The Rising Popularity of Tummy Tuck Surgery
Social pressures and clothing styles can be very unkind to those who have a lower tummy "paunch." For some, this problem is the consequence of years of recurring weight gain and loss, but for the majority of women this occurs during the normal course of one or more pregnancies and is most often unavoidable. Following months of stretching and expansion of the abdominal wall and skin (accommodating the growth of a fetus into a newborn baby), it becomes impossible for the body to ever again return to its pre-pregnancy shape and appearance. Even with extreme efforts through "diet and exercise," mothers are often left with stretched and excessive abdominal skin, annoying stretch marks within that skin, and displaced "abs" (abdominal muscles) that are no longer capable of maintaining a flat tummy.
Depending upon the degree to which this is affecting the appearance of the tummy, many women seek the benefit of a surgical "fix." This is just one facet of what is now being widely promoted— as a "Mommy Makeover," which also includes breast rejuvenation surgery and liposuction. The point is that tummy tucks and other forms of cosmetic surgery are a viable option in helping us stay connected with the "youth orientation" of our current society.
The dilemma for patients with this type of lower abdominal problem is how best to make the right decision between pursuing this surgery or simply doing nothing and becoming resigned to a continued life with their tummy appearance, forever showing the unwanted changes that occurred during pregnancy. Were it not for its associated expense, surgical risks, postoperative pain, anticipated recovery time and unavoidable scars, the choice to have this surgery could be very easy for all. Judging, however, from the rapidly increasing popularity of tummy tucks, many, in spite of those issues, are deciding to make their decision in favor of surgery. I now want to take a closer look at those issues that still cause concern among a large number of prospective tummy tuck patients.
The Cost of Having a Tummy Tuck
No surgery is inexpensive, and tummy tuck is not an exception. With steadily rising hospital costs, I have found my tummy tuck patients to be more and more willing to have this procedure performed with no "overnight stay" in a less costly outpatient surgery center. For many, this has made affordable a tummy tuck procedure that, if performed in a hospital with overnight stay, might be far too expensive. Tummy tuck cost now falls in line with the costs of other popular cosmetic surgeries such as liposuction or
breast augmentation. Furthermore, at the accredited outpatient surgery centers (in which I now perform many of these procedures), patients are assured their surgery will be performed by properly trained and licensed staff in a safe ambulatory surgical environment. No shortcuts are ever taken, in the interest of cost, which might place a patient's safety at risk.
The Surgical Risks of a Tummy Tuck
When tummy tucks are performed in a safe manner the risk of serious medical or anesthesia problems is no different than from any other operation requiring a general anesthetic. Fortunately, with skilled surgical and anesthesia personnel performing these procedures on healthy patients, this risk is extremely low. The more usual tummy tuck problems occur after the procedure has been performed when the patient is recovering from the surgery. These risks can be quite varied and are worth discussing:
Medical problems related to surgery and anesthesia/Potential post-operative problems:
Problems associated with tummy tucks are similar to those before and following almost any major surgery. I treat all of these medical problems, on a case-by-case basis with the same concern and diligence that my patients always deserve.
Insufficient Blood Flow to the Tightened Skin:
When a tummy tuck is performed, the loose tummy skin must be partially detached from the deeper muscle layer of the abdominal wall before it can be shifted in position and achieve the desired tightening. In this process, much of the normal blood flow becomes interrupted and a strain is placed on the skin, which depends on a good flow of blood to stay healthy. If all goes as planned, the skin does receive enough blood flow and healing proceeds normally. If things don't go as planned (e.g., in patients with impaired circulation from smoking, diabetes, etc.)) the blood flow may be inadequate, and normal healing won't follow. For these patients, some of the skin along the incision may turn dark and die. The dark areas then become slow healing "sores" that require a long time to get well and can eventually result in areas of thickened scar. This rarely happens, but when it does, it may be a reason for extreme disappointment.
Fluid Accumulating Under the Recently Tightened Tummy Skin:
Following all surgery, tissues that have been cut tend to give off "tissue fluid" until they have sufficiently healed. If the amount of this fluid becomes more than the body can absorb, it begins to pool in an area, and the fluid (then called a "seroma") must be drained. Drainage is by means of placing a needle through the overlying skin (which the patient barely feels because of the numbness still present after the surgery) and drawing off the fluid. This may be required on more than one occasion before the fluid goes away for good . Fortunately, with the tummy tuck method I now use, this problem has become quite rare, and I no longer find it necessary to use surgical drains with this procedure.
Blood Clot Formation in Deep Leg Veins (DVT):
Any operation, after which a patient is forced to limit the use of his or her legs for a period of time (e.g., a tummy tuck), is associated with a heightened risk of blood clot formation in the legs. Sluggish blood flow through leg veins is the main culprit. The worst consequence of this is the occasional patient who then has a pulmonary embolus or "PE,” which occurs when such a clot breaks loose and travels to the heart and lungs, causing serious illness or (very rarely) a fatality. Although this complication is extremely unlikely, I am always very aware of its possibility, and I take every appropriate measure to prevent its occurrence.
This list certainly covers the major (but definitely not all) possible risks of tummy tuck surgery. When this surgery is properly done, these complications tend to be very infrequent, and, eventually, the majority heal satisfactorily.
The Pain to be Expected with a Tummy Tuck
Of course, all surgery is associated with discomfort, and some operations hurt more than others. Also, when several different patients all have the same type tummy tuck, it's normal to receive a different report from each patient regarding the amount of experienced pain. Because of this, it's hard to advise prospective tummy tuck patients as to how much pain there will be and how long it will last. I routinely tell new patients that this pain, as described to me by many of my former patients, was much less than they had expected and that their prescribed pain medication was adequate to keep them comfortable. A large area of numbness of the tummy skin is present post-operatively, lasting for many weeks following surgery. This somewhat accounts for the reason tummy tuck pain for many patients is less than expected. In summary, I know that post-operative pain is variable, and for some a tummy tuck hurts "a lot”, but for others, a tummy tuck seems to be very tolerable.
Downtime from Normal Activities After a Tummy Tuck
The typical "down time" following a tummy tuck, before patients can drive and return to their work (or other moderate activities) is about 10 to 14 days. Full physical exertion is permitted after six weeks. Many patients also experience a diminished amount of energy for several weeks after surgery, making a full day of activity somewhat challenging.
The Scars Associated with a Tummy Tuck
By far, the main reason many patients shy away from having a tummy tuck is their objection to the long scar required by this operation. However, in reality, patients considering a tummy tuck don't have a "perfect" tummy for starters, and the reason they are considering this surgery is to rid themselves of loose "stretch marked" skin, lower tummy fat, widened tummy muscles and sometimes existing tummy scars. For these patients, the decision comes down to the realization that a tighter, flatter tummy, with a scar concealed by panties, is preferable to a lower tummy with which they are totally displeased because of its appearance. Once that conclusion is reached, the decision to proceed with surgery should be quite easy.
The Surgical Technique of a Tummy Tuck
Tummy tuck surgery started to gain acceptance as a safe and effective procedure during the 1970's. Several pioneering plastic surgeons of that decade worked out the technical details of the abdominoplasty operation, which have carried over, with little change, to the present day. A "full” tummy tuck procedure starts with outlining the area of skin and fat to be removed, in such a manner that the region of skin lying above the removed area can be pulled down and the area completely sutured closed. The drawing below shows the usual area to be outlined for removal (to the left) and the location and relative length of the closed incision and resulting scars (below).
The procedural steps that take place during a full tummy tuck, in addition to the elimination of an unwanted area of skin and lower tummy fat, is the suturing together of the "abs" (rectus muscles) to correct an unwanted distance separating them and, additionally, the surgical repositioning of the belly button so it ends up located in the proper place. Often, liposuction of adjacent areas is also performed to further improve the final result. An excellent video animation depicting the full tummy tuck procedure can be viewed to gain a better understanding:
