| Dr. Juris Bunkis is a plastic surgeon and has answered some of the common questions bizymoms visitors have about Tummy Tuck.
Q. What is a tummy tuck?
A. A tummy tuck tightens abdominal tissue that results from weight loss, including after a pregnancy.
Q. What are the benefits of a tummy tuck?
A. 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.
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.
Q. Who is an ideal candidate for a tummy tuck?
A. 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.
Q. How is a tummy tuck performed?
A. 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.
Q. Are there risks and complications in a tummy tuck procedure?
A. There are risks with EVERY procedure, every car ride, every time you eat, or go to a ball game. The trick is to keep the risks manageable and to do everything right to minimize the possibility of untoward events.
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 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.
Q. How much does a tummy tuck cost?
A. 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. Insurance carriers sometimes (rarely) pay for the muscle repair portion as this may be considered corrective surgery; they will not pay for the skin tightening or other purely cosmetic portions of the procedure. 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 ensures that the patient is sincere in his or 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 one week 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.
Q. How long do the results of a tummy tuck last?
A. 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. |
