FAQs

This issue is entirely dependent on the patient, and the location of the striae or stretch marks. If the stretch marks are entirely confined to the skin that will be resected, obviously all of the stretch marks will be gone. If there are stretch-marks present outside of the area to be excised, the stretchmarks will be stretched in the direction of their orientation. To be sure, stretching them in a direction perpendicular to their orientation will always make them worse. When stretch-marks are present in lose skin the adopt a raised appearance with color-variegation, and become very conspicuous. Stretching them along their long axis, however, generally camouflages them to a greater extent than they would be in an area of excess skin.

A mini-tummy-tuck is used in patients who have minimal upper abdominal skin excess, and a minimal to moderate amount of skin excess below the umbilicus or the belly button. It is called a “mini” abdominoplasty because dissection does not proceed above the belly button. The navel is not transposed, the horizontal extent of the incision is much less, and abdominal tightening is generally not included.

Losing weight after abdominoplasty can negate some of the effects of this body sculpting surgery. Losing adipose tissue relaxes the skin envelope in which it is contained leading to excess skin. If the weight loss is modest, less than twenty pounds as a general rule, this effect is not very pronounced. Losing more weight can produce visible skin laxity. It is best to be at a stable target weight prior to undertaking any form of body reshaping. Otherwise the results will be compromised.

Gaining weight after abdominoplasty can present a real problem. Tension is placed on the previous incision that can lead to a widened scar. The added adipose tissue can stretch the skin of the abdomen, negating the effects of tummy-tuck surgery. It is best to be at a stable target weight prior to undertaking any form of body reshaping. Otherwise the results will be compromised.

Prices range from as little as $3,500 to as high as $15,000. There are several factors that go into the price of breast enlargement surgery.

1. Geographical area is probably the most likely factor to affect the price of breast enlargement surgery. Prices tend to run lower in regions where the population is less affluent on average, where cosmetic surgery is considered less necessary, but also where competition is more prevalent.
2. Surgeon availability is another important factor in price setting. A surgeon whose schedule is entirely booked for months on end, will generally “skim the top,” in terms of patients who can afford higher prices. This does not mean there is no one out there who can do as good a job. It means that a particular surgeon knows he or she can get a certain amount of money for his or her abdominoplasty.
3. Another important part of the ultimate cost that is passed on to the patient is whether or not the plastic surgeon owns the facility at which the breast enlargement surgery is carried out. Although part of the facility fee may then go to the owning surgeon, it may be set substantially lower than a facility fee that would be paid to a third party such as a hospital or operating center when carrying out the tummy-tuck surgery.

A factor related to the facility fee is whether or not the surgeon prefers to use general anesthesia, or to employ the services of an anesthesiologist, or whether the plastic surgeon favors surgeon administered sedation with local blocks for carrying out abdominoplasty surgery. Obviously, the addition of an anesthesiologist or even a certified nurse anesthetist will add cost to a tummy-tuck. It is important to realize, however, that paying for an anesthesiologist does add a certain measure of safety, regardless of what anyone may tell you to the contrary.

There are several instances in which excision of abdominal skin is covered. Certainly there is no coverage for purely cosmetic tummy-tuck surgery. Patients who have undergone massive weight-loss and are troubled by constant recurrent skin infections and irritation under the abdominal skin flap that results (called pannus), may be covered. The concomitant presence of hernia and or abdominal wall weakness may be covered as well.

The most common complication of tummy-tuck surgery is seroma formation. This is a result of fluid accumulation as your body attempts to fill a potential space. Most seromae resolve with only a few drainage attempts, without an incision. In cases where post-abdominoplasty seromae fail to resolve, lining of the fluid pocket needs to be excised because this is what makes the fluid. Other complications include hemorrhage (bleeding), infection (superficial skin and soft tissue, or deep around the soft tissue surrounding the implant), incision dehiscence (wound coming open), loss of skin and fat due to compromised blood supply, and loss of sensation over abdominal skin (usually lower part). Major complications are much more common in patients who smoke, have poorly controlled diabetes, and have major systemic illness that interferes with healing. Apart from surgery related complications, problems related to anesthesia also need to be considered. Many times such troubles are more serious than any of the abdominoplasty related complications the most severe of which are blood clots travelling to the lung circulation (pulmonary embolism) or heart attacks (myocardial infarction). As with any patient undergoing a major surgery under general anesthesia, appropriate risk recognition and management is part of the standard pre-operative evaluation and plan.

Assuming the postoperative course is without complication; pain from tummy-tuck surgery peaks the day after surgery, and diminishes over the course of the following three to four days to be tolerable enough without the use of narcotics. Of course, pain tolerance varies significantly from patient to patient. The 72-96 hrs time frame is a “ballpark” figure, and a reflection of personal experience. Several other important factors are crucial to consider in breast enlargement surgery. Pre-incisional administration of local or dilute local (called tumescent) anesthetic greatly diminishes postoperative abdominoplasty pain. Sleeping with your back elevated and several pillows under your knees will reduce the tension on the abdominal incision and diminish your pain considerably. Apart from incisional pain, spasm of the tonic back muscles can cause a considerable amount of discomfort, muscle relaxants may be of benefit.

The ideal tummy-tuck patient is healthy, smoke-free, has attained a stable target weight, and if female, is through with planned pregnancies. He or she has excess abdominal skin in the abdominal area, and a minimal amount of excess adipose deposits.

The results of abdominoplasty surgery are less dependent on gravity, and more on maintenance of ideal weight, or in the very least the stable weight at which the abdominoplasty was performed. Gaining weight will not only add unwanted adipose tissue but also stretch out abdominal skin, in essence partially reversing the intent of the original surgery, not to mention the havoc weight gain can wreak on abdominoplasty incisions. Ideally, one tummy-tuck surgery should be all you need.

Abdominoplasty can take from two to four hours. This depends on the amount of tissue to be removed, patient size, and the possible addition of liposuction or hernia repair. Panniculectomy performed after massive weight loss generally takes longer because of the amount of skin to be removed.

The following information is given to Dr. Gerzenshtein’s patients before surgery to inform them of a typical course after abdominoplasty. Your plastic surgeon may have a different working environment and his or her patients a different experience. Consult with your physician about their impressions of patient experience. On waking from anesthesia, you will find yourself in the recovery room with dressings and/or abdominal binder in place. You will likely be able to depart once sufficiently recovered from anesthesia. A friend or family member should drive you home and stay with you for the next 2 days to help you with activities of daily living. You will need to sleep on your back with your hips flexed and a pillow or two under your knees. This will reduce the tension on your healing incision. When walking you will likely need to remain slightly bent at the trunk because of the same tension. You will feel tired and run down for the first several days after general anesthesia, this will improve substantially over the first week. Discharge should be minimal over the next 48 hours; bleeding may occur with excessive activity. If dilute local solution was used (superwet or tumescent technique) pain and discomfort will be mild initially, it will increase and peak within two days, it will then subside over the course of one to two weeks, please use pain medication as needed to help. Nausea and vomiting in the postoperative period is not uncommon and has to do with the type of anesthesia used, and overall patient sensitivity to the various medications, it generally resolves within one to two days after surgery, increasing fluid intake, especially via one of the “ade” (gatorade, powerade, etc.) solutions available for sports use, combined with anti-emetic medication should minimize this problem. Use of opiate pain medication, combined with inactivity, and dehydration may lead to constipation, increasing fluid intake will help this as well, especially in combination with walking, and the use of the prescribed stool softener. Swelling and bruising peak within three days of surgery and gradually subside over the following week. Healing incisions will adopt a pinkish hue which should gradually fade over the next six months to a year. Some patients react to absorbable (inside) suture, small pustules or whiteheads along the incision may signal this, the suture may be removed in the office if the problem becomes bothersome. Numbness may affect lower abdominal skin, this typically resolves on its own within six months.

The answer to the question depends on several factors. If you work at a desk job, in a clean environment and you feel up to it you may be ready to resume work within 1-2 weeks of your abdominoplasty. If your job requires heavy lifting, over 20 lbs, on a regular basis, or a fair amount of physical exertion, you will not be able to return to work for 4-6 weeks. Regardless of what your normal daily activities may consist of, a lot will depend on how quickly you recover from anesthesia, and the stress of surgery.

Your pain will be at its worst for the first three days after surgery and should diminish substantially after this. You should, however, get up and move about on the day after your surgery, attend to your basic needs, and cough and deep breathe as instructed. When sleeping or reclining, you should have two pillows under your knees, and your back slightly upright to reduce tension on the incision. When moving about you should be slight bent at the waist for the same reason. Presuming your drain output is minimal drains will be removed at the first post-operative visit. You should not engage in strenuous activity, heavy lifting, or straining the abdominal muscles. To maneuver out of bed you should roll sideways, for instance. You may shower 48 hours after the procedure. DO NOT bathe or submerge in water. Pat abdominal incision area dry, DO NOT rub. You should be able to get back to normal activities of daily living without much discomfort by 9-14 days. If your job does not involve much physical labor you may be fit to return within the same time frame. Heavier lifting and strenuous exercise should not be undertaken for at least one month after this surgery.

Preoperative markings are made just before going back to the operating room. Based on patient preference, the final incision may be planned such that either a V-shaped or a more straight-cut bikini would adequately cover it. With the patient under general anesthesia, the skin and fat is raised away from the covering of the abdominal musculature to the level of the belly button or umbilicus is. A cut is made around the navel, and it is dissected from the surrounding skin and left on a stalk. The abdominal skin flap is the dissected superiorly to the level of the xiphoid bone, the lowest portion of the chest plate. The lower edge of the incision is pulled down and the excess skin and its underlying fat are removed. The edges of the rectus abdominis; the six pack muscle, may be tightened by sewing them together. The deeper layer separating the deep from superficial abdominal fat compartments is closed. Drains are placed under the skin/fat flap; following this the deep and then the superficial layers of the skin are closed. A new opening is made for the navel; the belly-button is then brought through this aperture and sutured in place. To reduce tension on the incision and keep it from spreading, the incisions are covered with Steri-strips™. A binder may be placed for support.