Tummy Tuck(Abdominoplasty)

A tummy tuck is a procedure in which excess fat in the entire abdominal and waist area is removed, excess skin below the navel is excised, the loosened abdominal muscles and the anterior abdominal wall are repaired, and the belly button is given an aesthetic appearance. Depending on the condition of the patient's abdomen, a full tummy tuck, a mini tummy tuck or an endoscopic tummy tuck can be performed. In addition, it may need to be combined with liposuction (fat suction) to give the waist a better contour.

A full tummy tuck is most often performed on people who have given birth or who have gained and lost a great deal of weight. If the patient has excess skin above the belly button and, when sitting, a fold forms below the belly button that they can hold in their hand, they are a suitable candidate for a full tummy tuck. If the excess skin and fat have gathered only below the navel, a mini tummy tuck is performed. If there is no excess skin and only some fat, but the abdominal wall has loosened due to childbirth, an endoscopic tummy tuck is preferred.

In a full tummy tuck, liposuction is first applied to the entire abdominal and waist area. At this time, if necessary, fat injection into the buttocks is also performed. Then a long incision is made on the lower part of the abdomen so that it remains within the underwear. The abdominal skin is lifted off the abdominal wall up to the ribs. The belly button is separated from the skin. The loosened abdominal muscles are stitched together and the abdominal wall is tightened. Then all the skin below the belly button is removed. The skin above is pulled down and a new opening is made for the belly button. After a full tummy tuck, the areas above and below the belly button are tightened, the waist is slimmer, the abdominal wall is firmer and the belly button takes on a vertical, youthful appearance.

A mini tummy tuck is performed in patients whose excess skin is only below the navel and who have no, or very little, accumulation above the navel. In this operation, too, extensive liposuction is performed first. An incision is made on the lower part of the abdomen so that it remains within the underwear, but it is shorter than in a full tummy tuck. The skin below the navel is lifted and the excess is removed. If there is also some excess above the navel, the belly button is shifted 1–2 cm downwards. If considered necessary, the abdominal wall muscles can also be repaired.

An endoscopic tummy tuck is performed in patients who have no excess skin at all but whose abdominal muscles have loosened and whose abdominal wall has become bulging due to childbirth. Again, liposuction is performed first and the skin is thinned. If the patient has an old caesarean section scar, the incision is made there. If there is no scar, a short 2 cm incision is made. Access is gained with the help of an endoscope, a camera is inserted and the abdominal wall muscles are repaired while being watched on a screen. No skin is removed in endoscopic tummy tucks.

As with all operations, in tummy tuck operations aspirin and smoking must be stopped three weeks before surgery. In the last week, it is necessary to stay away from drugs and similar substances that may thin the blood.

Things that should not be used:

• Painkillers such as Apranaks, Voltaren and Vermidon (when a painkiller is needed, Minoset or Novalgin can be used),
• Multivitamin pills containing substances such as ginseng, ginkgo biloba and coenzyme Q,
• Herbal products such as green tea, flaxseed, cherry stalk and tomato seed
• All slimming products

For 3 days before tummy tuck surgery, foods that may cause constipation should be avoided, and vegetable dishes and easily digestible foods should be eaten. Especially in overweight patients, bowel cleansing with drugs that empty the bowels may be recommended before surgery.

Excess weight poses a risk for all operations. After surgery, patients get up with more difficulty, their wounds heal more slowly and lung problems occur more often. For this reason, overweight patients are advised to reduce their weight before surgery. However, if patients cannot move sufficiently and cannot lose weight because of the weight of their abdomen, a tummy tuck can be planned solely to reduce this load.

Tummy tuck operations are performed in an operating theatre and under general anaesthesia.

The duration of the operation is determined by the procedures to be performed. A full tummy tuck takes between two and three hours, while mini and endoscopic tummy tucks take between one and two hours.

If the right measures are taken, tummy tuck operations are not as painful as is often said. During the operation, local anaesthetics that act for about 10 hours are applied to all incisions and also to the abdominal wall, which can prevent patients from feeling pain in the early postoperative period. Although some pain appears the next day, the patients' main complaint stems less from pain than from the tightness caused by the tummy tuck and from being unable to stand upright. Mini and endoscopic tummy tuck operations are much less painful.

Using an abdominal binder after tummy tuck operations is recommended to support the tightened abdominal muscles and to help the liposuctioned areas take a better shape.

During the operation, patients are fitted with anti-embolism stockings, a urinary catheter is inserted and drains are placed. After the operation, an abdominal binder is put on. The patient is fed and helped to stand three to four hours after surgery. In the first days, they need to walk bent forward so that no strain is placed on the stitches in the abdomen. After four or five days they can stand upright. These periods are even shorter for endoscopic and mini tummy tuck patients. The next morning the catheter is removed and the patient is discharged. If necessary, the drains are left in place for a few more days. The night after surgery they can lie on their side. A shower can be taken 24 hours after the drains are removed. Since all the stitches are left under the skin, there is no need for stitch removal. One week after surgery, patients can return to their daily lives. After three weeks, sport can be started, except for abdominal exercises. After six weeks, all sporting activities are allowed.

The most feared complication of the operation is blood clotting inside a vessel and a fragment travelling to the lung (pulmonary embolism). This risk is higher in elderly, overweight and diabetic patients and in heavy smokers. Patients with excess weight are advised to lose weight before surgery. Another problem is skin loss and wounds failing to heal. Errors in preoperative planning, removal of too much skin, inadequate control of bleeding and smoking increase such problems. A few weeks after surgery, problems such as serum collecting under the skin may also be encountered. In such a case, the serum may need to be drained with the help of a syringe. In abdomens closed under too much tension and in some skin types, problems such as excessive scarring may occur. If this is due to tension, a revision procedure can be performed under local anaesthesia after one year to make the scar thinner.

Tummy tuck surgery (abdominoplasty) provides a radical solution to problems in the abdominal area, and its results can be said to be permanent. In the event of gaining and losing a great deal of weight again or becoming pregnant after surgery, the results may be somewhat diminished, but they never return to the previous state.

After tummy tuck (abdominoplasty) operations, patients need to watch their weight and eat a balanced diet. It will be good for them to reduce their alcohol consumption in order to reduce intra-abdominal fat. They need to use body lotions and moisturisers regularly so that the tightened skin does not develop stretch marks again. Regular exercise helps the abdominal muscles become strong again, thus maintaining the firm abdominal appearance achieved with surgery.

Pregnancy is possible after a tummy tuck (abdominoplasty), but pregnancy causes the abdominal wall to loosen again and the skin to become lax. For this reason, this operation is not recommended for patients planning a pregnancy in the near future. However, the operation does not prevent pregnancy.