Presentation

Abdominoplasty: Abdominal dermolipectomy.

Abdominoplasty or abdominal dermolipectomy (tummy tuck) is a surgical procedure to remove excess skin and fat from the inferior part of the abdomen and to tighten the stomach muscles of the abdominal wall.

This helps obtain a flatter stomach and reduce your waistline. The skin of the stomach is rearranged and the excess skin excised.

The umbilicus regains its place in the middle of the tummy,  sometimes it has to be lowered 2 to 3 centimetres.

• This operation can significantly improve abdominal distension.
• The abdominoplasty creates a permanent, long scar, which is far from insignificant.
• This scar is positioned so that it can be masked by a swimsuit or underwear.

A surgical clinic examination helps evaluate the size of the  stomach overhang/hanging belly fat – which can cover, or even extend lower than the pubis area – and look for a muscle diastasis or an associated eventration (sometimes at the site of a trocar orifice for a  coelioscopy) or an umbilical hernia or on a white line.

Sometimes an echography or an abdominal CT scan can be required to better evaluate the topography and importance of the  parietal defects. Several face and profile images are taken.

The surgeon will send a request for prior approval to the medical advisor if all the criteria for healthcare/social security are in place.

It is imperative to correct any deficiency in terms of vitamins and nutrition and to stop smoking at least 2 months before the planned surgery for optimal wound healing and to limit the risk of complications.

You will be evaluated by our assistant orthopaedist. Depending on your morphology, physical activity, and many other criteria relative to your lifestyle
as a patient, the orthopaedist will choose  the  support belt which suites you best, from a large range of products.

The intervention is only carried out when the patient’s weight has stabilised for a period of at least 15 months after undertaking bariatric/weight-loss surgery such as a  sleeve gastrectomy or a gastric bypass – LRYGB.

The daily application of moisturising cream on the abdomen, as recommended by certain teams, is unnecessary.

Technique

– Skin incision

• Situated just above the pubis (around 12cm long), at the same level as a horizontal C-section scar,  going up towards the top of the hips.
• Sometimes a small vertical midline incision is necessary.
• Furthermore, an incision will be made around the navel.

– Detachment

• From this incision, skin and fat are detached from the abdominal wall, up towards the lower margin of the rib cage.

– Restoring muscle tension

• If the long flat muscles of the abdomen are moved aside, leaving a space between them (diastasis, the separation of normally joined parts, is often secondary in pregnancy and  in weight fluctuations), they will be brought together along the median line, above and beneath the navel. The effect is to make the waist more centred and re-tone the abdominal wall. At the same time, it will be possible to correct an eventration at the level of the umbilicus.

– Rearranging the skin

• Excess skin-fat is removed.
• The navel (which stayed in place) is fixed after having created an orifice for its passage.
• Sutures are put in place (slightly taught).

Possible complications

• Haematoma.
• Infection.
  • Infection is a complication with a frequency rate of 1%.
• Skin necrosis.
  • Necrosis of the skin of the lower abdomen may occur and prolong the healing time. Normally, primary wound healing is completed after 10 to 15 days.
• Thrombosis.
• Seroma.
  • Light physical activity (walking) is recommended, and any violent exercise is to be avoided for 6 weeks.
  • The occurrence of thrombosis (the vein in a leg becoming blocked) is averted by getting up early the day after the operation and wearing support stockings on both legs.
  • Smoking increases the risk of complications and retards wound healing.