Abdominoplasty (Tummy Tuck) After Massive Weight Loss
Dramatic weight loss has many health benefits. If you've recently undergone (or are currently undergoing) a weight loss journey, congrats!
Unfortunately, after any substantial amount of weight loss - whether due to weight loss surgery or lifestyle changes, many people find that their skin and tissues lack the elasticity to conform to their newly reduced body size.
Luckily, there is a surgical option to remove the excess skin and fat and repair problematic muscle tissues. An abdominoplasty after massive weight loss is a surgical procedure designed to remove the excess skin and other concerns commonly seen in weight loss patients.
WEIGHT GAIN AND LOSS: Explained
Obesity changes the quality and dynamics of abdominal wall tissues, fat, and skin. As we gain weight, our skin stretches, stretch marks form, and our abdominal muscles weaken. Increased fat in the intra-abdominal area leads to a separation of muscles in the midline, which can be especially pronounced in women who have experienced pregnancy.
Weight loss decreases the amount of fat in the your body, especially within the subcutaneous layer. If you lose a considerable amount of weight, your skin might remain stretched and sagging even after you've lost the weight.
If the weight loss is more rapid than gradual (like in patients who have undergone a weight loss surgery), you might end up with skin that stretches and hangs over your abdominal area.
It is also not uncommon to see abdominal hernias in patients who have undergone significant weight loss - either within previous abdominal incision sites or even spontaneously.
And of course, as we lose weight - it doesn't always happen evenly. Some patients lose fat in the abdomen but not the hips or thighs (pear shape) - others lose fat in the arms and legs but struggle to lose weight in the abdominal area.
Each of these considerations demand an individualized approach to the abdominal contouring of a patient who experienced massive weight loss.
AM I A GOOD CANDIDATE FOR ABDOMINOPLASTY?
Like with most other post-bariatric body contouring procedures, a good candidate for the surgery is:
In reasonably good health
Has some established weight loss
Has realistic expectations and a positive outlook
Is not a smoker
The presence of scars from previous surgeries may limit some options. The procedure should also be postponed if an active infection is present.
If you smoke, you will be asked to quit smoking two months prior to treatment as well as during recovery to reduce risk of bleeding. If you do not follow these instructions, your surgery will be cancelled for your safety.
The purpose of your consultation with Dr. Majewski is to evaluate whether you are a candidate for abdominoplasty (or a different procedure) and to develop a treatment plan that will help you achieve your goals.
Dr. Majewski will ask you questions about:
Your surgical goals
Medical conditions, drug allergies and medical treatments
Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
He will also:
Evaluate your general health status and any pre-existing health conditions or risk factors
Discuss your surgical options and other non-surgical treatment options (such as CoolSculpting®)
Recommend a course of treatment
Discuss likely outcomes of abdominoplasty and any risks or potential complications
The consultation is the time to ask Dr. Majewski any questions you may have regarding the procedure, recovery, and expected results.
It's very important to understand all aspects of your tummy tuck procedure. It's natural to feel some anxiety, whether it's excitement for your anticipated new look or a bit of preoperative stress - or both. Don't be shy about discussing these feelings with Dr. Majewski.
The cost of the tummy tuck procedure varies depending on the extent of your surgery, and whether you decide to undergo other procedures at the same time. The cost of your procedure will include anesthesia fees, surgical facility costs, medical tests, post-surgery garments, prescriptions for medications, and the surgeon’s fee.
When choosing a board certified plastic surgeon for abdominoplasty, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the surgery.
You might also consider the cost of childcare or other assistance you might need during your recovery period - such as meal delivery, a cleaning service, etc. Although usually not necessary, some patients prefer to delegate some of their household responsibilities during the first few weeks of recovery so they can focus on healing fully.
During the procedure, you’ll be placed under anesthesia for your comfort and safety. A fully tummy tuck requires a horizontal incision in the area between the pubic hairline and belly button. The shape and length of the incision will depend on the amount of excess skin to be removed. In patients who have undergone massive weight loss, a second incision is often necessary to remove excess skin in the upper abdomen.
Once the abdominal skin is lifted, the underlying weakened abdominal muscles are repaired.
Once all excess skin and fat have been removed and muscles have been repaired, the incisions are closed and recovery begins.
Tummy tuck recovery typically lasts several weeks. Before scheduling your surgery, think through what time of year makes the most sense for you to undergo this procedure. If you typically get summers off of work, then summer might be a great time for you to recover from your surgery. If your work schedule is less flexible, you might consider getting surgery around a holiday or other break - such as around Thanksgiving, Christmas, or spring break - when you will have family around to help you as you recover.
During your tummy tuck recovery, dressings or bandages may be applied to your incisions, and you may be wrapped in an elastic bandage or a compression garment to minimize swelling and support your abdomen as it heals following surgery.
Small, thin tubes may be temporarily placed under the skin to drain any excess blood or fluid that may collect.
The exact timeline of your recovery period will vary depending on the extent of your procedure - but you should prepare yourself mentally for a recovery period with limited activity for a few weeks to months. Although every patient recovers differently, here is a general recovery timeline of a typical liposuction patient:
Weeks 1 and 2: May experience mild to moderate pain, which will be managed through prescription pain medication for the duration of this period. You will not be allowed to drive while taking pain medication and should plan accordingly. Bandages placed on scars will need to be changed in 1-2 days after surgery. Drains and sutures are removed by your surgeon the first 5-10 days, You may also experience bruising, numbness and swelling during this time. Some patients can return to work during this time, provided that their job does not require them to do anything too physically demanding.
During the first few days, you may not want to move too much, but you should walk and move around as much as you can to prevent blood clotting. The body compression garment given to you after surgery will help to minimize swelling, and should be worn for the first few weeks.
Weeks 3 and 4: The pain should subside. Most patients stop taking pain medications by this point, and are able to manage pain with over the counter (OTC) pain medications. You may still experience swelling and numbness, but will be able to return to work if you haven’t done so already.
Weeks 4-16: You should regain feeling and sensation in the area. Swelling may continue, but the final result should be apparent no later than six months. When you are able to return to exercise, take it slow, gradually working back up to your old exercise schedule. Be sure to ask Dr. Majewski for his recommendations regarding all physical activity including exercise.
You will be far more satisfied during your recovery period if you know what to expect - so be sure to ask Dr. Majewski for clarification regarding what to expect during your individual recovery period, including:
How to care for the surgical site and drains
Medications to apply or take orally to aid healing and reduce the potential for infection
Specific concerns to look for at the surgical site or in your general health
When to come in for your follow-up appointments
Make sure that both you and whoever might be assisting you understand your care instructions and ask any questions you may have. This will ensure a quick and smooth recovery.
Within a week or two after surgery, you should be standing tall and confident in your new slimmer profile. Your tummy tuck will result in a flatter, firmer abdominal contour that is more proportionate with your body type and weight. Most patients report a significant boost in confidence after their surgery!
Similarly to liposuction, you’ll experience some swelling for one to three months after surgery. When this swelling subsides and your skin tightens around the treated area, you’ll be able to see the full results of your surgery.
A tummy tuck does involve a larger incision - sometimes two. With proper scar care, scars will usually fade as much as they will after about one year. It is important to begin scar care as soon as the wound closes to ensure the scars fade as much as possible. In women who have undergone cesarean section, the existing scars may be incorporated into the new scar. This is a trade-off, but most women feel these are small compared to the large improvement in their self-confidence after surgery.
Dr. Majewski will provide his recommendation for a scar gel that will encourage your scars to heal quickly. As with all scars, keep your scar out of direct sunlight. Always apply sunscreen if your scar will be exposed to sunlight - the SkinMedica Essential Defense Mineral Shield Broad Spectrum SPF 35 formula is specifically formulated for post-procedure sun protection.
ARE RESULTS PERMANENT?
The results of your tummy tuck will be long lasting, provided you maintain a stable weight and general fitness.
As your body ages, it is natural to lose some firmness, but as long as you maintain a healthy lifestyle, you will continue to enjoy your results for years to come.
Ready to Get Started?
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