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When do you qualify for abdominoplasty?
Multiple-pregnancies, weight loss, and aging may cause laxity of the abdominal wall. Whether your condition can be improved by an abdominoplastic intervention needs to be judged by the plastic surgeon. An abdominoplasty will remove skin excess and abdominal wall weakness will be reinforced. However, correction of a heavy or weak abdomen will not correct excessive overweight. In contrast, if you are overweighted it is advised to postpone the intervention until your weight is optimized, since overweighed individuals run a higher risk of postoperative complications, such as delayed wound healing, higher infections rates, and a higher risk of thrombosis.
Weight reduction is necessary by means of a diet regimen and/or increased sport activities. You may want to consult a dietician or general practitioner, who can guide you during this period.
As soon as your weight has been optimized the operation can be carried out to obtain a satisfactory result with a lesser risk of complications.
This type of intervention should not be performed if you do still want to become pregnant, as a future pregnancy may induce major widening of the scar. In the case that scars at your abdomen are already present before the operation, the degree of success of the surgery depends on the extent and the location of these scars.
Preparing for the intervention
For this procedure you will stay preferable two days in the hospital. Major postoperative pain can thus be treated optimally, to allow for active mobilization within this period of time.
Please inform your surgeon whether you use medication that alters blood coagulation, such as Marcoumar or Sintrom. The use of medication containing Aspirin (acethylsalicylacid), needs to be terminated 14 days before the day of intervention.
Smokers are strongly advised to quit smoking at least 2 weeks before, and continue to do so at least 4 weeks after the intervention. Persistent smoking can have profound adverse effects on wound healing.
As the surgery is always carried out under general anesthesia, you must be sober before the intervention starting at 12 o'clock p.night.
Before the intervention a bladder catheter will be placed, which will stay in place until the next day. The scars will be made as low as possible in the suprapubic region. Coverage the scar with underwear is therefore possible. The length of the scar is dependent on the amount of skin excess. It is obvious that the scar will be longer when the skin excess is large. A circular scar around the umbilicus will be necessary in order to relocate the umbilicus. If the distance between the abdominal muscles has been stretched by earlier pregnancies, a reefing will be applied to support and reinforce the abdominal wall. In order to relieve tension at the wound margins you will be placed in a half-sitting position (flexed hips and knees) during the intervention. This position will be maintained in bed during the first 2 days. Drains will be placed in the pubic region in order to drain the excess of wound fluid. As soon as major drainage has stopped, these drains will be removed.
After the intervention
The abdomen will be tense and painful after the intervention. Coughing, sneezing attacks, squeezing, and laughing will cause additional pain. With time these complaints will reduce gradually. The second day after the intervention you will be mobilized. Initially you will walk with a flexed back. Straightening your back will also be gradually possible. If sufficient progress is made and no complications arise, you are allowed to go home the first or the second day after the intervention. In exceptional cases a longer hospital stay is advised.
What else do you need to know?
During a period of 6 weeks after the operation you need to wear a compressive abdominal bandage covering the complete abdomen (including the area above the umbilicus) in order to prevent fluid accumulation in the operated area.
Severe complications seldom occur. In principle, all complications inherent in a surgical intervention may occur, however. These include bleeding, infection, and delayed wound healing. The last complication is observed more frequently in smokers and obese patients. If the wound healing is retarded, the final scar may be wider in the involved area. Exceptionally, an additional correction is then required.
During the first postoperative months you may perform light work. Heaving lifting, however, is absolutely forbidden. After the first few weeks you may gradually resume normal activities. The scars need to be protected from sun exposure during 1 year. Initially, your abdominal wall is insensitive. The sensitivity will return slowly after a few months. In some patients a small insensitive area will remain.
The final appearance of the scar cannot be predicted in advance, since the healing process will be influenced by other factors, such as genetic healing tendency and the occurrence of delayed wound healing. Initially the scars will be red and hard. Sometimes postoperative treatment with silicone compression or cortisone creme may be necessary. After 6-12 months the scars will fade and become softer.