ABDOMINOPLASTY

The Abdominoplasty is a plastic surgery technique in which the excess of skin and fat in the abdomen is withdrawn, in addition to escrow (tie) abdominal muscles to make the abdomen more flat and mark the waist. This excess skin occurs after pregnancy or after major weight loss in obese patients.

Generally the abdominoplasty should be associated to processes of liposuction or liposculpture to obtain the harmony of the corporal contour. The surgery team consisting of 2 plastic surgeons, an instrumentist, an anesthesiologist and two circulating; performs the withdrawal of the excess skin of the abdomen by means of an incision located in the lower part of the abdomen that remained cover by the underwear and another in the navel (ask its plastic surgeon on the shape of the scar and its preference).

Jointly a liposculpture of back and waist is made to give harmony to the corporal contour highlighting the gluteal prominences and the waist (in a procedure associated call Liposculpture), the aspiration of the fatty tissue will take place on the same day of surgery, avoiding subsequent procedures (Liposculpture of belly) and obtaining better results in a single surgical time, therefore the period of recovery and the drainage of fluid is greater than in a lipectomy, procedure in which no fat is aspired of the abdomen. This procedure lasts approximately 4 to 6 hours.

Generally abdominoplasty is done with epidural anesthesia in which the patient is conscious but sedated (similar to the spinal but more superficial without reaching the central canal) or with general anesthesia. The anesthesia always will be administered by an anesthesiologist who accompanies the patient during all the surgery and recovery.

After the surgery the patient remains in recovery in the clinic for a period that various from 6 to 24 hours; then the patient is released and should remain with a drain for a period that various from 1 to 15 days, should also rest at home for two weeks. The surgical injuries remain with sensitive suture stitches generally covered by tapes.

Requisite The patient candidates to be submitted to any plastic surgery should be carried out a laboratory exams series and the appraisal preanestesica, that guarantees us the good state of the patient and that have not factors that contraindiquen the plastic surgery. The patients will be submitted to a pre photographic study and post operating that is a proxy for legal end and of appraisal of results.

REQUIREMENTS

Patients candidates to be submitted to any plastic surgery should take some laboratory tests and preanesthesic appraisal, which guarantees the good condition of the patient and not having factors that oppose to the plastic surgery.

The patients will be submitted to a pre and post operating photographic study that is mandatory for legal purposes and appraisal of results. The patient should also be aware that this is not a procedure that is performed to be able to eat without restrictions and without altering their measures.

- One or two days before the surgery patients should shave all the pubis (women) and the pubis and belly (men).

POSTOPERATIVE CHANGES.

After an abdominoplasty the patient remained with the skin of the abdomen tensed which obliges to walk semi arched to not stress the surgical injury.

- In the first and second day is common the exit of some quantity of bloody liquid by the orifices in the skin (generally in the navel, groin and back), as well as the pain is progressive in the areas operated as back and abdomen. Also it is common to present vomiting in the first day, dizziness and headache in the first week; therefore the accompaniment of the patient is recommended at the moment of taking bath in the early days.
- In the first week an alteration in the frequency of the intestinal depositions can be presented due to the rest, this inconvenience can be improve by increasing the consumption of fiber, fruits and water, we recommend the consumption of fruits as papaya and pitahaya.
- It’s also frequent the edema of legs and ankles in these first weeks.
- After the second day the edema (swelling) begins to increase to the point of being unable to wear the clothes that used to wear before the surgery.
- From the second week the swelling and bruising are declining and begins to appear a filling under the skin. These fillings (cravats) are dispelled and some nodules under the skin are formed until the third or fourth week when they go diminishing until disappearing around the 4 months. - Then the skin continues being contracted until the six months when the final result is reached and the softness and skin smoothness recovers.
- The under navel area will remain anesthetized by a period of approximately 1 year.
- The scar varies color and consistency; initially is red or pink and in approximately 6 months changes to white and soft.

The scar changes of color between a year and a year and a half. Eventually the internal stitches that are absorbable, can be expelled through the skin, a small amount of bloody-yellow liquid; without requiring a special conduct other than washing with water soap and cleaning with alcohol

COMPLICATIONS

The abdominoplasty is susceptible to complications as any surgery and some local disturbances or sequels generally are corrected by retouching.

In some cases the accumulation of liquid after removing the drainage is presented, in that case it will be necessary to remove it through a puncture.

POSTOPERATIVE CARE

- Maintain the arched position for 2 weeks to avoid tension on the injury producing distortions or lateralization of the navel.
- Do not receive sun until the ecchymosis disappears, generally from 3 to 6 months.
- Wash with soap and water the area of stitches (usually covered with tape), dry and then clean with alcohol, do not withdraw or change the tapes. After cleaning with alcohol gentamicin cream should be applied in the navel and into the hole where the drainage goes. Then apply moisturizing cream all over the body.
- Once a day (after the bath) the measure of the liquid drained should be measured and carry annotation of this. This drain is fixed to the skin of the pubis through a stitch which should not be cut or hale for any reason.
- It is recommended to use hyperbaric chamber to improve the oxygenation of tissues and thus reduce the formation of spots on the skin, also reduces the incidence of complications (necrosis and suture dehiscence), and also accelerates the patient recovery diminishing the convalescence time.
- Using a rubber belt or a body of Lycra for a month as recommended by your plastic surgeon.
- Use of an elastic girdle or of a body of Lycra by a month when be indicated it the plastic surgeon and always protecting the skin with diapers or protectors so that the skin do not get damaged.
- Receive medicines and care ordered in the medical prescription, by the time indicated.
- The controls with the surgeon are carried out to the 5, 15, 30 or 90 days according to the preference of the surgeon.
- The stitches are absorbable without need to withdraw.
- Eventually it becomes necessary to drain fluid accumulated under the skin (performed by the surgeon when he considers it is necessary)
- The post-operative massages are contraindicated in abdominoplasty.
- The work activities that do not require physical effort can be resumed within 2 weeks, sports and heavy works in three months.
- The patient should carry an adequate diet for his weight, stature, activity and age. Therefore if there is an excess of consumption, the nutrients will accumulate in the shape of subcutaneous fat tissue as occurs in any person with or without Liposculpture. The professional who will guide you on the best diet to follow is the nutritionist.
- In case of any doubt, call your plastic surgeon.
- Call your plastic surgeon also in case of fever (over 38.5 Celsius degrees), in case of abundant bleeding, severe pain in the chest or difficulty to breath (It’s common to be a difficulty to breathe because of the abdominal pain).