Tummy Tuck After Bariatric Surgery
Bariatric surgery is performed for weight loss purposes. Plastic surgery is performed to correct the aesthetic imperfections that can occur after massive weight loss. One of the most common side effects of bariatric surgery is excess skin on the abdominal area. Once the excess weight is lost, the abdomen that was stretched can’t retract on the new contours and is left sagging over the suprapubic or pubic area. The aspect looks like wearing an apron made out of skin and fat tissue. This side effect of bariatric surgery can be very disappointing for the patient who went through pain and discomfort to lose weight only to notice that the body hasn’t significantly improved its aesthetics. The tummy tuck surgery is performed to correct this abdominal apron and leave the patient with firm and flat abdomen.
Who can benefit from the tummy tuck procedure
The abdominoplasty is the most commonly performed aesthetic repair procedure. It is required by patients who undergo a massive weight loss, usually the result of a bariatric procedure or after multiple pregnancies. You need a tummy tuck if:
– You have skin sagginess in the abdominal area
– The abdomen stretches as low as to cover some or all of the pubic area
– The skin under the belly apron is affected by dermatological conditions due to the lack of proper oxygenation in the area
– You are having difficulties in finding clothes that will fit you well and not show off the abdominal apron.
How is the tummy tuck performed?
Clinical examination is essential during the preoperative consultation to assess skin condition, fat deposits and test your muscles to detect muscle weakness and possible abdominal wall hernia.
Diastasis of large abdominal muscles is common after pregnancies with babies with a high birth weight. This condition is defined by a gap between the two vertical muscles lying on either side of the abdominal midline. A umbilical hernia may be associated with diastasis. If you are suffering from any or both of these conditions, it can be difficult, if not impossible, to get a firm tummy.
For patients still confronted with a significant thickness of the fat tissue in the abdominal area (which is often the case after bariatric surgery), the plastic surgeon might decide to use liposuction during the abdominoplasty procedure to reduce the adipose layer. When this is the case, liposuction is first performed to remove unwanted fat deposits, and then the muscles of the abdominal wall are strengthened with sutures, the umbilical hernia is corrected, and the skin excision is performed.
The intervention requires a long scar that can go from hip to hip and is localized in the supra pubic area. The plastic surgeon will detach and pull the skin and fat tissue from the abdomen up towards the ribs. The skin is then pulled down, the excision is performed, and the belly button is repositioned. This means that if you have stretch marks on the skin that is sagging over the pubic area, chances are they will be removed at the same time with the excess skin. But if you have stretch marks on the upper part of the abdomen, they will remain and might be positioned lower after the re-draping of the skin following the surgical excision.
Types of abdominoplasty
Different patients have different needs, hence not all tummy tucks are performed the same. In the case of an absence of an abdominal apron covering the pubis, the procedure is called a mini tummy tuck. Most of the time, the procedure involves localized liposuction and the removal of a small quantity of skin tissue. The procedure is performed on patients with poor skin quality that would not have achieved impressive results just with liposuction alone. The mini tummy tuck leaves behind a small scar in the supra pubic area.
The extended tummy tuck is performed for patients who were obese or severely overweight and after massive weight loss are left with sagging skin on the sides of the midline as well. Multiple incisions need to be performed to correct this issue, and it has a longer recovery period. However, the results are satisfactory for a vast majority of patients and also stunning in terms of aesthetic accomplishments.
The procedures can take from one to four hours to be performed, depending on the type of tummy tuck and the anatomy of the patient. Hospitalization can be required for one or two days after the procedure, especially when a considerable amount of tissue was removed.
What to do before a tummy tuck
– Avoiding smoking for as long as possible before and after the procedure is essential, especially because we are talking about long incisions that can be severely affected by the loss of proper oxygenation. The patient is advised to not smoke a month before and after the procedure to allow for a fast and smooth recovery period.
– Oral contraceptives need to be avoided to reduce thromboembolic risks. Your plastic surgeon will tell you to stop taking your birth control pills a month before the intervention. You can resume taking your treatment the month following the procedure.
– Compression stockings should be worn starting the day of the surgery and for the three weeks following the procedure to avoid phlebitis.
– Because dermatological conditions are frequent on the fold created by the sagging skin over the pubic area, make sure to treat any infections or dermatitis before the date of the tummy tuck.
– As the procedure is performed with the patient under general anesthesia, a period of fasting of at least eight hours is necessary.
– A consultation with the anesthetist should be scheduled no longer than 48 hours before the procedure.
– Keep a balanced eating regimen before the procedure. Undergoing bariatric surgery and then a plastic surgery intervention is not a guarantee that you will never gain weight again. Weight fluctuations can significantly alter the results of your tummy tuck and create the need for additional interventions.
Important things to know about the tummy tuck
Abdominoplasty is a complex and major plastic surgery intervention. This means that it requires a great level of preparation and post-operative care to ensure you have satisfactory results. Choosing a board-certified, highly experienced plastic surgeon will considerably increase your chances of getting impressive results and avoiding complications. There are certain risks and complications that can occur following a tummy tuck procedure, such as:
– Blood or fluid accumulation at the surgical site. Drain tubes will be attached to avoid these from happening. Even if they occur, in a vast majority of cases they are small enough not to require any treatment. For larger seromas or hematomas, surgical treatment might be in order. Your plastic surgeon will give you all the details.
– Infections. Keeping a strict hygiene, not smoking and taking care of the surgical wounds according to your plastic surgeon’s advice can keep the infections at bay. To prevent infections, antibiotics will be given during surgery and prescribed to be taken for another five to seven days after the intervention.
– Skin necrosis is rare and occurs in limited areas. It is most often observed in smokers.
Follow-up after the tummy tuck
Compressive garments should be worn non-stop for at least two to three weeks and only during the day for another month. Injectable anticoagulants might be prescribed for a week or more.
Housework and the lifting or carrying heavy weights (including carrying babies or toddlers) are prohibited during the recovery period as the sutures might open. A good family organization on the return home is therefore essential. You will need someone to help you with the daily chores around the house, especially if you are the main caretaker of a family with children. Driving is to be avoided for at least a week or two, so make sure you have someone to drive you home from the clinic or to your appointments with the plastic surgeon.
The plastic surgeon will probably schedule follow-up consultations during the first week postoperatively, then after a month, three months, six months and a year. In the rare case that a complication occurs, get in touch with your plastic surgeon as soon as possible as he can indicate a treatment.
The result of the intervention is visible immediately. The abdominal apron is removed, and your abdomen will be flatter and firmer. However, with the swelling and bruising that naturally occur after any type of plastic surgery intervention, it can take up to six months before you can evaluate the final results.
The tummy tuck is the most frequently performed plastic surgery intervention after bariatric surgery as it corrects a common side effect of bariatric surgery – the abdominal apron, which is the sagging skin that covers all or part of the pubic area. The procedure will also correct muscle diastasis and umbilical hernias, leaving you with a firm and flat tummy.