Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Extended abdominoplasty is a major surgical procedure performed under general anesthesia. This ensures the patient is completely unconscious, feels no pain, and remains still throughout the operation. A board-certified anesthesiologist monitors vital signs, including heart rate, blood pressure, and oxygen saturation, throughout the entire procedure.
Strict safety protocols are employed to prevent complications such as deep vein thrombosis (DVT). Sequential compression devices (SCDs) are placed on the legs to promote blood circulation. The patient’s body temperature is maintained with warming blankets to prevent hypothermia, which aids in blood clotting and reduces infection risk.
Extended abdominoplasty is performed under general anesthesia. This ensures the patient is completely unconscious, immobile, and pain-free. The anesthesiologist secures the airway and monitors vital signs, fluid balance, and depth of anesthesia throughout the multi-hour procedure.
Fluid management is critical. Because liposuction is often involved, the balance between fluids administered and fluids removed must be precise to maintain blood pressure without overloading the system. Warming blankets are used to prevent hypothermia during long exposure.
The surgery begins with the infiltration of a tumescent solution into the targeted areas. This fluid contains saline, lidocaine (a numbing agent), and epinephrine (a vasoconstrictor). The epinephrine shrinks blood vessels, significantly reducing bleeding and bruising, while the lidocaine provides pain relief that lasts into the recovery period.
Liposuction is then performed to contour the flanks and upper abdomen. This debulking step thins the fat layer, allowing the skin to be draped more smoothly. It also defines the waistline and releases the skin from the underlying tissue, facilitating a more effective lift.
The surgeon makes the extended incision, starting low on the pubis and extending laterally over the hip bones toward the back. The amount of excess skin dictates the length of the incision. The skin and fat are then lifted off the abdominal wall up to the ribcage, exposing the rectus abdominis muscles.
Careful dissection preserves the blood supply to the skin flap. The surgeon navigates around the belly button, cutting it free from the surrounding skin but leaving it attached to the muscle wall on its stalk. This exposure sets the stage for the structural repair.
Once the muscle wall is exposed, the repair of the diastasis recti begins. Using heavy, permanent sutures, the surgeon plicates (folds and stitches) the rectus abdominis muscles together in the midline.
This tightening starts at the xiphoid process (bottom of the sternum) and continues down to the pubic bone. This step flattens the internal abdominal contents and significantly narrows the waistline, restoring the core’s structural integrity.
The patient is placed in a flexed position (beach chair) on the operating table. This brings the rib cage closer to the hips, relieving tension on the skin. The surgeon then pulls the elevated skin flap down forcefully.
The excess skin and fat, including the tissue from the flanks, are measured and excised. The surgeon carefully tailors the lateral edges to ensure a smooth contour without dog ears. The tension is distributed evenly along the extended incision line.
Since the skin has been pulled down significantly, the original belly button hole is removed with the excess skin. The underlying umbilical stalk remains attached to the muscle. The surgeon palpates the stalk through the new skin drape.
A new opening is cut in the skin at the appropriate level. The navel is brought through and sutured into place. Modern techniques involve creating a slight depression or “hood” to make the new belly button look natural and unoperated.
Drains are typically placed before closure. Two or more silicone tubes are inserted under the skin flap and exit through small holes in the pubic area. These drains remove the fluid (seroma) and blood that naturally accumulates in the space created by the surgery.
By removing this fluid, the drains allow the skin flap to adhere firmly to the muscle wall, facilitating healing. They are attached to suction bulbs that the patient will manage at home.
The incision is closed in multiple layers. Deep sutures take the tension, while superficial sutures or surgical glue align the skin edges for a fine scar. If the high lateral tension technique is used, extra sutures are placed in the hips to hold the lift.
Sterile dressings are applied to the incisions. An abdominal binder or compression garment is put on the patient immediately while still in the OR. This garment limits swelling and supports muscle repair.
The patient is moved to the PACU (Post-Anesthesia Care Unit). They are kept in a flexed position to protect the incision. Nurses monitor vitals and manage immediate pain and nausea.
Early mobilization is key. Patients are encouraged to wiggle their toes and legs to promote circulation. Once stable and awake, they are discharged to their caregiver with strict instructions on maintaining the flexed posture.
The extended tummy tuck involves significant muscle work, which causes soreness. Surgeons often inject a long-acting local anesthetic (like Exparel) into the muscle fascia during surgery, which numbs the abdomen for up to 72 hours.
Oral narcotics are prescribed for the first few days for breakthrough pain. Muscle relaxants are crucial for preventing painful muscle spasms. Patients transition to non-narcotic pain relievers like Tylenol usually within the first week.
Deep Vein Thrombosis (blood clots in the legs) is a serious risk. Patients are instructed to walk, hunched over, starting the evening of surgery. Short walks to the bathroom or kitchen every few hours keep blood moving.
Compression stockings are worn. In high-risk patients, blood-thinning injections may be prescribed for a week or two post-op. Hydration is enforced to keep the blood from becoming too thick.
The first week is the most difficult. Patients must walk and sleep in a flexed position (like a recliner) to avoid pulling the incision apart. They are dependent on help for getting up, food preparation, and personal care.
Showering is typically allowed after 48 hours, provided care is taken not to clog the drains. The focus is on rest, hydration, and managing drainage output.
Patients are taught how to care for their incisions. This usually involves keeping them clean and dry. Dressings may need to be changed if they become soiled.
Signs of infection (redness, fever, pus) must be monitored. If surgical glue was used, it peels off on its own. If tape was used, it stays in place until the follow-up visit.
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An extended tummy tuck typically takes between 3 and 5 hours. This is longer than a standard tuck because of the extra time needed to dissect the flanks, perform liposuction, and meticulously close the longer incision.
You will wake up groggy and tight. Most surgeons use a long-acting numbing shot in your stomach muscles that lasts for 2-3 days, so the initial pain is often very manageable. You will have pain meds for when this wears off.
Drains are removed when the fluid output drops below a certain level (usually less than 25-30ml per day). This typically takes anywhere from 7 to 14 days. It depends on your body and how much activity you do.
You must sleep with your back propped up and knees bent (recliner position) for the first 1-2 weeks. You can gradually lower the pillows as the tension in your stomach releases. Sleeping flat too soon puts dangerous pressure on the scar.
Most surgeons allow you to shower 48 hours after surgery. You will likely wear a lanyard around your neck to clip the drains to, so they don’t pull. You let the water run over you, but do not scrub the incisions.
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