ABDOMINOPLASTY (ABDOMEN)
Having a beautiful and well cared for body is no longer just a matter of fashion and aesthetics, but also means health, quality of life, and high self-esteem. Physical exercises and diet are fundamental in this process.
However, throughout life, our body changes and at some point it is quite possible that we will find a flabby belly with unwanted localized fat. This happens even for those who have normal body weight and proportion, practice physical activities, and eat properly. Those who have been through several pregnancies (twins, then!) or have lost a lot of weight may be very upset with this situation. Other causes of abdominal flabbiness, too, are old age and heredity.
WHAT IT IS AND HOW IT IS DONE
The plastic surgery indicated to treat flaccidity and excess skin and fat in the abdomen is the Abdominoplasty and, in some cases, to strengthen the abdominal tonus by restoring the muscles. It is one of the most performed procedures in Brazil. We make a careful preoperative evaluation in each patient to, first of all, verify if the procedure is indicated and if there is any risk of complications.
If everything is fine, we define the best technique to be used, according to the amount of abdominal tissue to be removed. Together with the anesthesiologist, we decide which is the best option between epidural or spinal with intravenous or general sedation, depending on the variation of the Abdominoplasty and if it is associated with other surgeries. The procedure lasts from 2 to 5 hours, depending on the amount of tissue to be removed.
There are three variations of this procedure. Each one has a different function and purpose, according to the profile and desires of each patient. For example, the Mini Abdominoplasty is intended for patients who need to remove only a little excess skin below the navel (“tires”). We make a small horizontal incision (similar to a C-section) in the area between the pubis line and the navel.
In the Classic Abdominoplasty, we also make an incision between the pubis and the navel, and usually continue up to near the hips, curving slightly upward. We make another incision around the navel. We take the abdomen down to the thorax and remove the excess fat, tissue and skin. We move the upper parts to a new, lower position in the abdomen. In some cases, we correct the diastasis (separation) of the weakened abdominal muscles by suturing (plicature) them. Different from the Mini, in this variation there is the repositioning of the navel in the new “skin” that occupies the region of its anatomical location.
The third variation, the Anchor Abdominoplasty, is normally indicated when the Classic is not able to remodel the body the way the patient wants due to an accumulation of skin on the sides, top and bottom. Besides the pubic cut, we make another vertical cut, from the navel to the pubis. The resulting scar resembles an anchor or an inverted “T”. We usually indicate it for people who had a great weight loss, but could not get rid of the flaccidity due to the excess of skin, very common among women who had children.
Abdominoplasty can be done in association with other procedures at the same surgery time. The most common is with Liposuction. We commonly call it Lipoabdominoplasty and it works well with the Classic Abdominoplasty.
We start with lipo of the posterior contour, back and flanks. Then we do the abdomen lipo. The decrease of the localized fat in this phase allows the contour of the belly and waist in the planned result to be more harmonious. Next, we continue with the incision in the pubis region and partially detach the skin and fat up to the upper abdomen region. To finish, we reposition the navel and eliminate the excess fat, tissue and skin.
At the end of the surgery, we apply dressings and bandages and put on the body shaper to minimize swelling and support the new contours of the abdomen as it heals. Drains may be temporarily placed under the skin to drain any excess blood and fluid that may accumulate.
INDICATION
It is a cosmetic surgery indicated for women and men that are bothered with the abdominal skin in apron, excess fat around the abdomen, flaccid abdominal muscles, among others. Patients who do not have pathologies that can impair healing or increase the risk of surgery, are close to their ideal weight for at least 6 months, do not smoke, and have positive perspectives and realistic expectations about the procedure can benefit the most from Abdominoplasty.
An important group of patients who come to us for this surgery are women and men who have had an intense weight loss, either by diet and physical conditioning or after a bariatric surgery (this subject is better dealt with in Post-Bariatric).
Another important group is made up of women who have recently been pregnant. If indicated, it is highly recommended to perform the surgery after 6 months of breastfeeding and with the weight stabilized near the ideal. The post-surgical of this surgery demands a lot, mainly in the first two months, which conflicts with the necessary care in the child’s first days of life. Under these conditions, we perform the Classic Abdominoplasty variation, because it is very common to have to reposition the abdominal muscles.
We suggest to women considering future pregnancies to postpone the procedure or at least wait until their recovery (about 1 year). Planned or unplanned, a pregnancy after an Abdominoplasty is like any other with respect to risk. Of course, the ideal is to have the surgery after all the pregnancies you want, but if life has led you down a different path that you wanted, then enjoy the journey!
It is important to note that Abdominoplasty is not a weight loss procedure, despite the tissue and fat removed. Although the result is technically permanent, significant fluctuations in weight after the procedure can throw off all the effort and commitment you have put into achieving a harmonious abdomen. Therefore, we advise you to maintain a balanced diet and exercise routine. Good for the body, good for your health!
Abdominoplasty does not correct stretch marks, although they can be removed or improved slightly if they are located in areas of additional skin that are removed, usually in the treated areas below the navel. Acids, peeling, dermabrasion, intradermotherapy, creams, laser, among others, can be used in the treatment of stretch marks, of course, under the supervision of a dermatologist.
Weak abdominal muscles are often associated with pain and some back problems. After the procedure, the patient may experience an improvement in body posture and, consequently, relief from some types of pain.
PREOPERATIVE
It is very important that you check the SCHEDULED THE SURGERY? page, which has a series of questions for us to talk about during the consultations, to help you with your doubts, and where you will find recommendations for the day of the procedure.
Besides that, for all variations of the Abdominoplasty, there follows a checklist to help you get organized:
🅐 Prior lymphatic drainage sessions help prepare the body for surgery and reduce the risk of post-surgical complications, such as infection, excessive edema, hematomas and scar tissue.
🅑 Buy a body shaper from a specialized company and take it with you on the day of the surgery, because it is placed immediately after the procedure. Choose a very comfortable model, fair, but not tight, considering the reduction of the abdomen.
🅒 Make sure that during this most critical period of recovery, from 2 to 3 weeks, nobody depends on you in the family or at work. Following the planning to the letter aims to ensure the desired results.
POSTOPERATIVE
Depending on the variant of Abdominoplasty, the patient is released after 12 to 48 hours of hospitalization. Even more, if it is done in association with another surgery. The pain is not usually very bothersome, but you will probably feel it for a few weeks while the swelling starts to go down, depending on each person and on the variation. The first two days must be of absolute rest, fundamental for healing and for the elimination of liquids (seroma) through the drain. If you are going to stand up, keep your posture bent over, because it is necessary to reduce any abdominal tension as much as possible.
Opt for lighter food on the 1st day (fruit, soup, gelatin, fiber, liquids, etc.). As of the 2nd day of the procedure, you can eat practically anything, but foods with a minimum of salt, so as not to increase swelling. Also avoid foods that produce gas (such as beans, garlic, chicken etc.), so as not to cause discomfort. Alcoholic beverages and cigarettes should be avoided during the entire recovery period.
Sleep on your stomach, with your arms along your body and torso elevated to be more comfortable and keep your body slightly inclined. The compression garment or body shaper must be worn all the time in the first 45 days (removed only to take a shower, to sanitize the garment or for quick events) and, afterwards, according to the patient’s will.
In the first baths after the surgery, if you feel dizzy, choose to use a chair. Avoid wetting the dressings, but if this happens, try to dry them carefully with a towel and/or a warm dryer at least 20 cm away. We provide a schedule for changing the dressing and removing the drain and the stitches, which is done in the doctor’s office in stages.
As in the preoperative period, schedule lymphatic drainage sessions from 4 to 6 weeks postoperatively. Besides eliminating the accumulation of liquid from the body, this treatment activates the immune system, helps reduce pain and discomfort, relieves bruising and swelling, and is effective in preventing and treating fibrosis and scar adhesions.
At least 2 weeks of relative rest and it is important to maintain a slightly bent posture. After this period it is already possible to return moderately to daily activities, but without physical effort. Light exercises (such as walking and stretching) from the 15th day on are allowed. More intense physical activities, contact sports, the use of tight clothes (jeans, underwear, etc.) and even driving are allowed after evaluation. Avoid weight lifting and sudden movements, much less those that make the abdominal region stretch, for at least 15 days. Avoid as much as possible the exposure of the scars to the sun for at least 6 months; then, always use sunscreen with a minimum of 30 SPF (sun protection factor) on the abdomen (and all over the body).
And, of course, the maintenance of the result depends on a balanced diet and physical exercises. After 6 months, the planned result begins to appear. All surgeries leave scars. In the case of the Abdominoplasty and its variations, part of the incisions are made in areas that can be hidden by the bikini. Except for the variation that requires a vertical incision from the navel. If the healing does not result in keloid or hypertrophic scarring, the tendency is that it can be clear and of good quality until it reaches its definitive appearance in two years.