Abdominoplasty – “Tummy-tuck” Questions and Answers

Patients frequently ask what they can do to tighten or restore the shape of their abdomen. This may be following the birth of children or after significant weight loss. Whatever the cause of the problem, it seems that exercise and diet will often not be enough to reverse the damage. An abdominoplasty may be the answer. It is necessary to first identify the extent of the problem and whether it involves skin only, skin and fat, or deeper structures such as the muscles and fascia of the abdominal wall. An operation can then be planned to correct the problems.

Q. What is an abdominoplasty? Is it the same as a tummy tuck?

A. An abdominoplasty is primarily an aesthetic (cosmetic) procedure used to correct deformities of the skin, fat, muscles and fascia of the abdomen. The procedure is sometimes called a tummy tuck.

Q. How do I know whether I need a tummy tuck or just liposuction?

A. Sometimes the patient realizes only that their abdomen protrudes, fat and skin bulge and hang over their belt, or they have difficulty holding their stomach in. Your plastic surgeon will be able to quickly determine whether the problem is primarily fat or involves skin and deeper structures. If the problem is mainly fat and the skin is not significantly loose, then liposuction may be all that is needed. A physical exam will give the answer.

Q. Where is the incision for a tummy tuck?  How big will it be?

A. The typical abdominoplasty incision is a low transverse (horizontal) incision, individually designed so that the necessary operation can be performed and the resulting scar can be hidden under minimal clothing. The length of the incision depends on the amount of skin that must be excised.

Q. Will I have a belly button after having a tummy tuck?

A. Yes, the belly button or umbilicus will remain although it will be brought out through a new “button hole” in the now tightened abdominal skin.

Q. How long will I need to take off from work?  When can I return to normal activity?  Will I have any limitations after surgery?

A. Most patients take 10-14 days off from work. Sedentary work can be done before then, depending on the patient. Limitations on straining, range of motion and running usually extend to about 2 months. Lighter exercise such as walking and light weights can resume after 2 weeks.

Q. Is the recovery painful?

A. Post operative pain varies from patient to patient, but the new “Pain Pump” technology and good pain medication help.

Q. Will I still need to diet and exercise after having a tummy tuck?

A. Absolutely! You will want to continue to improve your body and your health through exercise and diet.

Q. Is the surgery performed in a hospital or in the office?

A. In my practice, we do this procedure in a hospital with general anesthesia given by board certified anesthesiologists.

Q. How long does the operation last?  How long will I be in recovery?  Do I have to stay in the hospital over night?

A. Depending on the extent of the abdominoplasty, the procedure will take approximately 3 hours. You will be in the recovery room about one hour and we usually include one overnight stay.

Q. Do I have to wear any special garments after surgery?

A. In addition to surgical dressings, you will be placed in an abdominal binder which is primarily used for postoperative comfort and support.

Q. What are the risks involved with this surgery?

A. All surgical procedures carry some inherent risks, and abdominoplasty is no exception. Complications such as infection, bleeding and wound healing problems are very rare. Potential risks and complications will be discussed with you in detail prior to surgery so that proper consent can be obtained.

Q. What does a tummy tuck cost?

A. The cost for an abdominoplasty will depend on the extent of the surgery, length of the procedure and other considerations. As a general ball park figure, the cost including surgeon, operating room and anesthesia will be around $8,000.

Breast Implants May Be Linked to Rare Cancer, FDA Says

 

by

Robert Lowes
Freelance writer, St. Louis, Missouri


January 26, 2011 — Patients with either saline- or silicone gel–filled breast implants may have a very small but significant risk for a rare cancer called anaplastic large-cell lymphoma (ALCL) adjacent to the implant, the US Food and Drug Administration (FDA) announced today.

While the agency continues to investigate the possible association between ALCL and breast implants, it is advising clinicians to consider the possibility of the cancer in patients with breast implants with late onset of fluid build-up called persistent peri-implant seroma. Clinicians also should report any confirmed cases of ALCL in women with breast implants to the FDA.

The agency is advising women with breast implants not to change their routine medical care and follow-up. Because the risk for ALCL appears to be very small, the agency believes the weight of evidence "supports a reasonable assurance that FDA-approved breast implants are safe and effective when used as labeled."

A rare cancer of the immune system that can occur anywhere in the body, ALCL is diagnosed in 1 of every 500,000 women per year in the United States. ALCL in the breast is rarer still, diagnosed annually in roughly 3 of every 100 million women without implants. In women with breast implants, it is usually inside the fibrous scar tissue — called a capsule — surrounding the implant. It is not a cancer of the breast per se.

Treatment options for ALCL are chemotherapy, radiation, and surgery, said William Maisel, MD, MPH, chief scientist and deputy director for science in the FDA's Center for Devices and Radiological Health, at a press conference today. The evidence suggests that the kind of ALCL found in conjunction with breast implants is less aggressive and is sometimes
treatable by simply removing the implant, the capsule, and collected fluid, according to Dr. Maisel.

An FDA review of scientific literature published from January 1997 through May 2010 uncovered 34 unique cases of ALCL in women with breast implants throughout the world. The agency is aware of 60 cases in all, some of them identified through other channels. The FDA does not know how many of the 60 may be duplicates of cases found in the literature. An estimated 5 million to 10 million women worldwide have received breast implants, according to the FDA.

Of the 31 published cases of ALCL, 24 involved silicone implants, and 7 saline implants. The median time from implant to ALCL diagnosis was 8 years. For most of the women, the cancer was diagnosed when they sought treatment for implant-related symptoms, such as pain, lumps, swelling, or asymmetry, after their surgical sites had healed. These symptoms result from persistent peri-implant seroma, hardening of the breast area around the implant, or masses surrounding the implant.

Plastic Surgeons and FDA Will Develop Patient Registry

The vast majority of data suggesting a link between ALCL and breast implants emerged only after the FDA approved silicone gel breast implants made by Allergan and Mentor in 2006, said Dr. Maisel. From 1992 to 2006, such silicone gel implants were available only on an investigational basis.

Dr. Maisel noted that silicone from ruptured and even intact implants has been found in nearby breast tissue. According to one theory about the origins of ALCL, this silicone chronically stimulates immune system T cells and induces lymphoma.

"Please understand that is speculative, and a hypothesis," said Dr. Maisel.

To get to firmer scientific ground, the FDA will collaborate with the American Society of Plastic Surgeons and other groups to develop a registry to collect more information that would better characterize ALCL in women with breast implants. The agency also is asking implant manufacturers to report ALCL cases. And for the sake of patient and clinician education, the FDA will work with these manufacturers to update product labeling materials.

More information about today's announcement is available on the FDA Web site. The FDA's preliminary findings and analyses are available here.

To report adverse events related to breast implants, contact MedWatch, the FDA's safety information and adverse event reporting program, by telephone at 1-800-FDA-1088, by fax at 1-800-FDA-0178, online athttp://www.fda.gov/medwatch, or by mail to MedWatch, FDA, 5600 Fishers Lane, Rockville, Maryland 20852-9787.
Medscape Medical News © 2011 WebMD, LLC
Send comments and news tips to news@medscape.net.