< Back

Abdominoplasty (Tummy Tuck)

Not infrequently, following pregnancy in women, and after weight loss in both men and women, excess skin and fat carried on the abdomen causes consternation and embarrassment. The skin may also show conspicuous stretch marks which can be unsightly. This excess skin and fat is often unresponsive to dieting and exercise, which can be very frustrating.

The procedure known as abdominoplasty is an operation to recontour the abdominal wall, when the problem is one not just of excess fat, but also one of excess skin and frequently also of a bulging muscle wall. Unlike liposuction, which only involves very small incisions to remove fatty tissue only, the abdominoplasty, by its very nature, necessitates a lengthy scar to remove redundant skin. This scar is placed very low on the abdomen (below the customary underwear line), so that it is as inconspicuous as possible. In this way, the looseness of the skin can be corrected, and one is again able to wear clothing which exposes the abdomen without fear of revealing the surgical scar.

The Consultation

Patients seeking consultation for abdominal recontouring should plan to meet with Dr. Lemke for approximately 30 minutes for a comprehensive evaluation. First, the doctor takes a medical history. It is important to inform him of any medical conditions such as bleeding disorders, heart disease, hypertension, diabetes, asthma, hernias, or a history of smoking. . One should know that this is not an operation for obesity. Thus, any patient more than 50% over their ideal body weight should consult with a weight loss specialist prior to considering body contouring surgery. It is also important for women to know that they should only consider this procedure if they have no future plans for pregnancy. Pregnancy stretches the muscle wall of the abdomen, and often leads to weight gain. One would not want to go through with the procedure of abdominoplasty only to then stretch out the muscle and skin with pregnancy. Patients who have scars from previous surgery may not be candidates for this operation, because of the risk of surgical complications due to alterations in the blood supply to the skin. This can be determined at the time of the consultation with Dr. Lemke.

Following this, an examination of your abdomen is carried out by the doctor. Usually, computer images are then obtained of your abdomen, after which the doctor can demonstrate for you what he would anticipate as a likely result with the procedure. There are also photo albums of representative examples in the office for you to peruse. Some of these photos can also be viewed on this website, in Dr. Lemke’s PhotoGallery.

Before Your Procedure

Two weeks prior to your operation, you will need to discontinue medications which can lead to surgical complications. You will meet with Dr. Lemke and his nurse for a second visit, during which any remaining questions regarding the operation are answered. You will then be asked to sign a surgical consent which gives the doctor your permission to carry out the procedure of abdominoplasty, and allows for an Anesthesiologist to administer a general anesthetic.

Photographs will be taken of your abdomen and any other areas upon which Dr. Lemke will be operating. You will be asked to sign a photographic consent prior to having any photographs taken.

A general physical examination will be done to ensure that no ongoing medical problems are present which might interfere with the success of the operation. IT IS IMPERATIVE THAT YOU REPORT ANY POSSIBILITY THAT YOU COULD BE PREGNANT.

Specific instructions regarding the date and time of your procedure will be given to you in writing. You will need to arrange for an escort to drive you to and from our office on the day of the operation and for the first post-operative visit. You should wear loose fitting clothing that will wash easily in the event they are soiled. Do not wear jewelry, contact lenses, or bring valuables to the operating room. Remove all body jewelry from pierced body parts; this can interfere with the procedure and may represent a safety threat to you because of the use of electrocautery during the procedure. DO NOT SHAVE OR WAX your abdomen prior to surgery; this may increase your risk of infection. Appropriate shaving will be done on the morning of your procedure.

The balance of your surgical fee is due at this pre-operative visit. Please visit our Financial Center for our payment policies. You can find out the current fee for this procedure by contacting our office.

Finally, Dr. Lemke will write prescriptions for preventative antibiotics to decrease your risk of infection and a narcotic analgesic for post-operative pain relief. YOU NEED TO INFORM US OF ANY HISTORY OF ALLERGIC REACTIONS TO MEDICATIONS.

The Procedure

One the day of your procedure, you will meet with Dr. Lemke’s nurse and your vital signs checked. The doctor will place skin markings on your abdomen to direct him during the procedure. The anesthesiologist will review your medical history and he or she will then administer an anesthetic known as a general anesthetic. This implies that you will be completely unconscious during the operation, and will feel no pain whatsoever.

A full abdominoplasty usually takes 2-3 hours, depending on the extent of the work involved. During the procedure, the lower abdominal skin and fat are excised or removed. This tissue is discarded and will not return. The abdominal skin above the level of the navel is then lifted off the underlying muscle up to your lower rib cage, like lifting an apron. A cut is made around the navel , which is left alone.

The vertical abdominal muscles are then tightened with heavy sutures from your xiphoid (solar plexus) to your pubic bone. This provides a firmer abdominal wall and a narrower waistline. The skin apron is then pulled down to the pubic area and after a new opening is made for the navel, the skin is stitched. Drain tubes are placed under the skin apron to evacuate any fluid which may ooze after the operation. The drains exit in the area of the pubic hair through tiny holes and are stitched in place. These drains are removed approximately a week after surgery. The closure of the skin is done with dissolving-type suture material, which does not require removal.

Tapes are placed on the skin, completing the operation. An elastic belt or binder is placed to support your abdomen and provide comfort during the post-operative period. Almost always, patients are ready to be discharged from the recovery room an hour or two after the conclusion of their procedure, but it is necessary to have an escort to drive you home. Patients cannot be discharged to the company of a minor or to a taxi service. If you have no one to provide you with assistance, our office can make arrangements for medical transport at an additional charge. Out-of-town patients should plan to stay locally for approximately 7-10 days.

The Post-Operative Period

For the first few days, your abdomen will be swollen and you are likely to feel discomfort which can be controlled with medication. We will provide you with instructions for hygiene and activity. It is important for you to rest, but at the same time it is also important to begin walking as soon as possible. Occasionally, patients will be sent home with a Foley (urinary) catheter in place for their convenience, and for close monitoring of their fluid balance. This is placed after you are under anesthesia, and is usually not uncomfortable in any way. If used, the catheter is removed in 1-2 days.

You will be seen back in the office in 1-3 days, at which time the wound is checked, dressings changed, and if necessary, the urinary catheter is removed. On the next visit, usually at 7 days, sutures around the navel and the drainage tubes are removed. Most people return to work shortly after this, but in some instances, work cannot be resumed for 3-4 weeks. This depends on the occupation of the patient, and their individual pain tolerance and healing characteristics.

The abdomen does not usually feel "normal" for several months after surgery. There may be some temporary numbness, particularly just above the incision in the middle, that may stay permanently numb. The abdomen feels very tight, and one feels occasional twinges of pain from time to time during this later healing phase. The scars take at least a year to mature and fade, and may require additional treatment to optimize their appearance. While they will never disappear completely, the scars will not show under clothing, even bathing suits.

Risks of Abdominoplasty

Abdominoplasty is a common aesthetic procedure and thousands are performed successfully each year. When done by a qualified Plastic Surgeon who is trained in body contouring, such as Dr. Lemke, the results are generally quite positive. Nevertheless, there are always risks associated with surgery and specific complications associated with this procedure.

Post-operative complications such as infection and blood clots are rare, cut can occur. Infections can be treated with drainage and antibiotics, but will prolong your recovery. You can minimize the risk of blood clots by moving around as soon after surgery as possible.

Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers are advised to discontinue smoking one week prior to surgery, as smoking increases the risk of complications and delay healing, by altering the circulation to the skin.

You can reduce your risk of complications by closely following our instructions before and after the operation, especially with regard to when and how to resume physical activity. Complications which arise after such cosmetic operations may lead to costs to you other than the costs of your procedure.