Cosmetic surgery of the abdomen is a very common request. Many women and men are dissatisfied by the appearance of their abdomen. Once stretched by pregnancy or weight gain, the abdomen often does not return to its original state even with the most rigorous diet and exercise. People who just don't have the time or inclination to do rigorous diet and exercise can also be greatly helped by plastic surgery. Aging too is a factor with tissues sagging as the years pass.

Improvement of the abdomen requires a complex decision process. The patient and plastic surgeon must weigh the benefits, scars, recovery and tightening aspects of various procedures. Dr Koenig is very experienced in all options available and once the patient's goals are understood, will recommend the appropriate procedure.

The simplest plastic surgery procedure and often the best may be liposuction. In the patient whose muscle tone is excellent and who is not bothered by redundant skin, liposuction of the abdomen can have impressive results with a rapid return to normal activity. Patients who have some muscle laxity, but no skin laxity, can benefit from endoscopic tightening of the abdominal fascia and liposuction.

The next step in complexity is mini-abdominoplasty which keeps the incision short (just above the pubic hair area) and then tightens the muscle layer as well as the skin layer below the belly button.

The next step is a mini-abdominoplasty with umbilical float - this is similar to a mini but can have some tightening effect above the belly button. Next on the list is a full abdominoplasty. Here the incision lies in the bikini line but goes from hip to hip. The belly button is left in place and the abdominal wall is stretched downward with the excess being cut off. There is also an incision around the belly button. This tightens the entire anterior abdomen.

If laxity of skin extends more laterally, an extended abdominoplasty may be necessary. Often in patients with a great deal of weight loss, this can be quite helpful in tightening the flanks which full abdominoplasty does not do.

Finally the most extensive procedure is belt lift. This is usually performed on patients who have had massive weight loss often through gastric bypass surgery. The patients benefit not only from a tightening of the abdomen but also a tightening of the lateral thighs and a lift of the buttock.

Liposuction of the hips is a common adjunct to abdominoplasty and helps many patients with the final shaping.

THE OPERATION- TUMMY TUCK
Tummy tuck surgery is usually performed under general anesthesia, but liposuction and mini abdominoplasty can be done with local anesthesia and sedation. In patients with a full abdominoplasty (tummy tuck) and lesser procedures, the patient is able to go home the same day. A tummy tuck procedure takes about 2 hours. More extensive procedures require more time and recovery. An extended abdominoplasty requires an overnight stay and a belt lift may require 2 days in the hospital. The pain level after tummy tuck surgery is significant and pain medications are required. A garment is put on in the operating room and the patient must keep it on for the first 3 weeks after tummy tuck surgery. A drain is placed in most patients and removed in one week after your tummy tuck.

RECOVERY- TUMMY TUCK SURGERY
A full abdominoplasty (tummy tuck) usually has significant pain for the first 2-3 days and is sore for the first week. Often the patient cannot stand up straight for the first week after tummy tuck surgery. After 2 weeks most patients can return to driving and normal household activity; after 3 weeks most people return to work. Walking is encouraged on day one of the tummy tuck surgery and it is important not to become too sedentary. Restrictions on lifting and sit ups are in place for 6 weeks. After 6 weeks, full wound strength is present and there are no limitations. Mini tummy tuck has an accelerated recovery by comparison and extended abdominoplasty takes a bit longer.

COMPLICATIONS- TUMMY TUCK SURGERY
Abdominoplasty (tummy tuck) is major surgery and complications are possible. Bleeding and infection can occur. The most common complication for tummy tuck surgery is a collection of fluid under the skin which is drained in the office. More rare complications can occur with the most feared problem being a blood clot in the leg. Blood clots in the leg can be serious and even life threatening if the clot moves into the lungs. This is a rare problem and measures are taken to minimize the chance of this happening. Nevertheless patients must understand that it is a possibility. Smoking increases the chance of all complications and Dr. Koenig does not perform abdominoplasty on active smokers. If the patient is a smoker, they must quit one month before tummy tuck surgery and cannot resume smoking for one month after surgery.

PRE-OPERATIVE INSTRUCTIONS:

THREE WEEKS BEFORE TUMMY TUCK SURGERY:

• Laboratory and EKG (if they are required) must be done. If you are having your preoperative testing at a lab other than the one we suggested, you are responsible for having the written results of this testing arrive at our office one full week before surgery (our fax number is 585-271-4786).
• TUMMY TUCK SURGERY WILL NEED TO BE CANCELLED IF THERE IS ANY CHANCE THAT YOU ARE PREGNANT.
• All fees are due, including surgical, facility and anesthesia.

TWO WEEKS BEFORE TUMMY TUCK SURGERY:

• Do not take any products containing aspirin, ibuprofen (Advil, Motrin), non-steroidal anti-inflammatory medication or Vitamin E. Tylenol is acceptable.
• Refrain from all nicotine products, including cigarettes, pipe tobacco, chew or Nicotine patch. Nicotine interferes with healthy circulation and may affect the result of your tummy tuck surgery. It also places you at higher risk of complication when receiving anesthesia.

ONE WEEK BEFORE TUMMY TUCK SURGERY:

• Do not drink alcohol for 1 week before and after tummy tuck surgery.
• Please ensure that all laboratory tests and/or blood work has been completed by this time as ordered by the plastic surgeon/nurse practitioner. Our fax number is 585-271-4786.

THE DAY BEFORE TUMMY TUCK SURGERY:

• Call 244-1135 to obtain arrival time for the day of tummy tuck surgery.
• DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT. (This includes water and gum chewing). Tummy tuck surgery may be cancelled if this is not followed. A fasting state is required in order to receive sedation for surgery. The only exception is medication, which we instruct you to take with a sip of water the morning of surgery.

DAY OF TUMMY TUCK SURGERY:

• Go to suite 101 (Lindsay House Surgery Center).
• You may shower and shampoo the morning of tummy tuck surgery. Do not wear makeup, hair sprays or gels or nail polish. You may leave acrylic nails on.
• Please wear loose fitting clothing.
• Do not wear jewelry, including boy jewelry or bring valuables to surgery.
• If you have your menstrual cycle, please wear a feminine napkin. Do not wear a tampon.

POST-OPERATIVE INSTRUCTIONS:

COMMON INSTSRUCTIONS AFTER TUMMY TUCK SURGERY:

• A responsible adult must provide transportation for you after surgery (public transportation is not permissible).
• A responsible adult must stay with you overnight and after surgery until the morning following the procedure. If you are having several procedures, you may need or prefer assistance for 1-2 days following your procedure.
• Avoid making major decisions or participating in activities that require judgment for 24 hours after surgery.
• Do not drive for approximately 10-14 days and while you are taking pain medication.
• Avoid any activities that cause pain or discomfort.
• Limit your activities for the first 24 hours after surgery. Walk for short distances during the first 24 hours after surgery. You may not be able to stand straight up for the first week. This is normal. By the second week you will gradually notice that you are able to stand more upright. Keep your hips flexed while in bed for the first week or so to prevent excess tension at the surgical site.
• Take deep breaths often for the first 24 hours post operatively.
• Pump legs while lying down to prevent blood clots. Resume activities slowly. You may feel tired for the first few days. Avoid heavy lighting, bending and straining for 4-6 weeks. You may resume all activity after six weeks.
• Expect significant pain for the first 24 hours. Take your pain medication before pain becomes severe. \
• Take all medications as instructed.
• Swelling and bruising are normal. It is expected to take between 3-6 months to see your final results.
• Drink plenty of fluids for the first couple of weeks after tummy tuck surgery as this will h ell you to remain well hydrated and reduce swelling.
• After tummy tuck surgery it is common that you will have a drain at the surgical site. Drains help to remove excess fluid from the abdomen. The amount of drainage will determine how long the drain will be left in place. Follow the separate instruction sheet on drains that will accompany your paperwork post operatively.
• You may change the absorbent gauze pads that are placed at the surgical site needed to help keep the incision clean and dry.
• A surgical garment will be applied immediately after your tummy tuck surgery. This is to be worn continuously for the first week. After one week you may remove the garment to shower. After showering, the garment must be placed back on and worn for up to six weeks.
• You will notice some surgical tapes placed over your incision. If they get wet from showering, you may help them to dry by using a blow dryer (cool setting). Leave tapes in place as they will fall off on their own.
• Avoid direct sunlight to the incision for at least 1 year. Use a sunscreen with zinc oxide with SPF 20 or greater to help decrease the visibility of the scar.

CALL OUR OFFICE IF YOU DEVELOP ANY OF THE FOLLOWING:

• Fever of 101 degrees F or greater.
• Pain not relieved with pain medication.
• Swelling, redness, bleeding, and/or foul drainage from an incision site.
• Persistent nausea and/or vomiting.
• Any other concerns.

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