Sydney

Abdominoplasty (Tummy Tuck)

A traditional abdominoplasty uses a hip-to-hip incision, repairs the separated abdominal muscles and repositions the belly button. A mini abdominoplasty uses a shorter incision and removes skin and fat below the navel, but does not address the abdominal muscles at all. That last difference is the one that matters most.

If your main concern is muscle separation after pregnancy, a mini procedure will not correct it, no matter how much skin is removed. A mini suits a small amount of loose skin low on the abdomen with intact muscles underneath. Which one applies to you is determined by examination rather than preference, because the muscles have to be assessed directly. Ask specifically whether your abdominal muscles are separated, and whether the operation being proposed repairs them.

Only if your skin is firm and the concern is purely fat. Liposuction removes fat but does nothing for loose skin or separated muscles. In skin that has already lost elasticity, taking the fat out from underneath can leave it looser than it was before.

After pregnancy or significant weight loss, the problem is usually skin and muscle rather than fat alone, which is why liposuction by itself often disappoints in those situations. The two are frequently combined, with liposuction used on the upper abdomen, flanks or pubic area alongside the abdominoplasty. Liposuction is also not a weight loss treatment. If you are unsure which applies to you, that is precisely what the examination at consultation is for.

Sometimes, where specific criteria are met. Item 30175 covers radical abdominoplasty with repair of rectus diastasis following pregnancy. Item 30177 covers lipectomy with radical abdominoplasty for redundant skin and fat that is a direct consequence of significant weight loss. An abdominoplasty for appearance alone attracts no rebate.

The criteria are precise and evidence is required. Item 30175 requires a diastasis of at least 3 cm measured on diagnostic imaging before the service, moderate pain or discomfort at the site during functional use and/or lower back pain or urinary symptoms, and a failure to respond to non-surgical treatment including physiotherapy. Item 30177 requires intertrigo or another skin condition that risks loss of skin integrity and has failed three months of non-surgical treatment, redundant skin and fat that interferes with activities of daily living, and weight stable for at least six months. Start the documentation with your GP, because the imaging and symptom history need to exist before surgery rather than afterwards.

Where the abdominoplasty is performed for cosmetic reasons, the Medical Board of Australia’s cosmetic surgery guidelines apply, including a cooling-off period of at least seven days after informed consent before the surgery can be booked or a deposit paid. A GP referral is essential to see A/Prof Bish Soliman in any case.

There is more to the guidelines than the waiting period. You need a referral from an independent medical practitioner, and two pre-operative consultations at minimum, one of those face to face with the surgeon who will be operating. A validated screening tool is also used to check for psychological conditions. Under 18s are handled differently again, with independent evaluation and three months of cooling off rather than seven days. None of this applies in the same way when the surgery is medically justified, a diastasis repair that meets a Medicare item being one example. Ask at your first appointment which pathway you fall under, because your timeline depends on it.

In a traditional abdominoplasty, yes. Separated abdominal muscles, known as rectus diastasis, are brought back together and stitched. Whether that relieves symptoms varies between patients, and improvement in core strength, back pain or urinary symptoms cannot be promised in advance.

Diastasis is common after pregnancy and does not always cause symptoms. Where it does, Medicare recognises the combination of a measured separation of at least 3 cm with pain during functional use, lower back pain or urinary symptoms that have not responded to physiotherapy. Physiotherapy is generally tried first, and for some women it is enough on its own. If you are considering surgery for symptoms rather than appearance, ask what functional change is realistic in your particular case, and treat any guarantee of a specific outcome with caution.

The list is not short. Bleeding, infection, fluid collecting under the skin, wounds that break down, scars that heal poorly or spread, numbness that may be temporary or permanent, asymmetry or a result you are not happy with. Blood clots are a risk too, including deep vein thrombosis and pulmonary embolism. So are chest infection and complications of anaesthesia. Some patients need further surgery.

Abdominoplasty carries a higher complication rate than most aesthetic operations. A study of more than 25,000 cases published in Plastic and Reconstructive Surgery in 2015 reported major complications in 4 per cent, compared with 1.4 per cent for other aesthetic procedures, with haematoma, infection and venous thromboembolism the most common. Published risk factors include smoking, a body mass index of 30 or above, being aged 55 or over, and combining procedures. Stopping smoking at least six weeks before surgery is required. If you develop chest pain, breathlessness, or calf pain or swelling afterwards, seek medical help urgently rather than waiting.

Plan on about four weeks away from work, and no driving for the first fortnight or so. Heavy lifting and hard exercise are out for roughly six weeks, and you will be wearing an abdominal binder for about that long as well. Light housework and normal day to day things are usually manageable again after a week or two.

Drains are used in some cases to clear fluid that collects under the skin. You will be asked to walk short distances and do deep breathing exercises from early on, since both cut the risk of clots and chest infection. Most of the swelling and bruising settles inside a fortnight, but a few months pass before recovery is complete. Line up help at home for that first week. If you have small children, the lifting restriction makes this hard to manage on your own. The figures here are averages, so ask for the timeline that fits your own operation.

This is expected and temporary. Once the skin has been tightened, the abdomen feels tight and most patients walk slightly bent forward at first. It generally eases over the first one to two weeks as the swelling settles and the tissues relax.

You will be advised not to force yourself upright early on, since that puts tension across the closure. Walking short distances in a slightly flexed position is normal, and sleeping with your knees bent and upper body raised is usually more comfortable. Tightness and numbness across the area between the belly button and the scar are also common, can take months to improve, and occasionally some numbness persists. If tightness worsens rather than eases, or pain increases, contact the practice rather than waiting for your next appointment.

The scar runs low across the abdomen from hip to hip, positioned to sit below the bikini line where the anatomy allows. In a traditional abdominoplasty the belly button is repositioned, which leaves a second scar around it. Both scars are permanent.

Scar length depends on how much skin is removed, so a larger removal means a longer scar. Scars look at their worst in the first weeks, then flatten and fade over the months that follow, with most continuing to change for around 12 to 18 months. Keeping incisions clean, protecting new scars from the sun and following your wound care instructions all help. Ask to see the planned incision marked out before surgery, and ask where it will sit relative to the underwear and swimwear you actually wear rather than assuming.

Yes. Being at or near a stable weight for six months beforehand is advised, because further weight loss or gain afterwards can change the result. If you are planning significant weight loss, it is generally better to complete it and let your weight settle before surgery.

When your skin is still changing, judging how much to take away gets harder, and any weight you lose later can leave it loose again. Weight matters for safety too. A higher body mass index is a published risk factor for complications. If you are going through Medicare, six months of stable weight is not advice, it is a criterion you have to meet. Pregnancy afterwards stretches a muscle repair in much the same way, so bring it up at consultation if you are planning one, before anything is booked.

Most swelling settles within about two weeks, but complete recovery takes a few months and that is when the result becomes clear. The skin and fat removed do not come back, though weight change, pregnancy and ageing all continue to affect the abdomen afterwards.

Judging your result at six weeks is misleading, because swelling is still present and the abdomen usually looks fuller and feels tighter than it eventually will. A muscle repair generally holds unless it is stretched again by pregnancy or significant weight gain. Skin quality keeps changing with age regardless of surgery. Results vary considerably between patients depending on the starting point, skin quality and how much was removed, and no particular outcome can be promised.