Abdominoplasty: all about removing the fat “apron” on the abdomen

Excess weight is gone, but the stomach remains, or the muscles are stretched after pregnancy, diastasis was discovered. Abdominoplasty will help restore the beautiful appearance of the abdomen. However, like any operation, there are pitfalls.

“Abdominoplasty (from the Latin “belly”) is a volumetric surgery performed to restore the aesthetic proportions of the abdomen,” says Danila Kuzin, a plastic surgeon at the Selin clinic. “This operation is aimed at excising excess skin and fat deposits that have arisen for various reasons, mainly after a sharp weight loss.”

Losing weight is one thing, getting back in shape is another. With rapid and significant weight loss, the skin on the abdomen may be stretched and hang like an apron.

Often the appearance of the abdomen worsens after pregnancy, especially if the baby was born large. Stretch marks or stretch marks remain on the skin – microtears that first appear as red or pink scars that turn white over time. It is very difficult to fight them, because stretch marks affect the skin throughout the depth, not allowing it to contract. Usually this problem occurs in women after 35 years, but it also happens at a younger age.

A number of other problems may also arise in the abdomen, for example, an excess of the subcutaneous fat layer is found, from which it is impossible to get rid of; or the anterior abdominal wall sags; or diastasis develops – stretching of the rectus abdominis muscles.

The appearance of this part of the body can be spoiled by scars and scars after operations and injuries. All these problems can be solved by abdominoplasty.

“By and large, abdominoplasty is not a vital operation, it is often done for aesthetic reasons,” explains the plastic surgeon. – But there are cases when severe ptosis of the soft tissues of the anterior abdominal wall, diastasis or muscle weakness are combined with the formation of hernias of various sizes. This situation is a direct indication for a planned operation. In this case, abdominoplasty is combined with hernia excision and hernia ring plasty.”

“The first thing to do is make an appointment with a plastic surgeon,” says the doctor. “He will clarify the reason for the visit, collect an anamnesis to find out possible contraindications, conduct a visual examination of the abdomen, determine the condition of the skin, muscles and thickness of subcutaneous fat, find out the psychological state of the patient, and then answer whether he will undertake the operation or not.”

At this stage, it is important that a trusting relationship develop between the patient and the doctor, if after the meeting you did not feel this, try to make an appointment with another surgeon.

“If you abuse alcohol, you simply will not be taken for an operation,” says surgeon Kuzin. – Smoking, alcohol and drugs, in addition to obvious harm, affect the elasticity of the vascular wall. The ability of small arterioles and venules to fully supply tissues with blood, oxygen and nutrients, and to ensure the outflow of venous blood is impaired. With abdominoplasty, this is fraught with purulent complications, necrosis and a very long rehabilitation. If you are an experienced smoker, it is useless to give up a bad habit before the operation, more than six months must pass for the effect. With inactive use of cigarettes – more than a month.

Before the operation, an extensive list of blood and urine tests is mandatory. Instrumental research methods include ECG, FLG (or X-ray of the lungs), ultrasound of the veins of the lower extremities. With all the results, the patient goes to the therapist, who assesses the general state of health. After that, the anesthesiologist admits or does not allow him to the operation.

The expert is sure that abdominoplasty, however, like any successfully performed plastic surgery, benefits patients, improves their psycho-emotional state, and increases self-esteem.

“A confident woman is already physically healthier,” says Kuzin. “Yes, and with men, this effect works just as well: the removed excess fat and a heavy apron greatly facilitate the load on the back, the back muscles feel lighter, the weight decreases, the state of health improves, lightness appears, pressure can normalize, shortness of breath disappears, and so on.”

Nevertheless, it is important to consider that abdominoplasty is a complex surgical procedure performed under general anesthesia, and therefore has a number of contraindications.

So, absolute contraindications to abdominoplasty are: autoimmune pathologies, inflammatory diseases in the acute phase, acute and chronic heart failure, pregnancy, breastfeeding period, diabetes mellitus, oncological diseases, as well as blood diseases in the patient (and even in the next of kin), obesity caused by endocrine pathologies and any exacerbations of chronic diseases.

Doctors do not recommend surgery if a woman dreams of becoming a mother in the near future. Of course, this moment is quite difficult to plan, but you should know that after plastic surgery, there will be less skin on the abdomen, and, of course, it will be less elastic, and the temporary inability of the rectus muscles to “diverge” will not allow the abdomen to grow forward.

Fetal pressure can cause disruption of the internal organs, especially the intestines and urinary tract, after the birth of a child, and the abdomen itself may be deformed.

Therefore, the expert strongly advises to postpone this operation, having it done after childbirth, or to plan it long before the expected pregnancy.

“It is important to wait for the rehabilitation period after the operation and try to get pregnant no earlier than a year later,” recommends Dr. Kuzin. – An earlier pregnancy can affect the result – greatly stretch the scars or sutures on the muscles. Obstetricians may also encounter certain technical issues during a caesarean section. However, doctors who know the anatomy and the specifics of the operation well will not experience any difficulties.”

It makes no sense to do abdominoplasty even in the first six months after childbirth, since there is a high probability that the skin will shrink and the contours of the figure will be restored without radical intervention.

Often people confuse abdominoplasty and liposuction, although these are two fundamentally different operations: liposuction is aimed at removing adipose tissue, abdominoplasty eliminates excess full-thickness skin-fat flap and strengthens the muscle corset.

“The operation can be combined with liposuction, but abdominoplasty by itself will not solve the problem of excess weight,” Danila Kuzin is sure. “With severe obesity, the patient will only be helped by bariatric surgery, aimed at treating this problem exclusively.”

To make a final decision about a possible abdominoplasty, the surgeon needs to look at the patient’s blood counts, the presence of concomitant pathology, the level of compensation for chronic diseases, such as diabetes mellitus or hypertension.

Important is the distribution of adipose tissue throughout the body and the proportion with visceral fat, says the surgeon. The level of safety of abdominoplasty and liposuction for obesity of I and II degrees is determined individually. In the case of extreme obesity, it is better to give up thoughts of surgery.

Between the first meeting with the surgeon and the day of the operation, at least a month will pass. This time is necessary for preparation. The patient may be prescribed a special diet to reduce body weight and cleanse the intestines.

For a week, you will have to limit the use of products that lead to gas formation, and two or three days before the operation, reduce physical activity and stop using decorative cosmetics.

You need to come to the clinic on an empty stomach. Before the start of the procedure, markings are made on the patient’s body and anesthesia is administered. After the surgeon makes two incisions: around the navel and above the pubic region, excising excess skin and subcutaneous fat. The rectus abdominis muscles are also tightened and sutured, the navel occupies an anatomically correct place and the waist is modeled. There is plastic surgery without pulling up the navel, sometimes the operation is combined with liposuction.

At the end, an intradermal cosmetic suture is applied, which eventually turns into a barely noticeable white line.

General surgical risks should be excluded as much as possible at the stage of preparation for surgery. But no one will ever give a 100 percent guarantee of the safety of any surgical intervention. Directly with the type of operation (abdominoplasty, liposuction), risks such as marginal skin necrosis, severe hematomas or bleeding, prolonged seromas may be associated.

Recovery and rehabilitation depend on the volume of the operation, the weight and age of the patient, his state of health. Initial rehabilitation takes two to four weeks. At this time, bruises, basic swelling disappear, the scar heals, pain and discomfort completely disappear.

Within 8-12 months, the stomach completely returns to normal, sensitivity is restored, a scar is formed, new shapes and outlines appear.

Additional sources:

1. Prevention and treatment of complications of abdominoplasty
2. Technique options in abdominoplasty: a historical digression and a modern view on the location of surgical incisions