again to answer any further questions you may have. He will also mark where your incisions will be made at that time. When possible he will keep the incisions within the swimsuit lines. You will be in surgery for approximately 2 to 4 hours, depending on any additional procedures being performed. The length of the incision will depend largely on the amount of skin to be removed. Working through this incision Dr. Pledger will tighten the underlying muscles by pulling them together and stitching them in place. Any excess skin from the lower abdomen will be trimmed away. Skin that contains stretch marks may be removed. With the exception of the mini-abdominoplasty, a second incision will be made around the navel. The excess skin above the navel will be separated from the deeper tissues so it can be pulled downward and removed. Although the navel’s position remains unchanged, its appearance may be slightly altered.
Once the procedure is finished you will be placed into an abdominal binder. A drainage tube will have been placed beneath the skin to help prevent fluid from accumulating. You will probably sleep for the rest of the day and through the night. Any pain you may feel can be controlled with medication. The nurses may have you periodically get up and stand by your bed to maintain good blood circulation. Dr Pledger will see you the following morning and release you to go home. Before you leave the nurses will instruct you on how to operate the drainage tube.

Postoperative Recovery

Dr. Pledger will prescribe pain medication to help control the pain. Although you may not be able to stand perfectly straight at first, you are encouraged to get out of bed often to promote blood circulation. You should avoid straining, bending, and lifting. You will need to sleep with your knees bent and elevated. Most patients prefer to sleep in a Lazyboy chair if they have one. Dr. Pledger will see you in his office 3 to 5 days following surgery. You will need to monitor your drainage levels. Once it falls below 50cc. in a 24-hour period Dr. Pledger will remove the drain. Within the first week your bruising and swelling will reach its peak. After 1 to 2 weeks you may return to nonstrenuous work and begin to increase your activity and exercise. The bruising and swelling will continue to subside and you will begin to see your final results.
In the months following surgery it is important to treat your healing skin with extra care. This means avoiding sun exposure. Your feelings of numbness and tightness will disappear and your incision line will begin to fade from its reddish color. Full fading of the skin may take a year or more. Dr. Pledger may also instruct you in abdominal exercises to start in order to strengthen the muscle.