Abdominoplasty or tummy tuck is a procedure designed to remove the excess sagging skin and fat which accumulates in many of the women following child birth and lack of activity. Though most commonly done in women, as part of the "Mummy Makeover", it is also done in men with huge paunches or following Massive Weight Loss after a Baraitric procedure, as a part of a Body Lift. This infra umbilical portion of the skin has multiple stretch marks and hangs in front of the groin causing hygiene problems apart from other things.
This, sets forth a vicious cycle in the sense that, when this happens women tend to move around less, which further aggravates the problem. Apart from it causing problems in ambulation and looking cosmetically unacceptable, it can cause back pain because of the change in posture, fungal infection in the folds of skin.These can lead to serious infections if the patient is immunocompromised and also breathing problems when the patient lies down (PickWickian Syndrome). Another important problem associated is the loose abdominal muscles called the Rectus muscle. These are two veritcall muscles in the midline which give strength to the abdominal wall in the front. More often than not , there is an associated weakness of this muscle or there is a gap in between these two mucles which is called a "Divarication of Recti". This causes the intra abdominal contents to bulge out and if not treated can go on to form a hernia. This is also repaired during the procedure. So, this operation is helpful for women with lax and loose abdominal skin usually after having children or nowadays seen after losing excessive amounts of weight. Liposuction is also combined with an abdominoplasty for the upper abdomen and flanks.
The procedure is done under general anaesthesia or spinal anaesthesia.
Apart from removing the excess skin and fat, many a times tightening of the abdominal muscles might have to be done in most of the cases. In this procedure the whole of the abdominal skin is raised like an apron and brought down and stitched at the groin crease and the excess skin and fat is excised. The umbilicus is usually repositioned at a higher level. At no time during the procedure is the abdominal cavity proper, entered.
Post Op:
Post operatively, the patient has little pain for the first post operative day, but are usually covered by painkillers and epidural anesthesia. The next day, they can be ambulated but have to move around a little bent over for the first day or two till they feel adjusted to the new tightness around their tummy. By the end of the first week most of the patients are up and about doing routine activities, though strenuous activity may have to wait for a few weeks.
The procedure is well tolerated by almost all of the patients.
For a few weeks there might be a strange numb feeling in the lower abdomen which is because of the cutaneous nerves supplying that area of skin, which are stretched during the procedure and are injured. As they start recovering, there maybe funny sensations like tingling and mild irritation in the area for a few weeks. These symptoms usually settle down without any treatment.
The patient is required to wear an abdominal corset for support, for the next three to six weeks. Problems: The main area of concern is the scar. The scar is a long scar, from one hip bone to the other, going along the groin crease. But it cannot be avoided and is usually a hidden scar, covered by undergarments. Over a period of time the scars mature and become less conspicuous. In patients who are overtly obese with thick abdominal aprons, sometimes there may be localised areas of fat necrosis leading to delay in healing in those areas. Mini abdominoplasty is an abbreviated version of the formal tummy tuck, in which only little areas in the abdomen below the umbilicus, which has the stretch marks and loose skin is removed and sutured along with tightening of the muscle. Usually suited for patients of younger age group with not much of skin laxity. Here initially the umbilicus looks pulled down as the umbilical repositioning is not done. Lateral Tension Abdominoplasty is a varaition of the regualr abdominoplasty and is useful in cases where there is a lot of skin excess in the sides and around the hips. | 
