Abdominoplasty

Your GP or another specialist that knows you well must make a referral to Dr Avery. The decision to have a consultation may be made after talking with family or friends or following your own research into plastic surgery and Dr Avery.

The purpose of your initial consultation with Dr Avery is to discuss your motivations for surgery and expectations from surgery. It is an opportunity to openly communicate what you want to change, alleviate or remove. We will discuss any concerns you may have about your potential surgery and its outcome. We will also collect information that is specific and tailored to you, to add to the knowledge you acquired through your research outside of the consultation process.

When you arrive at Avery, you will check in with our Care Team and complete a medical history form, if not already completed. We encourage you to bring a supportive family member or friend who can remain with you throughout the consultation if you like, and be a sounding board during your decision-making process following the consultation.

The consultation with Dr Avery will include an examination of the area of your body that you are concerned with and considering changing. Our aim will be to determine if plastic surgery can achieve what you hope it will, and if so, what specific plastic surgery procedures will address your concerns and meet your expectations in a realistic way.

Plastic surgery procedures can impact physical appearance and there may be a psychological response to the changes in your body after surgery. Besides the reasons for having plastic surgery, it is important to be fully aware of any potential limitations of the operation and how they apply to your unique situation. This includes the risks of having surgery and all of the possible complications that can occur after surgery, and what can be done if these occur.

We will discuss what the surgery involves, how it relates to you specifically given your uniqueness and current state of health, what the possible risks of the surgery are, and then decide if having the surgery is a safe and appropriate choice for you as an individual.

Your consultation will also include a discussion of the estimated financial implications of having this surgery or surgeries that were discussed with Dr Avery.

After your consultation, our Care Team will be there to talk through any further questions you have, including the cost of the surgery.

At Avery, our goal is to ensure you are equipped with the knowledge needed for you to feel empowered throughout the decision-making process, surgery and post-surgery.

There are a number of variations to an abdominoplasty surgery, depending on your unique starting point and goals.

Common variations on an abdominoplasty include a traditional abdominoplasty, mini-abdominoplasty, a ‘Fleur de lis’ abdominoplasty, a reverse abdominoplasty, and finally a circumferential abdominoplasty or body lift.

Traditional Abdominoplasty

A traditional abdominoplasty is the most common type of abdominoplasty performed and is indicated when there is an excess of loose skin that can be pinched and pulled away from the body. A traditional abdominoplasty typically achieves a flat abdominal contour with a scar that extends from hip to hip and an additional scar around the umbilicus (belly button).

The upper layers of skin and fat are then lifted up to expose the abdominal wall. These stretched abdominal muscles are then sutured together to tighten the inner abdominal core.

Once the muscles of the abdominal wall have been repaired, the remaining skin layers are stretched down below the incision on the pubic line. The excess skin is removed and a new hole is made for the umbilicus.

Mini-Abdominoplasty

A mini-abdominoplasty (mini tummy tuck) can be performed when less skin removal is required and repositioning of the abdominal muscles is also required. A mini-abdominoplasty is indicated when the skin is a little loose and there is a bulge on the abdomen rather than excess skin. A mini-abdominoplasty typically requires a shorter lower abdominal incision and does not result in a scar around the umbilicus (belly button).

The following abdominoplasty variations may place scars in different locations on the abdomen influenced by the location of skin excess, previous scarring and individual goals:

Fleur de lis Abdominoplasty

The Fleur de lis (FDL) technique for an abdominoplasty is an extended variation of an abdominoplasty and is best suited when there is a pre-existing vertical scar on the abdomen or the skin is loose horizontally on the abdomen as well as vertically. The FDL surgery results in a vertical scar along the midline of the abdomen in addition to the traditional lower abdominal scar.

Reverse Abdominoplasty

The reverse abdominoplasty (also referred to as reverse tummy tuck) is less commonly performed and is only considered when there is loose skin in the upper abdomen, or previous scars. This makes this procedure a safer alternative. The reverse abdominoplasty results in a scar that sits along the upper part of the abdomen, essentially underneath the breast line.

The circumferential abdominoplasty (or body lift) has a scar that runs along the full width of the lower abdomen and back.

The length of the surgery will depend on the amount of skin and tissue being removed and any additional operations being performed. A partial abdominoplasty usually takes between 1–2 hours, while a complete abdominoplasty can take between 3–4 hours.

As with all surgical procedures, abdominoplasty surgery does have risks, despite the highest standards of practice. It is not usual for any surgeon to outline every possible side effect or rare complication of a surgical procedure. However, it is important that you have enough information about the most common risks to fully weigh up the benefits, risks, and limitations of surgery.

The following possible complications are listed to inform and not to alarm you. There may be other complications that are not listed. Smoking, obesity, and other significant medical problems will cause greater risk of complications.

Some general risks and possible complications of surgery include, but are not limited to the following:

• Heavy bleeding from an operated site. This may require a blood transfusion.
• Infection that may require treatment with antibiotics or further surgery in some cases.
• Allergic reaction to sutures, dressings or antiseptic solutions.
• The formation of a large blood clot (haematoma) beneath an incision site may require further surgery.
• Complications such as heart attack, pulmonary embolism or stroke may be caused by a blood clot, which can be life threatening.
• Pain, bruising and swelling around the operated site(s).
• Slow healing, often related to smoking or diabetes.
• Short-term nausea following general anaesthesia and other risks related to anaesthesia.
• Tissue cannot heal without scarring and that how one scars is dependent on individual genetic characteristics. Dr Avery will do his best to minimise scarring but cannot control its ultimate appearance.
• Smoking or using nicotine products during the 3–4-week pre-operative and post-operative periods is prohibited as these could dramatically increase the chances of complications.
• All medications I am currently taking, including prescriptions, over the counter remedies, herbal therapies and supplements, aspirin, and any other recreational drug or alcohol use can affect the safety of my surgery.
• There can be no guarantees about the results of any surgery.

Some specific risks for abdominoplasty surgery include, but are not limited to the following:

• Seroma or fluid under the skin
• Infection and Delayed healing
• Asymmetries of contour
• Recurrent laxity of skin
• Bleeding or haematoma (clot) requiring surgery
• Loss of skin from insufficient circulation (requiring further surgery and skin graft)
• Change in sensation or numbness of abdominal skin
• Loss of umbilicus (belly button) or displacement to the side
• Pulmonary embolism or blood clots in the lung
• Changes in shape or appearance of pubic hair
• Permanent scars
• Pain (may be prolonged)
• Need for more surgery for surgical corrections (revision surgery) or further treatment
• Further recovery time if further surgery is required
• Failure to alleviate symptoms of rash and back pain
• Extended hospital stay may be required, beyond the typical time indicated
• DVT (deep vein thrombosis) - clot in legs or PE (pulmonary embolus) – clot in lungs
• Allergic reactions to tape, suture material, topical preparations, medications
• Disappointment or dissatisfaction with result
• ‘Dog ears’ (excess skin at scar end)
• Loss of skin from insufficient circulation (requiring further surgery and skin graft)

The Australasian Society of Aesthetic Plastic Surgeons (ASAPS) has further information about abdominoplasty surgery including the possible risks for this surgery.

When undergoing an abdominoplasty you’ll typically stay in hospital overnight from 1-4 nights to aid with recovery. Depending on the complexity of the surgery and any additional procedures, and the nature of your job, from 2-4 weeks off work may also be recommended.

In the case of a full abdominoplasty, drainage tubes are often inserted below the main incision to allow the release of fluid. These tubes, and any residual stitches will usually be removed prior to discharge from hospital.

There will be some bruising and swelling, in addition to a feeling of muscle tightness due to the abdominal muscle separation repair, which generally subsides about 2-6 weeks after the surgery. You will be required to wear a compression garment for up to 6 weeks to provide support and reduce post-operative pain or swelling.

It is recommended that you avoid heavy lifting or vigorous exercise for at least 6 weeks after an abdominoplasty. Depending on the physicality of your job, you should be able to return to work and light exercise after 2 weeks.

A customised pain relief program will be created for you and issued before leaving the hospital. If circumstances change at any stage during the recovery period, then the pain medication can certainly be adjusted accordingly.

Scars from an abdominoplasty can vary depending on whether or not the umbilicus (belly button) is relocated and how well your skin copes with scarring. The large scar from an abdominoplasty should be hidden when wearing underwear or a swimsuit and will generally fade with time.

The financial aspects of your surgery are as important as the medical elements when planning for surgery. At Avery, the surgeries we offer fall into three different financial categories: Self-funded – aesthetic surgery; self-funded – plastic and reconstructive surgery; and health insured – plastic and reconstructive surgery.

To make sense of these three financial categories, we have created a detailed price guide to help you understand what may or may not be covered by your health insurer/Medicare and your out of pocket expenses.

To download this guide, please click here.

For more information or to book a consultation, please contact our team on 02 4002 4150.

Abdominoplasty (which has also been referred to as a tummy tuck) is a surgery that consists of the removal and tightening of the abdomen skin, removal of excess fat where appropriate, and repositioning or tightening of the rectus abdominis muscles if required.

Scarring will vary between patients. The size and location will depend on the type of surgery had, as well as your skin type. Usually, the scar will be red at first, but fades over time, finishing a little lighter or darker than the surrounding skin after 12-18 months.

Abdominoplasty does not affect your ability to get pregnant. The skin of the abdomen stretches during pregnancy and this may be uncomfortable following an abdominoplasty. The abdominal muscles will also possibly stretch again during pregnancy and any gap that has been repaired during an abdominoplasty may recur. For this reason, it is a good idea to wait until after having children before having an abdominoplasty.

Gentle movement, such as walking, is advised, and is recommended during the first 2 weeks after surgery. An increase in activity is encouraged between 2-6 weeks, limiting this increase based on how your body feels and responds. From 6 weeks you can be mostly unrestricted with exercise but it may not be until 12 weeks following surgery that you feel you are back to pre-surgery fitness.

Pain following surgery is common and will vary depending on the extent of surgery and your own unique circumstances. Pain immediately after surgery may be reduced by the use of local anaesthetic at the surgical site, given during the surgery. The pain will also be managed with tablets or injections as required during your hospital stay and over your recovery at home. Physical measures such as the dressing, supportive garments, limited movement and possibly ice packs will all help minimise any pain. Pain is usually well tolerated within a few days after surgery with all of these measures in place. If your pain is increasing following surgery this is usually a sign that you may need a review to ensure your recovery is proceeding as expected.

The Avery Care Team is available to check in with regularly to monitor your pain levels and recovery. A good general rule throughout your recovery is if an increase in movement or activity does not increase any discomfort or swelling, then it is probably safe and this gradual progression back to ‘normal’ will be encouraged.

There are a number of types or variations of abdominoplasty, and what type of abdominoplasty is appropriate for any given person will depend on a number of factors unique to the individual. A mini abdominoplasty involves removing skin from the lower abdomen. A traditional or full abdominoplasty involves incision along the lower abdomen and around the umbilicus (belly button). An extended abdominoplasty involves incisions extending further around the lower part of the body and in a circumferential abdominoplasty this may join up around the entire abdomen and back area. This is sometimes referred to as a ‘360 abdominoplasty’ or a ‘body lift’. A Fleur de Lis (FDL) abdominoplasty involves a vertical incision along the length of the abdomen in addition to the lower horizontal abdominal incision. In addition to the skin removal component, a variable amount of liposuction may be involved with an abdominoplasty, and there also may be ‘muscle repair’ if required, eliminating an excessive gap between the rectus abdominis muscles, or tightening this inner layer of the abdominal wall.

Before considering any surgery, researching the type of surgery and the potential surgeon to perform this surgery is important. The next step is a consultation where the surgeon can listen to what you’re hoping to achieve and examine you to determine if this is a reasonable expected outcome of the surgery being considered. During this process the surgeon will determine what type of abdominoplasty is best for what you’re hoping to achieve and what is clinically possible.

Liposuction is the surgical removal of fat from the underneath the skin. It may be performed with an abdominoplasty to areas of skin that are not excised to help ensure the contour of the remaining skin is appropriate.

Typically, if your surgery is considered cosmetic in nature and does not have a related item number, private health insurance does not cover this surgery. If the surgery is being considered to address significant developmental differences, changes from previous trauma, or to relieve nasal obstruction, then a Medicare item number may apply to the surgery and there may be some cover of this procedure through private health insurance.

Sun exposure can adversely impact early wound healing and have an adverse effect on the pigmentation and long-term quality of you scar(s). All scars should be protected from sun until they are mature, which may not be until one-year post-surgery. A spray tan is okay after a few weeks (once the wound is healed).

Muscle separation, otherwise known as rectus diastasis or divarication refers to an increased gap between the vertically aligned rectus abdominis muscles that sit on either side of the midline of the abdominal wall, these are the muscles that can give the appearance of a ‘six pack’. With pregnancy, it is possible that the two muscles move apart from each other and after pregnancy, the muscles stay apart and the layer of tissue that encases the muscles becomes loose. During an abdominoplasty this separation can be repaired and the lose tissue layer covering the muscles can be tightened.