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Abdominoplasty

Get A Flatter Tummy With a Tummy Tuck (Abdominoplasty)

A tummy tuck is also known as an abdominoplasty. The goal of an abdominoplasty is to improve the appearance and shape of the abdomen. The procedure involves removing excess skin from the abdomen and tightening the abdominal wall. Laxity of the abdominal wall can be caused by weakened or separated muscle.

An abdominoplasty is ideal in women who are at their optimal weight but have extra loose or hanging skin on the abdomen. Often, this extra skin will not go away despite dieting and exercise. There may be separation of the abdominal muscles which appears as a vertical mound in the center of the abdomen when straining. This is also known as “rectus diastasis”.

During an abdominoplasty, the muscle separation is corrected by bringing the muscles back together in the center and suturing them in place. This procedure is called an “abdominial plication”. The excess skin from the abdomen is removed and the abdominal skin is stretched tight and sutured low on the abdomen. The belly button is kept in the same place on the abdominal wall but is brought through the new overlying skin. This can help rejuvenate the belly button’s appearance if you have a droopy belly button.

Liposuction can be incorporated with an abdominoplasty, but is limited in the amount that can be done. Liposuction on the flanks and back can help improve the final contour. If the patient has a lot of fat on the abdominal wall, it is recommended that they pursue weight loss or liposuction first, if appropriate, prior to having an abdominoplasty. Stretch marks are usually located on the lower abdomen and can be removed during the abdominoplasty, but if there are stretch marks higher up, they cannot be removed during the procedure.

The results of an abdominoplasty are technically permanent, but the results can be affected by fluctuations in weight. The surgery should be done when you are at an optimal weight. If you are planning any major weight loss or pregnancies in the future, the surgery should be postponed. An abdominoplasty is not a substitute for weight loss or exercise.

Variations of the Procedure

Depending on the extent of the surgery, you may be a candidate for a drainless tummy tuck (abdominoplasty). For fleur-de-lis abdominoplasties or those requiring a lot of skin and fat removal, drains are usually placed.

For patients that have undergone major weight loss and have a lot of excess skin, additional procedures may need to be done due to excess skin in multiple areas. Options are a “fleur-de-lis” procedure where the skin is removed in the middle in addition to at the bottom or a lateral excision where excess skin is removed on the side so there is no incision in the middle of the abdomen. The choice of procedure is dependent on your anatomy and will be discussed during your consultation with the surgeon.

A mini-abdominoplasty is removal of only the excess skin and fat below the belly button. This is usually done for patients that have excess skin that are hanging over c-section scars. The abdominal muscles are not tightened and the belly button is not moved. This is not a good procedure for patients with extra skin above the belly button or a sagging belly button. Liposuction can be combined with a mini-abdominoplasty.

A variation of an abdominoplasty is a panniculectomy which is removal of excess skin only without tightening up separated or weakened muscles. This procedure is usually done as medically necessary for hygiene or chronic infections under the excess skin. There is no abdominal tightening done during this procedure.

Why Should You Choose the Surgeons at Hill Country Plastic Surgery?

Both Dr. Farber and Dr. Shah were fellowship-trained at the most prestigious institutions and their techniques for delivering patient results and satisfaction set the standard for plastic surgeons in the field. They use the most advanced techniques and consistently achieve superior results. Their warm demeanor, genuine care, and dedication to their patients are second to none. Ultimately however, patients choose Dr. Farber and Dr. Shah for the results. Their patients look and feel their best, and so can you. Discover the difference here in San Antonio!

Initial Consultation

During your initial consultation with your surgeon at Hill Country Plastic Surgery, we will discuss your concerns and goals before recommending treatment options that are tailored specifically to your needs. Prior to your consultation, we recommend that you review the procedures on our website so you are familiar with the terms we will be using during our discussion.

During your consultation, we will review your health, goals, and lifestyle to determine the best treatment options for you. Your medical history, surgical history, medications, allergies, family medical history, and other important details are reviewed. It is very important that we obtain accurate information in all of these areas as it may impact the outcome of your surgery.

While discussing different treatment options, we will perform a physical exam and take measurements that are necessary for planning for your surgery. Pre-operative (before surgery) photos will be taken either at your initial consultation, or during your pre-operative visit.

After your consultation, you will receive access to your notes on the patient portal in addition to information about your specific surgery. If you have not activated your patient portal, this can be done at your appointment by asking any of our staff to assist you. If you have questions after your appointment, you can contact our office or message us through the patient portal. Some patients will require medical clearance from their primary care physician or a specialist or additional tests before undergoing surgery.

Once you have determined that you would like to have surgery and have completed any clearances and tests that were requested, contact our office at (210) 658-3555 to schedule a pre-operative appointment with one of our surgeons.

Pre-operative Appointment

On the day of your pre-operative appointment, we will review your procedure in detail and go over the surgical plan with you. We will also address any questions and concerns you may have. Please read over the procedure consent prior to this appointment and have any questions ready so we can discuss them.

During your pre-operative visit, we will provide you with all of the after-care instructions as well as necessary medication prescriptions. Prior to your surgery you will get lab testing and depending on your age and health, EKG and/or chest x-ray. You will also be provided with a post-operative appointment for follow up after your surgery.

Before the Day of Surgery

Please do not smoke (cigarettes, vape, or pipe) or use any nicotine products 4 weeks prior to and after your surgery. Smoking and nicotine greatly impair healing, which can cause increased risk for infection and complications, such as delayed incisional healing or wound opening which lead to worse scarring. Please stay away from second hand smoke as well, as this can also cause wound healing problems. If you use nicotine products, you will need to stop 4 weeks prior to surgery and then you will need to undergo a cotinine test prior to surgery to ensure that the nicotine is out of your system.

Please do not drink alcohol before or after your surgery (until cleared by your surgeon). In addition, please do not drink alcohol while taking pain medication, as this can have serious, and life threatening side effects.

Please leave all valuables at home. If you have body piercings, kindly remove them prior to surgery.

Please have someone available to drive you home. Due to the lasting effects of the general anesthesia, you will be unable to operate a car after surgery. A taxi or car service is not adequate either. You will need a family member or friend who can assist you.

You may have been asked to obtain pre-operative tests at a lab facility or your primary care physician. Your pre-operative tests (labs, X-rays, EKG, etc) need to be completed at least three days before your surgery. If you have them done at your doctor’s office, the results will need to be faxed to (210) 362-1582.

The surgery facility will call you the day before your surgery to let you know what time and where you should arrive.

Shower the morning of or the night before your surgery with your normal soap and water. Do not use deodorant, lotion, cream, perfume, aftershave, oils, or makeup after bathing.

Do not take Advil, Aleve, Naproxen, Fish Oil, Garlic, CoQ10, Omega 3,6, Motrin, Excedrin, Ibuprofen, Aspirin, medications for arthritis or any medication that contains these medications for ten days prior to your surgery and two weeks after.

Do not eat or drink anything after midnight the night before your surgery.

Please call our office if you have an infection of any kind prior to your surgery.

Day of Surgery

On the day of surgery do not take the following blood pressure medications with generic names that end in “-pril”, “-sartan” before your surgery. If you are on metformin, you will be asked to not take it on the day of surgery.

On the day of surgery, your plastic surgeon will meet you in the pre-operative area to go over any last minute questions or concerns you may have. Your plastic surgeon may make some preoperative markings and will perform extensive checks with careful attention to detail, ensuring high quality care and safety. You will meet the anesthesiologist and their team, as well as the members of our plastic surgery operative team.

During the plastic surgery procedure, our plastic surgeons pay meticulous attention to detail and work as a highly experienced team to ensure a great result. Your family will be updated of your status periodically and will be able to talk with the plastic surgeon in person after the procedure is completed. The incisions will be placed in a dressing or a compression bandage. Instructions for care on these will be given to you in your preoperative paperwork.

Aftercare

In order to make your recovery faster and more comfortable, we recommend that you prepare before your surgery. Things you can do are:

●      Prepare a sleeping area that is easy to get to. For example, set up a couch downstairs instead having to walk up to an upstairs bedroom. Keep your toiletries close by and prepare food ahead of time. Arrange for someone to be with you the first night after surgery.

●      You may receive your post-operative medications at your pre-operative appointment. You should pick up these medications prior to your surgery.

●      If you’re having an outpatient same-day procedure you will be released to go home the same day and will need someone to drive you home.

●      Review your post-surgery instructions given to you at your pre-operative appointment

If you have a history of nausea or vomiting after anesthesia, please let us and your anesthesia provider know. We can prescribe anti-nausea medications and take extra steps to prevent nausea and vomiting after surgery.

When undergoing general anesthesia, you will need to have someone drive you home. You will not be allowed to undergo surgery if there is no confirmed designated driver.

Medications:

After surgery you will have discomfort and the goal of pain medications is to reduce pain, but it will not completely remove all pain. A good measure for if you need more pain control is that you should be able to take a deep breath without severe pain. Do not wait until your pain is unbearable to take the next dose of pain medication because it will take longer to get your pain under control again.

You may resume your home medications after surgery except blood thinners and as determined by your surgeon. We will give you a prescription for a pain medication. If you are prescribed medications that contain acetaminophen (tylenol) it is important that you not exceed 3500 milligrams of acetaminophen (tylenol) per day.. Do not drive, operate heavy machinery or make important decisions while taking narcotic pain medications.

Narcotic medications may cause constipation. Ensure you have adequate (>25 grams/day) of fiber in your diet and drink at least 64 oz. of water daily. You may also wish to take an over the counter stool softener such as Miralax or Colace once or twice daily.

You can alternate your narcotic medication with Ibuprofen 600mg every 6 hours and/or Gabapentin 300mg three times a day.   Take ibuprofen with food to protect your stomach from irritation.

If you have a history of nausea or vomiting after anesthesia, you may be prescribed an anti-nausea medication (Ondansetron) which can be taken as needed.

Before prescribing any narcotic medications, we are required to check the Texas controlled substance history database (Texas Prescription Monitoring Program). If you currently have a pain medication contract with another physician or are currently on narcotic medications, we will have to coordinate your medications with that physician.

We will prescribe pain medications for recovery after surgery, but do not prescribe long-term pain medications and do not do more than one refill for any pain medications. If you have pain that is beyond what is usually anticipated for your surgery and there is no surgical reason that can be found, we will help by referring you to one of the many pain management specialists that we work with.

Surgical Site Care:

You may shower 48 hours after your surgery. Do not scrub the incisions, just let the water run over them and gently dab them dry afterwards. Apply gauze over the surgical site daily as needed for light drainage. Do not immerse your incisions in baths or hot tubs until at least 2 weeks after surgery or when cleared by your surgeon.

Right after surgery, you will be placed in an abdominal binder or a compression garment. You should wear the compression garment at all times except when showering for the first 6 weeks.

Drain Care:

Sometimes it is necessary to place a drain after surgery. The purpose of a drain is to remove excess fluid from the surgical area. Empty the bulbs and measure the output whenever the bulbs are half full or at least twice a day. You will be given a sheet to record how much is coming out of the drains. Bring this sheet to your follow-up appointment. In general, drains remain in place until there is less than 30mL (1oz) out of the drain for two days in a row.

Please Call Immediately if:

Please call if you have the following signs/symptoms:

●      temperature greater than 100.5 F

●      bleeding or pus draining from the wound site. If you have bleeding, apply direct pressure to the area for 20 minutes

●      increasing pain that is not controlled on oral pain medications

●      increasing redness or size at the surgical site

●      your drain is not holding suction

●      if your incisions come apart

●      Any other concerns

For non-emergency questions:

During business hours (8 AM – 4:30 PM): call (210) 658-3555.

After hours and on weekends/holidays: call (210) 658-3555 and you will be forwarded to the on call surgeon.

If you are having any serious problems or symptoms such as difficulty breathing or chest pain, call 911 or proceed to your nearest emergency room.

Activity restrictions:

No vigorous activity: no pushing, pulling, bouncing, housecleaning, yoga, running, heavy lifting greater than 5 lbs until your follow up appointment. Avoid activities that raise your blood pressure or heart rate. You are encouraged to walk around and you can climb stairs after surgery. You should not lay in bed and not move.

Follow-up Clinic appointment:

Your clinic appointment will be scheduled at your pre-operative appointment before surgery. If you need to change your appointment time or date, please contact our clinic at (210) 658-3555.

Limitation, risks, complications

Risks of the procedure include risks of anesthesia, bleeding, infection, fluid collections, opening of the incision, widened scarring, numbness on the abdominal wall, skin discoloration, recurrent looseness of skin, deep fat may die (fat necrosis), deep vein thrombosis, cardiac and pulmonary complications, asymmetry, need for revisions, persistent pain.

The surgeon may adjust any of the above guidelines and instructions based on the patient and type of surgery performed.

Abdominoplasty FAQs

The procedure can take place at an ambulatory surgical center, or at a hospital on an outpatient or inpatient status. The choice of location is based on many factors, but is ultimately based on what is safest for you.

After an abdominoplasty, most patients are able to go home. If we are doing an excision of a large amount of skin or additional procedures, you may need to stay overnight in the hospital or surgical center.

During your consultation, your surgeon will review all the options and give you recommendations. In general, abdominoplasty is a good option if you are at your ideal weight and have been stable at that weight for at least 6 months. You should be nicotine free since nicotine can cause severe complications such as death of the abdominal skin and the wound coming apart.

If you have any bleeding or clotting problems, it is important that we know about it and we work with your hematologist to determine if this is a safe operation for you to undergo. If you have significant medical problems, we will work with your physicians to determine if you can safely undergo surgery.

A cosmetic abdominoplasty is not covered by insurance. If you have chronic rashes under excess skin, your insurance carrier may cover a panniculectomy. If you are having a panniculectomy, the abdominal muscle plication and any additional dissection and liposuction is not covered. These procedures can be combined with the panniculectomy, but will be an additional and separate cost. We will work with your insurance carrier but the final decision is theirs.

You can return to normal activities at 6 weeks. If you had a tight abdominal plication performed, you may want to limit your abdominal core workouts until 3 months after surgery. When resuming activities, it is recommended that you start slow and wear an abdominal binder at first and slowly increase your activity level.

A cosmetic abdominoplasty is not covered by insurance. If you have chronic rashes under excess skin, your insurance carrier may cover a panniculectomy. If you are having a panniculectomy, the abdominal muscle plication and any additional dissection and liposuction is not covered. These procedures can be combined with the panniculectomy, but will be an additional and separate cost. We will work with your insurance carrier but the final decision is theirs.

The costs are variable between patients and depends on the amount of surgery that is needed. For example, a mini-abdominoplasty would cost less than a full fleur-de-lis abdominoplasty. When determining the affordability of the surgery, the total cost of the abdominoplasty should be evaluated. The total cost includes anesthesia fees, hospital or surgical center facility fees, medical test, compression garments, prescriptions, and the surgeon’s fee.

Interested?

Are you interested in learning more about this procedure? To schedule a consultation, please contact us. Hill Country Plastic Surgery is the premier plastic surgery center in the San Antonio and Austin area, and our friendly team members are here to help you and will reach out promptly.

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