Tummy Tuck surgery can be one of the more painful cosmetic procedures performed by plastic surgeons. The overwhelming majority of the discomfort comes form the muscle-tightening portion of the procedure, not the skin incision as most people believe. This is evidenced by the fact that many patients who undergo tummy tuck surgery and skin the muscle-repair portion of the procedure have relatively little pain after surgery.
Another technique, which Dr. McMahan has found to be more reliable that pain pumps, is the use of tumescent fluid at the time of surgery. Tumescent fluid is a very dilute concentration of local anesthetic that is infiltrated into the area of surgery to deaden the sensory nerves both during and after surgery. As a result of this numbing effect, patients receive less narcotic medication from the anesthesiologist both during surgery and in the recovery room, which helps to reduce the incidence of nausea and vomiting after surgery.
Other Tumescent Benefits
Patients who have had a tumescent tummy tuck generally have much less pain after surgery and, therefore, take much less pain medication during their recovery. As a result, they experience fewer problems with nausea and vomiting, which can be miserable after abdominal surgery.
Another benefit of having less pain after surgery and taking fewer pain pills is it reduces problems with constipation, which is associated with the use of oral narcotic medication. There is minimal increase in OR time with tumescent infiltration and no cost elevation. Dr. McMahan has been using tumescence with tummy tucks for over a dozen years in Columbus, OH and has had some patients take nothing more than Tylenol after surgery.
Patients who have less pain after surgery are able to ambulate sooner and more often, which helps to reduce the risk of blood clots.
One technique designed to reduce pain after surgery is the insertion of pain pumps. These pumps are connected to small tubes which go through the skin with their ends positioned in the area of surgery over the muscles. The reservoir is filled with local anesthetic which is pumped through the tubes at various intervals to reduce pain sensation. Some disadvantages of these pain pumps include a variable response in some patients, the increase in cost (around $300) of the procedure, occasional malfunction of the pump and the potential increase in the risk of infection.
Dr. McMahan uses both short and long acting local anesthetics in his tumescence in an effort to get the best of both anesthetics. Recently, an encapsulated form of the long acting local anesthetic (bupivacaine) has become available allowing for a slow release of the product into the tissues to provide a much longer form of pain relief. This gradual liberation of bupivacaine into the abdominal muscles can provide up to three days of pain relief or reduction and, by that time, many patients are ready to switch to non-narcotic pain pills such as ibuprofen. At this time, there is an additional charge to obtain Exparel® for use at the time of a tummy tuck or other surgeries such as a Mastopexy, Arm Lift or Thigh Lift.