Information about the procedure
Removal of excess skin and fat from the abdomen and repair of separated abdominal muscles for a flat, firm contour.
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What it involves
Abdominoplasty removes loose skin and fatty tissue from the lower abdomen and, where necessary, repairs separated rectus abdominis muscles — a condition known as diastasis.
Diastasis is one of the main reasons the abdomen protrudes despite a normal weight and regular exercise. The muscles have drifted apart, the abdominal wall no longer holds the internal organs in and the abdomen bulges forward. When exercise cannot bring the muscles back together, only surgery can.
Abdominoplasty is not a weight-loss method. It reshapes the abdomen in someone who has already reached a stable weight.
Types and approaches
Full abdominoplasty
A horizontal incision above the pubic area, removal of the skin between the navel and the incision, plication of the aponeurosis — the anterior sheath of the rectus abdominis muscles — and repositioning of the navel. Suitable for marked excess skin with diastasis.
Mini abdominoplasty
Treats the lower abdomen only, with a shorter incision and without repositioning the navel. Suitable for limited excess skin below the navel and no significant diastasis.
Extended abdominoplasty
For patients who have lost a significant amount of weight and whose excess skin extends to the sides as well. The incision is longer and continues towards the hips.
Combined with liposuction
Liposuction of the flanks and hips complements the result and gives a cleaner overall contour. Combining the two requires particular care to preserve the blood supply to the skin.
Who it is suitable for
Suitable for
- Loose skin after pregnancy or significant weight loss
- Diastasis of the rectus abdominis muscles
- Stretch marks on the lower abdomen, which are removed together with the skin
- A stable weight for the past 6–12 months
- Family planning completed
Not suitable, or postponed, in cases of
- A planned pregnancy — pregnancy after abdominoplasty undoes the result
- Ongoing weight loss or an unstable weight
- Current smoking — the risk of skin loss is real and serious
- Poorly controlled diabetes, or severe heart or lung disease
- Thrombophilia or a history of thrombosis without prior assessment
- An expectation that surgery will take the place of weight loss
Preparation
- Reach and maintain a stable weight
- Stop smoking at least four weeks before surgery
- Full pre-operative tests, an ECG and a consultation with a cardiologist or an anaesthetist
- Assessment of your thrombosis risk and planning of preventive measures
- Arrange help at home for at least a week — movement is restricted for the first few days
- Prepare a place to sleep with your upper body raised
How it is performed
The operation is performed under general anaesthesia and usually takes four to five hours. You stay in hospital for one to two nights.
The incision is planned low so that it stays hidden under underwear or swimwear. The skin is raised upwards, the aponeurosis is plicated along the midline, the excess skin is removed and the navel is brought out through a new opening.
Drains are inserted and are usually removed after a few days. A compression binder is put on.
Recovery
- The first 48 hoursThe most difficult period. You walk bent forward and get out of bed in stages. Pain relief is given on a fixed schedule. Early mobilisation is essential to prevent thrombosis.
- The first weekThe drains are usually removed between the third and seventh day. You gradually walk more upright. The compression binder is worn day and night.
- 2–4 weeksMost patients return to light office work after 2–3 weeks. No heavy lifting and no straining of the abdominal muscles.
- 1–3 monthsThe swelling goes down considerably. Numbness around the incision is normal and lasts for months. Scar care begins.
- 6–12 monthsThe final contour emerges and the scar fades. The result is assessed after this period.
Pain and discomfort
Abdominoplasty is one of the more painful aesthetic operations, particularly when the abdominal wall is plicated. The first three to four days are difficult, with a feeling of marked tightness every time you straighten up or cough. After the first week the discomfort eases quickly. Pain relief is planned in advance and given on a schedule, not only when needed.
Risks and complications
Every intervention carries risks. Listing them does not mean they are expected to occur — it allows you to make an informed decision.
- Fluid collecting under the skin (seroma) — the most common complication
- Haematoma
- Delayed wound healing or skin loss, considerably more common in smokers
- Deep vein thrombosis and pulmonary embolism — rare, but the most serious complication
- Persistent skin numbness above the scar
- A thickened or widened scar
- Asymmetry or malposition of the navel
- Residual laxity where the original excess was very pronounced
Results and longevity
With a stable weight the result is long-lasting. The skin that has been removed does not come back, and the plication holds for years.
Pregnancy after abdominoplasty stretches the abdominal wall again and largely undoes the operation.
Significant weight gain brings the fat back, although it may be distributed differently.
The scar is long and permanent. It is positioned so that underwear hides it, but it is the unavoidable price of this operation.