Tummy Tuck Orange County Abdominoplasty Tummy Tuck
A flat and tight abdominal wall is something most men and women strive for but cannot always achieve through diet and exercise alone! This loss of abdominal elasticity occurs most commonly following weight loss or pregnancy. The following information has been prepared to familiarize you with facts about the surgical procedure known as abdominoplasty ("tummy tuck") or abdominal fascial repair. You are requested to read this information thoroughly and to discuss any questions which might arise with your surgeon before you give your consent to proceed with this procedure. You are also requested to keep this form as a reference in the postoperative period.
TUMMY TUCK INTRODUCTION
An abdominoplasty is an operation in which excess skin and fat from the abdominal wall, particularly below the navel, is removed and the remaining skin tightened. This is accomplished by elevation of the skin and fat, tightening the underlying muscles if necessary, pulling the excess skin downward, and excising the excess. It is particularly effective in removing stretch marks from the lower abdomen, but it must be understood that not all stretch marks can be eliminated, and that some laxity, particularly noticeable when flexing the hips, will persist. The same navel is reinserted into the skin after the tightening procedure.
Frequently, particularly after childbirth or weight loss, patients present with a weakness of the abdominal wall muscles; in such cases, the defect between the anterior muscles is repaired (“fascial repair”) before trimming the excess skin and fat. This procedure can be combined with other abdominal or non-abdominal operations such as liposuction, microfat grafting, facelifts, breast enhancement or other procedures. Combining a tummy tuck with breast enhancement is frequently referred to as a “Mommy Makeover”, a popular option at Orange County Plastic Surgery!
The operation is directed toward an improvement and does not in any way guarantee complete obliteration of all folds and stretch marks. You must accept the judgment of your plastic surgeon and realize that he/she will remove as much as is safe and suitable. Particularly in patients with thicker abdominal walls or marked skin excess, it may be desirable to return for a secondary liposuction of the abdominal wall or an additional skin excision to obtain an optimal result. Should this prove desirable, the patient will be responsible for all costs associated with all secondary surgical procedures.
The type of skin, degree of elasticity and age of the patient all influence the overall result that is obtained. The operation should not be undertaken if the patient intends pregnancies in the near future. Should a patient become pregnant after an abdominoplasty, a normal pregnancy will ensue but the abdominal wall will again get stretched. While it is not necessary for the patient to reach a certain weight before surgery may be performed, it is desirable that the patient's weight be stable for at least six months prior to surgery and that the patient be at a weight he/she feels can be maintained after the procedure.
A common question is, "How long will the results of this procedure last?" This is impossible to state. Factors affecting the length of the improvement include physical conditioning afterwards, type of skin, and alterations in weight. In general, it is not necessary to repeat this procedure to maintain the optimal result. It should be noted that this procedure removes the skin and fatty excess that a patient has at the time of the abdominoplasty but does not prevent a patient from gaining weight and stretching the abdominal wall again in the future. Should a patient wish to repeat the operation, regardless of the length of time since the initial operation, the degree of laxity or fatty excess remaining, each patient will be responsible for the cost of a subsequent procedure.
TUMMY TUCK PREOPERATIVE PREPARATION
You may visit your surgeon as many times as you wish, to have all of your questions answered. At your preoperative visit (which takes an hour or more), your final questions will be answered and you will confirm that you understand the procedure to be performed, that this material has been explained to you, that you have read and understand these information sheets, and that you accept the risks by signing the informed consent forms. You will be given prescriptions for surgical soap that will be used before surgery, as well as for pain pills and antibiotics, along with instructions for their use. Certain laboratory tests will also be required within two weeks of surgery.
If you are over the age of 50 or have had any cardiac problems, you will have to obtain a cardiogram at your doctor’s office or any licensed laboratory. You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor’s office or other laboratory (e.g. Kaiser Hospital, etc.). Smoking constricts blood vessels and hinders normal healing - all smokers will be asked to stop smoking three months prior to surgery in an effort to maximize your body’s ability to heal the incisions following the operation.
It will be necessary to scrub the chest, abdomen, groin, flank regions, and thighs for ten minutes the evening prior to surgery and a final time the morning of surgery before leaving home. Washing the surgical site these two times with Hibiclens® soap will lower the possibility of an infection occurring after surgery. All ibuprofen (Advil®) and Aspirin® products are to be avoided 2 weeks.
Your anesthesiologist may call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Surgery Center, prior to your procedure. You must make arrangements to have someone drive you to and from the Surgery Center (Orange County Surgery Center in Newport Beach, Orange County or the Tracy Surgery Center in Northern California) and stay with you at home for the first two or three days afterwards. Arrangements can also be made to have a registered nurse care for you for the first night or two as well, either at your home or at a local hotel.
TUMMY TUCK OPERATION
The operation will be performed in an outpatient facility under very deep sedation or light general anesthesia, supplemented by local anesthetics. An incision is made across the lower end of the abdomen, and the skin and fat of the abdominal wall are elevated to the rib margins.
The navel remains attached to the abdominal wall, but is released from the surrounding skin and fat through a diamond shaped incision around the navel. The abdominal muscles are tightened by suturing them together in the midline. These internal sutures are permanent but all of the remaining sutures used for the skin closure are absorbable. The excess skin and fat from the lower abdomen are trimmed.
On occasion, it may be appropriate to suction some of the excess fat that can not be resected, but there is a limit to how much can be removed without jeopardizing the viability of the skin flaps. A new opening is created in the skin of the abdominal wall to reinsert the navel.
Drains and pain pump catheters are inserted prior to suturing the wound closed. The pain pump catheters are connected to a reservoir that contains local anesthetic solution that will automatically infuse into the surgical site for the first three days or so to minimize your discomfort.
The pain pump catheters are optional (strongly recommended) but all patients will have drainage tubes inserted. The drains remove excess blood and serous fluid and will be removed after the drainage has decreased to less than 25-30 cc. (about an ounce) of fluid per day. This usually takes about a week to ten days but can take up to a month.
TUMMY TUCK POST-OPERATIVE CARE
Adequate pain medication will also be prescribed. All patients, who go home on the day of surgery, will find that an assistant at home is a necessity for the first three days or so. This can be a family member or a trained nurse. High bulk foods are highly encouraged and laxatives may be necessary to prevent straining associated with constipation. Patients will be encouraged to walk as much as possible at home after surgery as this will reduce the possibility of pneumonia or of clots forming in your calf veins. It will be necessary to keep the hips gently flexed for the first week to minimize discomfort and to prevent excess tension on the suture lines. Each patient is allowed to stand up straight when comfortable doing so. Patients will be allowed to shower after the drains have been removed, but soaking in a bathtub is to be avoided for two weeks. Wounds are generally closed with absorbable buried sutures.
The incisions are covered with Dermabond, a surgical glue, which will wash/peel off spontaneously over a few weeks. It is recommended that patients begin applying MD Performance® Ultimate Scar Formula once the glue peels off to the incisions to optimize healing. The Ultimate Scar Formula should be applied twice daily as directed until the scar has finished healing (scar should turn flat, soft and without a trace of pink or purple left). The skin may itch after any surgical procedure. After the first week, the skin can be moisturized with the MD Performance® Avocado CoQ-10 Body Balm – this will relieve the dryness and itchiness and help any crusts fall off the suture lines quicker.
Your first post-operative visit will generally be scheduled two to four days after surgery at which time the pain pump catheters will be removed. The drainage tubes will be removed at a subsequent visit. You should continue taking antibiotics as long as the drainage tubes are in place. You will be required to have someone drive you to the office for your first and second visits. Most patients find that they can gradually increase their activity levels thereafter. You may drive a car with caution, wearing a safety belt, beginning 48 hours after your last pain pill or sedative, if you feel comfortable and physically able to do so.
TUMMY TUCK POSSIBLE COMPLICATIONS
Serious complications after an abdominoplasty are relatively uncommon. However, there will be a long scar (usually, but not always, within the bathing suit line) extending from hip to hip. The scar may remain itchy, painful, thick, or otherwise unsightly. It is unusual, but possible, for areas of fat to liquefy and drain through the incision for many months, or to cause a tender mass to develop beneath the skin, which may require excision at a later date. As with any abdominal procedure, it is also possible for a suture to become infected and to erode through the skin years later.
One of the most common problems after an abdominoplasty is a persistent collection of serous fluid under your skin flap after the drains have been removed. Should this occur, this fluid will be aspirated with a needle during your post-operative visits. Such drainage always stops eventually (but may persist for more than a month) and usually does not affect the final results. If wound problems develop, it may take several weeks or even months for healing to take place and the patient will be required to wear dressings over the open wound. Because of the extensive skin and fat undermining, areas of skin may die and slough, or even require surgical debridement or a skin graft. Rarely, phlebitis may develop in leg veins and even more rarely, blood clots could travel to the lungs, potentially leading to a fatal complication.
Perfect symmetry does not exist before or after abdominoplasty surgery. Scars will never be identical from side to side and the umbilicus will not be exactly midline.
Secondary procedures may occasionally be desirable to revise scars, to excise more skin, or to thin the abdominal layer above the scar (usually with liposuction). The patient will be responsible for all costs associated with secondary surgical procedures.
It is not possible to list every conceivable complication. As with any operation, there could be potential complications, which could even be fatal. The foregoing is not intended to frighten or upset you but to enable you to make your decision with an understanding of some of the involved risks.
The surgical scars are permanent; however, the incisions are placed so that they are barely discernable on normal visual observation, barring complications, which may result in thick and/or painful, disfiguring scars. If this problem occurs, treatment by excision or steroid injections may be indicated, but it may be impossible to improve an unsightly scar.
It is recommended that patients begin applying MD Performance® Ultimate Scar Formula to the incision about two weeks after surgery. The Ultimate Scar Formula should be applied twice daily until the scar has finished healing and no longer contains any hint of pink or purple.
Social activity should be limited while the patient is uncomfortable. A good general rule of thumb is that patients should avoid any physical activity that causes discomfort.
There is no set time table for resuming strenuous activity – just avoid activities that cause discomfort – but as a general rule of thumb for most patients, it takes approximately six weeks for the muscle repair to heal to a point where strenuous activity does not cause discomfort. Basically, most patients find that they can return to normal activity as the discomfort of the operation fades away.
Office work can usually be resumed within 1-2 weeks of surgery, but the patient should expect a six-week delay before returning to physical labor or strenuous exercise. It will take longer than a year for scars to fade and the abdomen to feel relatively normal. The lower abdominal skin may feel numb forever and completely normal feeling is not to be expected.
If a significant spreading of the anterior muscles or a hernia is present, your insurance company may, rarely, reimburse you for a portion of the Surgery Center bill and of the professional fees. In some instances, it may be possible to verify the amount covered by your insurance carrier in advance; the office staff can assist you in making this determination, but cannot guarantee a level of payment. The office staff will provide you with the necessary information to submit to your insurance carrier. All fees are due prior to the surgical procedure and, if any portion of your procedure will be covered by your carrier, you will be reimbursed directly by your insurance company. Payment of all fees, however, is the patient's responsibility; all fees are due prior to surgery and the proceeds of the insurance check will go to you when the check arrives (minus a 6% billing fee if you chose to use our billing service).
If requested, the office staff will assist you with forms, but recovery of any insurance benefits is between you and your insurance company. Insurance companies never pay for the entire fee and never pay for operations which are solely designed to improve your appearance. Insurance carriers rarely pay for the muscle repair portion or hernia repair even though these may be considered corrective surgery; they will not pay for the skin tightening or other purely cosmetic portions of the procedure. All fees will be discussed freely in advance by the office staff. Financing may be arranged if desired. If desired, the office staff can also help you arrange financing for your procedure.
In compliance with suggestions adopted by the American Society of Plastic Surgeons®, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in his/her motivation and can afford the surgery, thus creating a better patient/physician relationship. A non-refundable deposit will be required to secure your desired surgery date when booking your procedure. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but never later than two weeks before surgery. Additional fees are also required for laboratory tests, surgical facility fees and the anesthesiologist. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete.
It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.