Tummy Tuck (Thousand Oaks)
A tummy tuck, or abdominoplasty, is a surgical procedure for removing extra skin and fat in the abdomen. It can be combined with liposuction for contouring the hips, waist, and upper abdomen. A tummy tuck also involves tightening the rectus (“six-pack”) muscles that are often stretched out and bulging in women who have been pregnant. Our surgeons have published scientific papers aboutabdominoplasty (tummy tuck) and liposuction and are well-versed in all the newest techniques and advances.
Before & After Photos
46 year old mom from West Hills
She had previous abdominal surgery and requested cosmetic improvement of the contour and the scars on her abdomen. She underwent a full abdominoplasty with modification of her scars.
The underlying muscle and tissue is stitched together which narrows the waistline and strengthens the abdominal wall.
The final scar can be mostly hidden in the panty-line and also goes around the belly-button.
Who is a good candidate for a tummy tuck?
Women or men who have extra abdominal skin but who are not excessively overweight are the best candidates. Women who have been pregnant and do not plan on having any more pregnancies are good candidates. Women who have never been pregnant and men may only need a “mini” tummy-tuck in which skin is removed but the muscles are not tightened. Ask your surgeon which procedure is best-suited for you. Other good candidates include massive weight loss patients (such as after gastric bypass), whose weight has been stable for over six months and are at their goal weight. Smokers must quit for 6 weeks before and 6 weeks after the surgery. If they do not quit smoking, there are significantly increased risks associated with the surgery.
Does insurance cover tummy tuck surgery?
Because most insurance companies do not consider a tummy tuck to be medically necessary, carriers generally do not cover the cost of this procedure. It is important that you discuss all the costs and fees during your consultation. If the tummy tuck is performed in conjunction with another procedure (e.g. a hysterectomy or hernia repair), it is possible to have part of the operating room and anesthesia fees covered by your insurance carrier. Our surgeons have published a scientific paper that addresses the issues involved in combining a tummy tuck with other procedures.
Preparing for surgery
Tell your surgeon about any medical problems you have, and any problems you may have had with surgery in the past. Most importantly, tell your doctor if you have had any hernias or any abdominal surgery in the past. Inform him what medications you take-both prescription and non-prescription (including herbs and dietary supplements). You will be told which medications to stop and which to take before surgery. Aspirin and anti-inflammatory medications such ibuprofen and Alleve must be stopped for 7 days before surgery.
The night before surgery you should shower and wash your pubic area with antibacterial soap. Since the incision from a tummy tuck will end up very close to the pubic hair, you may want to shave the area before surgery. Finally, you must strictly follow the instructions about when to start fasting before surgery (usually at midnight). If you get sick or have any health issues in the days before surgery, please notify the office at once in case we have to postpone your operation.
The surgery and the incisions
The operation itself takes 2-3 hours depending on how much liposuction is done in conjunction with the tummy tuck. The morning of surgery, your surgeon will answer any last minute questions you may have. He will mark the incisions on your abdomen. In most cases, the incision can be hidden in the panty-line. The length of the incision depends on how much extra skin has to be removed. It usually spans from one hip bone to the other. You will also have an incision around your belly-button, however this incision is also well hidden once it heals.
A tummy tuck can be performed under “twilight” anesthesia or general anesthesia. Twilight anesthesia consists of intravenous sedation and pain medication that keeps you relaxed and sleepy during the surgery. In addition, the surgeon uses local anesthesia to numb the abdomen. General anesthesia involves going completely to sleep with a breathing tube in your throat. There is a slightly higher risk of nausea and vomiting after general anesthesia, however both techniques are extremely safe. Your surgeon will discuss the anesthetic options with you before surgery.
What kind of dressings and drains are there?
You can remove the gauze dressings the day after surgery. It is normal for a small amount of fluid to leak from the incisions for the first few days, especially if you have had liposuction. This fluid looks like “Cool-aid” or fruit-punch and is part of the normal healing process. If you have leaking fluid that persists more than 48 hours after surgery, call the office. If there is tape or adhesive strips directly on your incision, do not remove these. If they fall off in the shower there is no need for concern.
Tummy tuck surgery requires that you have one or two drains after surgery. These help drain the fluid that is produced under your skin as part of the healing process. Without drains, this fluid can accumulate, termed a seroma. In some cases, a single drain may be sufficient, and in rare instances no drains are needed at all. They stay in until the drainage is less than 25 ml per drain in a twenty four hour period. This usually takes 5-7 days, but can be shorter or longer in some cases. The drains are easy to take care of, and do not hurt to take out.
Can you go home the day of surgery?
A tummy tuck can be done safely as an outpatient, and most patients will be able to go home the same day. In some cases, your surgeon may recommend that you spend a night in the hospital after surgery. Also, some patients may prefer to spend a night or two in the hospital if they have young children at home or live alone and do not have any help at home.
How much pain is there after surgery?
Pain from tummy tuck surgery is highly variable, and ranges from minimal to severe. It is worst in the first few days after surgery, but then it rapidly improves. It is impossible to predict a person’s expected pain. If you have done well with surgery in the past, you will likely be fine after this surgery. Our surgeons have a lot of experience treating pain, and have published scientific articles and written book chapters about anesthetics and pain control. They will do everything possible to minimize your pain, including using pain pumps after surgery and utilizing all the newest pain medication. By the end of the first week, most people’s pain is controlled with plain Tylenol or Motrin.
What about swelling and bruising?
Swelling and bruising are normal signs of the healing process. They occur after any surgery to varying degrees. Swelling peaks at about 48 hours, and then rapidly decreases. By the end of the first few weeks, 50% of the swelling is gone. By 6-8 weeks, a majority of the swelling has diminished. By six months, almost all the swelling is gone. Any remaining swelling is almost not perceptible. Bruising is worst the day after surgery and then rapidly gets better. It is usually gone by two weeks.
What restrictions are there?
You can shower the day after surgery, but you should not take a bath, use a hot-tub, or go swimming for at least two weeks. The first two days after surgery are usually spent lying in bed or sitting in a chair. Most patients then begin walking around the house. Climbing stairs is difficult in the first few days after surgery, but becomes more manageable within days. By the end of the first week, you will probably be ready to leave the house for short trips and light walks. More vigorous walking and mild stretching exercises can be resumed about two weeks after surgery. Strenuous activities such jogging, aerobics, weight-training, sit-ups, and sex should not be done until 6 weeks after surgery. Also, you shouldn’t do any heavy lifting (over 10 pounds) during these 6 weeks.
When can I travel?
Traveling after surgery (air travel, long distance car trips, train rides, etc) should not be done before the drains are removed and you have had your first postoperative visit. Typically, this occurs 5-7 days after surgery. Patients who are at high risk for developing a blood clot should not travel until instructed by their surgeon. Short car trips under 60 minutes can be done before the first visit. A good rule of thumb is when you are off the stronger pain medication and can get up without assistance you are ready to go for a short drive. You should not drive the car yourself, however, until your surgeon gives you clearance for this.
When can I go back to work?
This, of course, depends on the kind of work you do. Most people go back to work after two weeks. Sedentary jobs, such as computer work or talking on the phone can begin even sooner. If you have a strenuous job that involves a lot of lifting or physical activity, you may have to wait 6 weeks until you are ready for work. Please review the restrictions for further guidelines about getting back to work.
What kind of scars can I expect?
Scarring is an unpredictable part of any surgery. It is impossible to cut through the full thickness of the skin and not have a scar. Our surgeons have published numerous scientific papers about the scarring process and wound healing, and will do everything possible to minimize scarring. To a large extent, however, scarring is determined by your genetics. If you are prone to hypertrophic (wide, raised) scars or keloids, make sure to inform your surgeon ahead of time. Our surgeons will use all the available techniques to minimize your scars based on their extensive research experience on hypertrophic scarring.
Your scars will be firm and pink for at least six weeks. After six weeks, scars are very strong and can withstand any activity. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely. It takes 1-2 years for a scar to completely heal. Make sure to apply sunscreen containing zinc-oxide to your scars for six months so that they do not darken due to increased pigmentation.
What if I have a problem? When should I call the office?
The Kryger Institute welcomes calls from patients. If you have any concerns at any time, please feel free to call our office. If it is an emergency, the answering service is available 24 hours a day, including weekends and holidays. There is always a plastic surgeon on call. Your surgeon will discuss all the risks and potential complications with you before surgery. You will receive detailed instructions about situations that warrant a call to the office.