A standard tummy tuck (abdominoplasty) is the most common procedure performed to correct the deformities of the stomach sustained as the result of pregnancy or significant weight loss. The idea behind this type of abdominoplasty is to remove all excess skin and fat from above the belly button (umbilicus) down to the pubic area and tighten the muscles of the abdominal wall.
Prior to surgery, the patient is placed in a standing position for marking of the planned incisions and to estimate the amount of skin to be removed. After institution of anesthesia and appropriate skin prep, surgeons like Dr. McMahan who prefer to do everything possible to reduce pain and bleeding with surgery, inject a liter or more of a solution of dilute local anesthetic (Xylocaine) and epinephrine into the fatty layer of the abdomen to numb the area and constrict blood vessels.
The surgery starts with a small circular or diamond shaped incision around the belly button to separate it from the surrounding skin; leaving it attached to the underlying muscles. A curved incision is then made across the lower abdominal skin which is carried through the skin and fat, down to the muscle which is left intact. All skin and fat is then raised off of the muscle using an electric cautery to separate the layers and control bleeding at the same time. This separation is performed up to the level of the rib cage before the abdominal wall muscles are tightened with sutures. Dr. McMahan prefers to double sew the muscle layer to prevent a patient from accidently tearing out these sutures by coughing or sneezing after surgery. At that point, the bed is flexed so that the patient is bent at the waist and the excess skin along with any accompanying fat is pulled downward to determine how much can be taken out. After the extra skin and fat is removed, drains are inserted, the incision is closed in layers with sutures and a small opening is made over the belly button, which is then sutured into position. Just prior to the closure, Dr. McMahan takes a few minutes to inject more dilute local anesthetic directly into the abdominal muscles to reduce pain as much as possible immediately after surgery. A dressing is then applied along with an abdominal binder to hold the dressing in place.
After surgery, it may be difficult to stand straight up because of the tightness of the skin. The best position after surgery is a semi-sitting pose in a reclining chair. It is best to not try and stand up straight for a few days to avoid putting unnecessary stress on the incision. In a few days, as the tissue stretches and swelling goes down, most patients are able to stand erect and lay flat in a bed. To avoid excess stretch on the muscle repair, it is recommended that patients do not lift more than twenty pounds for the first six weeks after surgery.