Tummy tuck: why have it and possible complications of surgery

Tummy tuck (or abdominoplasty) is an operation which reduces the size of the abdomen by removing excess skin and fatty tissue from the middle and lower abdomen and routinely tightening the muscles on the front of the abdominal wall. The procedure is often combined with liposuction of the flanks/ love handle areas for best results.

Here, we spoke to one of our highly experienced plastic surgeons, Professor Charles Malata, about the most common reasons to have the procedure and, as with any surgical procedure, the possible risks.
 

Why have a tummy tuck or abdominoplasty?

Reasons for a tummy tuck include:
 

• Tummy tuck with liposuction dramatically improves the contour of a protruding, lax, floppy or saggy abdomen. It eradicates any lower abdominal overhang, the so-called “apron”, thus giving a “flat” tummy.
• Following pregnancy and childbirth, you may wish to improve the appearance of your abdomen. A tummy tuck operation is an integral part of what is often referred to as “mummy makeover surgeries” that many women elect to have after having children in order to improve the changed appearance of the abdomen.
• You may also want to have a better definition of your waistline.
• Abdominoplasty also improves lower abdominal scars such as caesarean section, gynaecological and other surgical scars.
• An abdominoplasty is also indicated for the treatment of diastasis recti which is the presence of a large gap between the front muscles of the abdomen which results from large pregnancies, delivery of twins, or severe previous overweight followed by weight loss. The treatment involves plicating (i.e. suturing together) the rectus sheath covering of the straight vertical muscles on either side of the middle of the abdomen.
• A tummy tuck type procedure is also often used to treat hernias on the front of the abdomen by providing large access to the hernia and getting rid of the excess skin and fatty tissues. These hernias are often the result of previous abdominal operations often in the context of massive weight loss.
   

Does a tummy tuck leave scarring?

It leaves a long hip-to-hip “bikini line” scar but occasionally a T-scar (fleur-de-lys) is necessary in cases where there has been significant weight loss or if there are numerous scars already on the abdomen.
 

What are the possible alternatives to a tummy tuck?

The alternatives to a tummy tuck operation include:
 

1. Weight loss by diet and exercise: this reduces the size of a fatty abdomen but does not tighten it or improve the rolls of tissue or the waistline.
2. Liposuction alone: this gets rid of the excess fat and might improve the waistline, however, it does not eliminate the loose skin. The final appearance is largely dependent on the elasticity of your skin, and in general, the results of liposuction alone are not as good as a tummy tuck operation. Professor Malata reserves liposuction for patients who do not want a bigger operation and are prepared to sacrifice the quality of the result for a less invasive operation with a quicker recovery.
3. Mini-tummy tuck: this operation has a similar scar pattern to a standard tummy tuck but does not involve repositioning of the umbilicus. By design, the improvement that can be achieved with a mini-tummy tuck is limited. It is best reserved for those with a small abdominal overhang especially above a caesarean section or gynaecological surgery scar and is best considered a scar revision for such scars rather than a limited scar tummy tuck. Professor Malata often combines it with liposuction of the rest of the abdomen.
4. No surgery at all (camouflage with baggy clothes): this is always an option and you have to weigh the benefits and risks of this operation for you before deciding to undergo any surgery. You might benefit from physiotherapy, support corsets, and exercise.
    

What are the possible complications of tummy tuck surgery?

As with any surgery, there are benefits, risks and the final results are not guaranteed. Your specialist should discuss the following possible complications that are specific to abdominoplasty with you before surgery:
 

Bleeding & hematoma (less than 5-10% chance)

Sometimes there may be bleeding into the surgery area, which manifests as swelling, pain, and/or bruising. In the event of a significant blood collection or persistent bleeding, I would take you back to the theatre to remove the collected blood and stop any bleeding points. In rare instances, you may require to be transfused.
 

Bruising and swelling of the tissues

Bruising and swelling after tummy tuck surgery is very common and typically subsides after a couple of weeks. However, there will be some residual swelling, especially in the lower part for several months as the lymphatic drainage has been interrupted by the transverse incision. This can be helped by massaging and milking the tissue fluid (known as manual lymphatic drainage). This tissue fluid swelling is different from seroma fluid, which is fluid collection underneath the skin (vide infra).
 

Seromas (very common with 1 in 3 chance)

Blister-like fluid collection under the abdominal skin is quite common after tummy tuck surgery because of the large raw areas created under the skin. This is not dangerous or a danger to your life however it can cause swelling and discomfort, opening up of the wound and at worst may get infected. The excess fluid may ooze through the umbilicus or through the incision site as it tries to find a way to escape. It is treated simply by drawing out (aspirating) the fluid with a needle and syringe. Fortunately, you will not feel any pain from the aspiration, as the needle is introduced through your numb skin. It is only necessary to drain the fluid once per week.

Drainage may be needed for three to four weeks. Rarely a drain might have to be reinserted and in extremely rare cases, an operation may be required to cut out the sac into which the fluid collects.
 

Wound infection (less than 15% chance)

The wound may get infected either at the time of surgery or later. I prescribe antibiotics starting in theatre and continuing after surgery to minimise this risk. Wound infection will cause redness of the surrounding tissues, wound discharge, pain and swelling. You may also get a fever (high temperature) or experience chills and rigours.

Treatment of wound infection is dependent on its severity. It may entail one or more of the following measures: frequent dressing changes, application of antiseptic to the wound, administration of oral antibiotics, admission for IV antibiotics or drainage and washout in theatre. In the extremely rare but life-threatening “flesh-eating bug” (necrotising fasciitis) you would require emergency admission to hospital, radical debridement (cutting out of the infected/compromised tissues) and a stay on the intensive care unit. This would leave you with disfiguring scars.
 

Slow healing and wound breakdown (less than 5-10%)

Breakdown of the wound and slow healing are common in smokers, the obese, diabetics or patients on steroids and after massive weight loss. They can also occur in patients who overdo things too early after surgery such as running, heavy lifting, strenuous exercises, dancing, etc. This tends to occur at the long incision site or around the umbilicus and treatment is dependent on the severity of the breakdown – often only dressings are required.

Infrequently, I might take you to theatre for cleansing the wound, washing it out, trimming it and closing it neatly. In some cases, there may be fat necrosis around the incision which manifests as lumps (especially in relation to the deep sutures) or oily discharge. If the latter develops, it will not stop until all of it has subsided.

Unavoidable things - pregnancy!

The following occurrences are unavoidable and to be expected in almost every patient: swelling of the tissues which sometimes can be prolonged, discomfort/ tightness especially on moving or coughing, bruising, long scars, and numbness of the skin.

It should also be noted that the appearance of the abdomen will inevitably change with age, large fluctuations in weight and pregnancy.

I recommend that if you are planning to get pregnant in the future, it is best to postpone the tummy tuck operation as you will most likely compromise the result of the initial surgery and potentially waste your money and time. It is possible to carry a pregnancy to term even after the previous tightening of the abdominal wall during a previous tummy tuck procedure.

Numbness is quite profound after a tummy tuck type procedure. This is because the excess skin together with its skin nerves has been removed while at the same time the remaining skin and nerves are stretched out. The sensory recovery begins about 6 to 8 weeks after surgery and starts as twinges, sharp pains, cutting, stabbing or shooting pains etc. The recovery takes several months but the sensation will not return to normal especially in the lower middle section of the abdomen immediately next to the scar. However, from day to day you will not notice this altered sensation.
 

Scarring

Tummy tucks leave long scars. Whilst long scars are unavoidable, unsightly scars are uncommon. Sometimes, depending on your genetic make-up (redheads, dark skin, family history, etc), the scar may become lumpy, raised, itchy, painful, and unsightly. This is called scar hypertrophy or keloid scaring depending on its severity.

In these cases, treatment is undertaken with topical creams or gels, silicone gel (Kelocote or Silgel or Dermatix) and frequent injections into the scars with steroids once every two months. Surgery is rarely required in conjunction with steroid injections. If all other forms of treatment are unsuccessful, radiotherapy may be considered as a last resort.
 

What are the general risks of surgery?

The general risks of surgery and anaesthesia include vomiting during or after the general anaesthetic used to put you to sleep, developing a chest infection (smokers are especially at risk), or a blood clot developing in the legs (known as venous thrombosis) which, if it travels to the lungs (pulmonary embolism), is life-threatening. Other problems may include:
 

• Contour irregularities - depressions, ridges, wrinkling. These are uncommon but can occur in patients who have had liposuction as an adjunct to the tummy tuck operation or quilting sutures to reduce seroma formation.

• Umbilicus - problems with the umbilicus after an abdominoplasty can vary from slow wound healing, malposition, scarring, unacceptable look to partial or total loss. While minor healing problems are common, the umbilicus hardly ever requires revision surgery.

• Revisional surgery - Infrequently some touch-up surgery is requested by some patients. The reasons for this include dog ears, any residual asymmetry, poor scars, or dissatisfaction with the results. The latter is rare while dog ears are common.

If you are considering a tummy tuck, you can book an appointment with Professor Malata now via his Top Doctor’s profile here and get his expert opinion.