.--Abdominoplasty

Consultation  Pre-Operative Visit  Day of Surgery  Recovery Period  Risks


Background On Abdominoplasty
Abdominoplasty (panniculectomy, abdominal lipectomy, tummy tuck) is a surgical procedure on the abdomen for removing excessive skin and fat, tightening muscles and eliminating or improving scars of the lower abdomen. Abdominoplasty is a frequent procedure in Dr. Capella's practice. He has performed over 800 abdominoplasties.

Following pregnancy and after weight loss in both men and women, the skin of the abdominal wall can become loose and stretched leaving permanent marks. In addition, fat collects in the tissues below the skin and the abdominal wall muscles become relaxed, both conditions causing the lower abdomen to become more prominent. When large amounts of excessive skin are present, it may cause rashes between the skin folds and may make certain activities such as exercise uncomfortable. Unfortunately, the combination of loose skin, excessive fat and relaxed muscles is usually unresponsive to dieting and exercise. An abdominoplasty is designed to correct these problems.

Abdominoplasty is also an essential component of a procedure called a body lift. A body lift is a simultaneous abdominoplasty, thigh and buttock lift and is Dr. Capella's preferred procedure for patients with cellulite of the thighs and buttocks, skin irregularities secondary to liposuction or who have undergone significant weight loss.

A procedure called liposuction may satisfactorily treat individuals who have a firm abdominal wall but excessive fat below the skin. These patients tend to be younger and may not have had children. Unlike liposuction, which involves very small incisions to remove fatty tissue only, an abdominoplasty requires a longer scar to remove excess skin. The scar is placed very low on the abdomen, generally in the pubic region and is hidden by most contemporary underwear and bathing suits.



Abdominoplasty Consultation
At the first office visit, Dr. Capella will take a medical history and perform a focused physical examination. Medical conditions such as bleeding disorders, heart disease, hypertension, diabetes, asthma, hernias or a history of smoking will be of particular concern to Dr. Capella. Information regarding medications you are currently taking or have taken in the past, including all kinds of pain medications will be requested by the doctor. Your height and weight will be recorded. One should know that this is not an operation for obesity. Patients who have scars from previous surgery in some cases may not be candidates for this operation because of the risk of surgical complications due to alterations in the blood supply to the skin. Dr. Capella will determine this at the time of the consultation. He will also estimate the length of scar that will be required to remove your excessive skin. For individuals who have relaxation of the abdominal muscles but minimal excessive skin, a procedure with a smaller scar, a " mini-abdominoplasty" may be all that is needed. You may be asked to view an informational videotape and will be given informational materials.

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The Abdominoplasty Pre-Operative Visit
You will meet again with Dr. Capella approximately two weeks prior to surgery at which time any remaining questions you may have regarding the operation will be answered. You will be asked to discontinue medications that could lead to bleeding during the surgery. The specific medications will be reviewed with you at the visit. You will then be asked to sign a consent for the surgical procedure as well for our board certified anesthesiologist to provide anesthesia. Dr. Capella performs abdominoplasty operations with general anesthesia.

Photographs will be taken of your abdomen and any other areas upon which Dr. Capella will be operating. Specific instructions regarding the date and time of your procedure will be given to you. You are not to eat or drink anything after midnight the night before surgery. Exceptions may be made for certain individuals. You will need to arrange for an adult to drive you to our surgical facility on the day of the operation and for the first visit after the surgery. 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 electro cautery during the procedure. Do not shave or wax your abdomen prior to surgery; this may increase your risk of infection. Any shaving that is necessary will be done the day of surgery by our staff.

The balance of your surgical fee is due at this pre-operative visit.

Finally, Dr. Capella will write prescriptions for preventative antibiotics to decrease your risk of infection and a narcotic analgesic for post-operative pain relief.

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The Day of Abdominoplasty Surgery
On the day of your procedure, you will meet with Dr. Capella'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 will then administer an anesthetic.

A full abdominoplasty takes 2-4 hours, depending on the extent of the work involved and whether it is combined with liposuction or other procedures. During the procedure, the lower abdominal skin and fat are excised or removed. The abdominal skin above the level of the navel is then lifted off the underlying muscles up to your lower rib cage, like lifting an apron. A cut is made around the navel, which is left in place.

The vertical abdominal muscles are then tightened with heavy sutures from your ziphoid (solar plexus) to your pubic bone. This provides a more firm 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. In some cases, liposuction will make up part of the abdominoplasty procedure to further improve contour. Drain tubes are placed under the skin to evacuate any fluid which may ooze after the operation. The drains exit in the area of the pubic hair through tiny holes. 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. Several sutures will be placed at the navel which will require removal.

Dressings are placed on the incisions. A binder is also applied to support your abdomen, provide comfort and decrease swelling during the post-operative period. Patients are discharged from the recovery room to a nearby nursing facility. Patients remain at the facility one to two nights depending on the extent of the procedure.

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The Abdominoplasty Recovery Period
For the first few days, you are likely to feel discomfort which can be controlled with medication. Your abdomen will be swollen. The swelling will resolve over a period of weeks depending on the extent of your abdominoplasty. In general, 75% of the swelling is resolved at 6 weeks, 95% at three months and nearly all at 6 months to a year. We will provide you with instructions for personal hygiene and activity. We suggest you begin walking as soon as possible, although rest is important as well. Walking up stairs is discouraged for the first two weeks unless necessary.

Dr. Capella will visit you the day following surgery at the nursing facility. Dressings will be removed at that time. You will then be seen at the office in approximately one week. At the time of this visit, sutures around the belly button and one or more drainage tubes will be removed. Showering is permitted 48 hours after the surgical procedure. Individuals with desk- type employment may resume work two weeks following the procedure. Lifting should be limited to 15-20 lbs for 6 weeks. Others with work involving prolonged periods of standing, walking or heavy lifting may need to wait from 3 to 6 weeks. Vigorous or aerobic exercises should not be resumed for 6 weeks.

In the first few days after surgery you will feel like you need to be flexed at the waist to feel comfortable. Over the next several days you will gradually be able to stand upright. It takes several months for the abdomen to regain a normal feel. Temporary numbness, particularly just above the incision in the middle is common. In some instances this numbness may be permanent. The abdomen feels very tight for several weeks. Occasional shooting pain is not unusual for several months following the procedure. The scars often become more red several weeks after surgery and begin to fade at 2 to 3 months later. While they will never disappear completely, their appearance is usually very satisfactory. It may take scars as long as 18 months to reach their final appearance.

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Risks of Abdominoplasty
Abdominoplasty is a very common aesthetic procedure in Dr. Capella's practice. 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, but 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 three weeks prior to surgery and 3 weeks after surgery. Smoking, among other harmful side effects, decreases blood flow to the skin, increases the risk of complications and delays healing.

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. If you have any questions regarding your postoperative instructions, do not hesitate to contact the office.

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