Changes in the abdomen
Abdominoplasty is the surgical procedure that makes the most effective difference in the correction of changes that occur in the belly, waist and upper abdomen (stomach) region, especially after the pregnancy process. It is effective because it interferes with many tissues such as skin, fat, muscle, fascia. Because, especially after multiple pregnancies, not only excess fat and skin occurs in this region, but also the structures that limit the abdominal cavity, which we call the anterior abdominal wall, which limits our internal organs, also stretch and become loose, resulting in a cambered appearance. Apart from this, stretch marks (striae) occur in the abdomen due to pregnancy. No matter how much the person weakens or builds muscle, organs such as the stomach and intestines in the abdominal contents slide forward with the effect of gravity, creating camber and sagging. In addition, the enlarged skin cannot shrink to its former state, so a sagging, layered appearance is almost always present. There is currently no treatment for cracks other than surgery.
Although pregnancy often seems to be the cause of these conditions, similar situations occur after severe weight loss. In this case, the tissues that expand the anterior abdominal wall are not the uterus and the baby, but the adipose tissue in the structure of the internal organs and surrounding the internal organs. Similar mechanisms and results are equally valid. In addition, the same appearance may occur in advanced age, as the hardness and durability of the tissues decrease.
Options for abdominal aesthetics
Although there are multiple options for this region, tummy tuck (abdominoplasty) operation is an intervention that includes all procedures. Smaller operations can also be performed in line with the condition, needs and expectations of the person’s abdomen.
If there is a slight excess of skin or flexibility in the anterior abdominal wall, successful results can be obtained with liposuction alone. Liposuction should be considered, especially if fat accumulations in the waist and upper abdomen are disturbing. This procedure is mostly preferred in male patients over normal weight or in young women who have not given birth. In people with excess skin, only liposuction will reduce the waist and belly circumference in centimeters, but the appearance of sagging will increase. However, if there is some excess skin, only a small amount of skin removal, called a mini tummy tuck, can be added. Especially if there is an old cesarean section scar, an extra scar can be avoided by doing it on the same scar.
Although tummy tuck seems to be an option that solves all problems, it also has some shortcomings. The most important of these is the scar that will occur after the operation. The criterion that determines the scar is the amount and length of skin to be taken. The length of the scar can be roughly estimated when you pay attention to how far the excess skin that forms in the lower abdomen extends on the sides when you lean forward. One of the misunderstood issues here is that this scar will be the same length as the cesarean section or the speed will not be visible because it is an “aesthetic stitch”. Only in mini tummy tuck operations, a scar as short as a cesarean section is formed. Under normal conditions, after the tummy tuck operation, a scar should be 2-3 times the length of the cesarean section. However, in aesthetic tummy tuck procedures, this scar never extends to the back. It may sometimes extend to the middle of the back in operations such as panniculectomy performed after excessive weight loss (post bariatric) or health-related operations, but this aesthetic tummy tuck is not called a tummy tuck operation. If there will be a scar that will extend to the back, the patient should be informed and other treatments should be applied first. Another issue where tummy tuck is insufficient is that the cracks in the skin area above the belly button cannot be removed. There is no other successful treatment in this regard today.
In addition to tummy tuck surgery, liposuction can also be applied. This may vary depending on the condition of the abdomen, the type of tummy tuck surgery to be performed, and the surgeon’s approach. Sometimes a 2-session procedure can be preferred by applying liposuction before the tummy tuck surgery and sometimes after the surgery. Large amounts of liposuction in the same session may conflict with the tummy tuck surgery technique and cause undesirable results. In newer abdominoplasty techniques, both the abdomen and waist region are intervened and liposuction is easily applied.
This operation can be performed on any person who has medically completed adolescence. In general practice, this operation is mostly performed after birth.
Incidentally, another misconception that should be mentioned is that one should not get pregnant after tummy tuck surgery. Abdominal stretching does not interfere with any organs related to pregnancy and childbirth. Abdominoplasty does not prevent further pregnancies and births in any way. Moreover, since problems such as umbilical hernia and weakness in the anterior abdominal wall are corrected, problems that may occur in subsequent pregnancies are also prevented. However, it is not allowed to become pregnant for 6 months after the operation.
Appropriate timing for surgery should be waited for at least one year after birth. During this period, the changes in the body that occur during pregnancy will return as much as possible and the picture to be corrected will emerge. If possible, the end of the breastfeeding period should also be waited because it will not be possible to breastfeed during the surgery and recovery period.
This surgery is not recommended for active smokers. Smoking creates problems in two ways. Since it impairs wound healing, it is possible to open the suture line, which is closed tight. In the advanced period, it may cause loss due to circulatory disorder in the skin. In addition, since smokers cough frequently, ruptures may occur in the abdominal muscles and membranes, which are sewn like a corset, due to severe coughing. Surgery is recommended after at least a 1-month smoke-free period.
For those who have had previous abdominal surgery, old surgery scars may affect tummy tuck surgery. We see such scars not only as scars but also as obstacles that impair skin circulation.
A full abdominal examination should be performed before the operation, and accompanying conditions such as possible mass, abdominal wall defect, and hernia should be reviewed, and radiological examinations should be performed if necessary.
Abdominoplasty is performed under general anesthesia. Local or regional anesthesia (from the waist) cannot provide the numbness and muscle relaxation required for the ideal tummy tuck. However, it can be done for pain control after surgery.
It is an operation that takes 2-4 hours on average. Depending on the additional procedures to be applied, the time may be extended. Drains will be placed to drain the blood that will accumulate in the area during the operation and will be kept for 3-4 days.
Although it is not necessary to stay in the hospital at night from a medical point of view, it is recommended to stay for at least 2 nights due to pain, sitting and walking difficulties that may occur after the surgery. Likewise, the hospitalization period can be extended, as the transfer from the hospital to the home will be painful for the patient.
At the beginning of the problems that may occur in the early period are bleeding and infection, which is valid for every surgery. Bleeding that may occur due to the fact that no operation is performed on the large vessels is not life-threatening, but it causes blood accumulation and requires additional procedures. Similarly, infection is a condition that requires treatment. Necessary precautions are taken in every surgery to avoid these situations.
In the late period, the most common problems are the enlargement and swelling of the scars. Since it is a tight suture, such problems may occur, but procedures that are not stretched cannot be called tummy tuck. Small corrections can be made with local anesthesia after 3-4 months in such scars.
Asymmetries and the formation of sunken – raised areas are more common in obese patients. In particular, the potholes (also called dog ears) formed on both sides of the incision scar are corrected with small interventions in the future.
A supportive corset (binder) is used for 2 months after the operation. Stitches are not usually removed. It should be rested as much as possible for up to 2 weeks. After 2 weeks, light physical movements are allowed. After 1 month, it is returned to normal daily life. A supportive corset should be used for 2 months. After 2 months, heavy exercises can be started. The final shape of the abdomen takes 6 months to 1 year.
FREQUENTLY ASKED QUESTIONS:
Can’t be a scarless tummy tuck surgery?
No. Many procedures can be applied in abdominal aesthetics, but it is not possible for the tummy tuck option to be scarless. This is a scar that is under the underwear / swimsuit.
Does it have to be long scars up to the waist or back?
Not often. However, it is the amount of excess skin and sagging you have that determines this. When you lean forward, squeeze and pull the excess skin with your hand, and you will notice how far the scars should extend. If you want a shorter scar, it is recommended to lose weight before the operation.
What happens if I have liposuction instead of a tummy tuck?
When you measure with a tape measure, you get thinner in centimeters. You get an effect just like losing weight. However, the external appearance may look worse as the excess skin and looseness of the abdominal wall continue.
What is the difference between a mini abdominoplasty and a classic tummy tuck?
A mini tummy tuck is a procedure performed by removing a small amount of skin just below the navel. It is usually performed in addition to the liposuction procedure or alone under local anesthesia. A very obvious change is not expected, an incision is made as much as the cesarean section mark. Muscles and fats other than excess skin are not interfered with. If the conditions are difficult, the place of the belly button may slide down and an unnatural result may occur.
Is it true that if I have tummy tuck surgery, I can’t get pregnant afterward?
No. Abdominal stretching does not interfere with any organs related to pregnancy and childbirth. Abdominoplasty does not prevent further pregnancies and births in any way. Moreover, since problems such as umbilical hernia and weakness in the anterior abdominal wall are corrected, problems that may occur in subsequent pregnancies are also prevented. However, it is not allowed to become pregnant for 6 months after the operation.