As mentioned in our last column, pregnancy can be quite hard on a woman’s body.  Despite every cream and body butter imaginable, many women still develop large stretch marks that linger long after the baby is born.  Often after delivery, the skin over the lower and midportions of the abdomen remains loose as well. This results in unsightly bulges seen in snug or low-riding clothing.  In many women, the skin will tighten within one year of delivery, but in others it never returns to its pre-pregnant state.  The last undesirable effect of pregnancy on the abdomen is bulging of the abdominal muscles.   This occurs because pregnancy stretches the rectus muscles (six-pack muscles) greatly to allow for growth of the uterus.  In many women, not even hundreds of sit-ups and abdominal work-outs can correct this problem.  For all of these post-pregnancy effects on the tummy, there is help in the hands of a cosmetic surgeon. 

Full abdominoplasty is a big operation that takes 2 or more weeks to recover.  The procedure itself involves saving the umbilicus (belly-button) and removing skin and fat from the lower abdomen (which contains the pregnancy-related stretch marks).  The abdominal muscles are then tightened with sutures to restore the pre-pregnancy shape and flatness.  After this is performed, the upper abdominal skin with its underlying fat is liposuctioned and brought down to the lower abdomen. It is sutured in a straight line across the pubic hairline.  The umbilicus is then placed into its normal position on the abdominal wall.  A small drain is placed to help the flap of skin and residual fat stick to the muscles again and prevent fluid from accumulating within this new space.  The drain is generally removed in 10 days.  For select patients, a mini-abdominoplasty may be recommended.  This procedure is a smaller surgery very similar to the full abdominoplasty except it only focuses on the lower abdomen below the umbilicus.  The choice of procedure depends on your body and your goals for the procedure and therefore must be determined at the time of consultation.  The results of both procedures are youthful tummies that many women desire.   Many times, the new abdomen is better than the one you had before your pregnancy! 

One limitation of abdominoplasty is the fact that it does not alter the flanks (love handles).  For this area, liposuction is recommended.  Many women undergo both procedures together to rejuvenate their waistlines as well as to flatten their abdomens.  The liposuction includes removing fat around the waist area through a tiny incision in the middle of the back.  Swelling after this procedure is common and generally peaks at 5 days.  Because of this, the results of the liposuction are not generally seen for several weeks and the best results are not seen for approximately 3 months. 

Postoperatively, women generally go home the same day.  An abdominal corset or binder is placed immediately after the surgery and will be worn for several weeks after surgery is completed.  Patients are strongly encouraged to walk every several hours once they are home in order to prevent blood clots that can migrate and become fatal.  With frequent walks, this risk is minimized.  Women with high risks of this complication are often prescribed a blood-thinning shot to take for several days as well.  Generally, patients are walking well and straight within 1 week.  The drain is removed within 1-2 weeks and the corset is worn for at least 1 month.  Many patients are able to return to work after two weeks.  Patients can resume most jobs and light exercise within 2-4 weeks and can resume all normal exercise/work activities after 6 weeks.

Overall, abdominoplasty and flak liposuction are great procedures for rejuvenating the abdomen and waistline.  The results are permanent (assuming no major weight gain or pregnancy) and result in very youthful figures seen prior to pregnancy.  If you are finished having children and want to restore your abdomen and waistline, please call our office for a free consultation.  You’ll be glad you did!

  Lane F. Smith, MD              Loucinda R. Dampier, MD