An abdominoplasty or abdominal plasty is a surgical technique consisting of remodeling the abdominal wall when there is excess skin (usually with stretch marks and poor quality), tissue laxity or distension and separation of the anterior muscles (rectus abdominis diastasis) that make up the abdominal wall. These abnormalities occur mainly in women after pregnancy and, in general, in any obese person who experiences a large weight loss.
The purpose of this surgery is to strengthen the anterior abdominal wall, reducing the risk of midline hernias, in addition to improving its functionality and aesthetic appearance, giving slenderness and youthfulness to this part of our anatomy.
Abdomen: target of fat accumulation
The complete abdominoplasty is a technique that acts both at the level of muscle planes and skin level, requires a wide horizontal suprapubic incision, a detachment of all the anterior abdominal skin, a disinsertion of the navel, a suture repair of the muscle planes (plication of the rectus), a stretching and removal of excess abdominal skin (dermolipectomy) and a surgical closure by planes with the repositioning of the navel (umbilical transposition).
Sometimes it can be associated with liposuction of the flanks and/or anterior abdomen to slim these areas and give shape to the silhouette. There is another minor variety of abdominoplasty, indicated in small redundancies or slight excess of skin at the abdominal level, without alteration of the muscular planes and without serious deformation of the abdomen. In this case, the simple removal of skin restores anatomical normality in this area.
Excess weight determines an accumulation of fat in specific areas of the body, one of them is the abdomen, perhaps the most notorious, because along with the external fat accumulated in the skin, there is an increase in intra-abdominal visceral fat, which determines a bulging of the belly and makes this area of our body stand out more.
Is any patient suitable for the procedure?
Each case must be evaluated very carefully and the different aspects that guide us on the suitability or not of this technique. An exploration of the muscular plane must be done to see if there is damage at this level, and the degree of redundancy or excess skin must be evaluated very meticulously to be able to predict if this skin can be removed without compromising the closure of the abdomen, which is the main setback in this surgery.
We must also take into account the presence of previous abdominal scars, mainly after other surgeries (e.g. gall bladder), which oblige us to be very cautious due to the additional limitation they have on the elasticity of the skin and its subsequent surgical closure. And a very important aspect to take into account is whether the patient smokes, since this surgery always produces tension in the surgical edges and in smokers this can cause vascular compromise and important postoperative skin problems. Once all these aspects have been evaluated, the indication can be made in any patient who meets the surgical criteria.
The risks are minimal, so caution should be exercised during the procedure.
The risks of an abdominoplasty are those typical of any surgery, that is to say, the anesthetic risks, derived in this case from the general anesthesia required, and the surgical risks, common to all surgery (infection, hemorrhage, etc.).
The risks specific to this intervention are commonly those derived from a tension closure of the skin, caused by a previous miscalculation in the planning of the surgery. This causes dehiscence (separation of the edges), or even partial necrosis of the edges (more frequent in smokers), which causes thick and unsightly scars and even deformation and asymmetries in the skin of the abdomen. Sometimes there may be hematomas and also liquid collections of fat, especially if abdominal liposuction has also been performed, which are slowly eliminated through the scar. The quality of the scar may also be suboptimal, especially if the above circumstances have concurred.
In general, a detailed medical history and careful physical examination is very important to take all factors into account in the design and execution of this surgery.
What happens now?
After surgery the patient should sleep in the unloaded position with the headrest incorporated for a few days until he/she can gradually acquire the horizontal resting position. He must keep relative rest and move progressively until he can perform a normal activity without effort. He must also wear an orthopedic brace permanently for several weeks, which provides security and comfort, especially at the beginning. It is not advisable to start playing sports before the first month after the surgery and always in a very gentle way so as not to cause discomfort or influence the healing process.