Abdominoplasty with Liposuction
Changes to the skin and muscles in the belly can happen due to aging, pregnancy, or a large amount of weight loss. Cosmetic surgery can help restore the belly skin and muscles to their natural shape and position. Abdominoplasty (also called a “tummy tuck”) and liposuction are two cosmetic procedures. They can be done together to improve the look of your waist and belly. During a tummy tuck, excess fat and skin can be removed from your belly. And certain muscles can be repositioned to improve belly weakness. Liposuction removes excess fat from under the skin. It allows for greater fat removal and contouring (shaping) than can be done with a tummy tuck alone.
Be aware that, for lasting results, you will have to control your weight. And for some areas of the body, these procedures can’t be combined. Talk to your healthcare provider about your cosmetic goals and the options available to you.
Preparing for surgery
Prepare for the surgery as you have been told. In addition:
Tell your healthcare provider about all medicines you take. This includes herbs and other supplements and any illegal or illicit drugs. It also includes any blood thinners, such as warfarin, clopidogrel, or daily aspirin. You may need to stop taking some or all of them before surgery.
Don't eat or drink during the 8 hours before your surgery, or as directed by your surgeon. This includes coffee, water, gum, and mints. (If you have been instructed to take medicines, take them with a small sip of water.)
The day of surgery
The surgery takes about 2 to 4 hours. You may go home the same day. Or you may stay overnight.
Before the surgery begins
An IV line is put into a vein in your arm or hand. This line delivers fluids and medicines.
You will be given medicine to keep you pain free during surgery. This may be general anesthesia, which puts you into a state like deep sleep. (A tube may be inserted into your throat to help you breathe.) Or you may have sedation, which makes you relaxed and sleepy. If you have sedation, local anesthetic will be injected to numb the areas being worked on. The anesthesiologist will discuss your options with you.
Fluid is injected into the belly so that it is firm and swollen. This makes it easier to remove fat. The fluid also contains medicine to numb the belly and to reduce pain and bleeding caused by the surgery.
One or more tiny incisions are made in the lower belly. Or they are made near the bellybutton (navel). You and your healthcare provider will discuss the incisions to be used before the surgery.
A thin metal tube called a cannula is placed through the incisions to reach the fat layer under the skin. The cannula is attached to a small vacuum or syringe. As the cannula is moved back and forth, it suctions excess fat from the belly and waist. Other tools may be used as well. These use ultrasound, laser, or mechanical power to help loosen or remove fat.
Incisions are closed with stitches, surgical glue, or both.
For the tummy tuck
An incision is made in the belly from hipbone to hipbone. This is often along the lower part of the belly just above the pubic hairline. You and your healthcare provider will choose the exact incision site before surgery. An incision is also made around the bellybutton.
The skin and fat beneath are lifted to expose the abdominal wall beneath. The abdominal wall includes fibrous tissue and muscles.
If needed, the belly muscles are pulled together to tighten the abdominal wall. Stitches are used down the middle of the belly, to hold the muscles in their new position.
After the abdominal wall is tightened, the skin and fat are pulled back down. Excess fat and skin are then removed from the belly.
Once the skin and fat are pulled down, the bellybutton may be covered up. In such cases, an incision is made so the bellybutton can be seen. The skin is then sewn into place around the bellybutton.
Small tubes (drains) may be placed near the incisions. These drain excess fluid that may build up as the wound heals.
Any incisions made during the surgery are closed with stitches, surgical glue, or both. If stitches are used, they may dissolve on their own. Or they may need to be removed by the healthcare provider at a later date.
After the surgery
You will be taken to a recovery room to wake up from the anesthesia. You may feel sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. You will be given medicine to help prevent infection and manage pain. You will also likely be given compression garments to wear. These reduce swelling and help form a smooth shape. If you need to stay overnight, you will be moved to another room. Once you are ready to go home, you will be released to an adult family member or friend. Have someone stay with you for the next couple of days to help care for you as your healing begins.
Recovering at home
Once home, follow any instructions you are given. Your healthcare provider will tell you when you can return to your normal routine. During your recovery:
Take any prescribed medicines exactly as directed.
Walk slightly bent at the waist, if suggested by your healthcare provider. Stay in a flexed position when you sleep. This helps protect the abdominal wall as it heals.
Care for your incisions and the dressing (bandage) over them as instructed by your healthcare provider.
Don’t shower for 72 hours after surgery, or as instructed by your healthcare provider. Don't swim, take a bath, use a hot tub, or do other activities that cause the incisions to be covered with water until your healthcare provider says it’s OK.
If advised by your healthcare provider, use a cold pack wrapped in a thin towel to relieve discomfort and control swelling. It’s important not to leave the cold pack on for too long, or your skin could be damaged. Put the pack over your bandages for no more than 20 minutes at a time. Then, leave it off for at least 20 minutes. Repeat this as often as needed during waking hours until swelling starts to improve. Don’t fall asleep with the cold pack on. If you’re not sure how to safely use the cold pack, ask your healthcare provider.
When you shower, gently wash your incision sites. Then pat the incisions dry. Don’t apply lotions, oils, or creams to the incisions until after they are fully healed.
Don’t lift, push, or pull anything heavier than 10 pounds for at least 14 days.
Avoid strenuous activity and exercise as directed. Talk to your healthcare provider about light exercise, such as walking, that you can do to maintain your weight until you’re fully healed.
Wear compression garments as directed. Doing so is important for a good cosmetic result.
Walk at least a few times daily. But don’t push yourself too hard.
Don’t drive until you are no longer taking prescription pain medicine and your healthcare provider says it’s OK. When riding in a car, carefully position the seatbelt so that it doesn’t compress your belly.
When to call your healthcare provider
Call your healthcare provider right away if you have any of the following:
Extreme chest pain or trouble breathing (call 911)
Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
Symptoms of infection at an incision site such as increased redness or swelling, warmth, worsening pain, or foul-smelling drainage
Pain not relieved by medicines
Not urinating within 24 hours
Pain, swelling, redness, or warmth in your leg, calf, or thigh
You will have follow-up visits so your healthcare provider can see how well you’re healing. If needed, stitches or drains will be removed at one of these visits. During these visits, you and your healthcare provider can discuss the results of your surgery. Let your healthcare provider know if you have any questions or concerns.
Risks and complications
Risks and cossible complications include:
Bleeding or infection
Poor wound healing
Changes in sensation, such as numbness or pain
Abnormal collection of fluid (seroma)
Death of fat cells deep in the skin (fat necrosis)
Injury to nearby nerves, blood vessels, muscles, and organs
Contour (body shape) irregularities
Not happy with cosmetic results
Risks of anesthesia. The anesthesiologist will discuss these with you.
November 07, 2017
Rectus abdominis diastasis. UpToDate
Fraser, Marianne, MSN, RN,Lickstein, David, MD