Abdominoplasty (tummy tuck)

Abdominoplasty

Abdominoplasty or a 'tummy tuck' is cosmetic or reconstructive surgery. It is used to tighten muscles that have become loose or split following pregnancy, or to remove fat and extra loose skin from the abdomen after massive weight loss.

In most cases, abdominoplasty will:

• restore weakened or separated muscles
• help alleviate pain
• improve bladder function
• reduce itching and skin infections caused by excess skin
• change the shape and tone of the abdomen to create a firmer and smoother profile.

Abdominoplasty is not a substitute for weight loss or exercise. It may be possible to achieve a flatter stomach without surgery, through healthy eating and exercise, but not always. Many medical practitioners recommend that abdominoplasty be considered only after dieting and exercise have achieved the right body shape underneath.

If you are concerned about the way you look or are thinking about cosmetic treatments to boost your confidence, there are alternatives. These may include lifestyle changes or talking to a counsellor or psychologist, which may help you overcome your concerns about your appearance.

Changes to laws that affect cosmetic procedures

In 2018, amendments were made to the Health Services Act 1988 to regulate all surgery, including cosmetic surgery. The changes specified that:

• all surgery must be carried out in a registered private hospital or day procedure centre
• liposuction and anaesthesia, including intravenous sedation and anything more than a low dose of local anaesthetic, must be carried out in a registered private hospital or day procedure centre.

This means that it is now illegal in Victoria for:

• any surgery (including cosmetic surgery) to be performed in facilities that are not registered with the Victorian Department of Health
• anaesthetic (other than low doses of local anaesthetic) to be administered in an unregistered facility.

How do I know if a facility or health service establishment is registered?

To find out if a facility is registered, you can:

• visit the Department of Health Private hospitals page and download the ‘contact details for private hospitals’ sheet.
• email the Department’s Private Hospitals Unit privatehospitals@health.vic.gov.au
• ask to see the facility’s certificate of registration (this is usually on display in an obvious place where consumers can see it easily).

You can also contact the unit to report suspected illegal activity or for further queries regarding liposuction, cosmetic surgery or anaesthesia in Victoria.

Things to consider before deciding to have abdominoplasty

Before you choose to have abdominoplasty, some of the important issues to keep in mind include:

• The results of abdominoplasty are considered permanent. However, any major changes in your weight after surgery could change how you look. If you are planning substantial weight loss or considering future pregnancies, postpone the operation.
• Abdominoplasty is not considered a treatment for stretch marks, although any stretch marks in the treated area will be removed along with excess skin.
• Think about the financial cost. Medicare and private health insurance may cover some of the costs, but you must be prepared for some out-of-pocket expenses. For more information:
  • Ask your medical practitioner about any out-of-pocket costs you can expect, and if you will be eligible for a rebate.
  • Visit PrivateHealth.gov.au for more information on private health insurance.
• Smokers are at increased risk of complications from any surgery. To decrease the risk of these complications, and for your general health and wellbeing, try to quit smoking before having surgery.
• Consider asking another medical practitioner for a second opinion. It is important to have as much information as possible, before deciding to have abdominoplasty.

Finding a qualified medical practitioner

Ask your GP (doctor) for advice about finding a reputable medical practitioner or hospital where abdominoplasty is performed.

At your first consultation, ask the medical practitioner about their training and experience.

This procedure should be done by a medical practitioner who is specially trained to perform abdominoplasty and who has a lot of experience in carrying out this type of procedure. Ask to see the practitioner’s certificates that show them to be qualified to perform this specialised surgery.

All doctors practising in Victoria must be registered with the Medical Board of Australia (the Board). Find out if your medical practitioner is registered with the Board by searching on the AHPRA website.

Your current medical status and abdominoplasty

If you are considering having abdominoplasty, you need to discuss your current medical status with your medical practitioner. This includes discussing:

• your physical health – including your past medical history, such as diseases, illnesses, surgeries, immunisations and current physical status, which will include your diet and exercise regime. This would be a good time for the medical practitioner to check your blood pressure, temperature, heart rate/rhythm, oxygen saturation and respiratory rate
• your mental health – any mental illnesses or issues and their treatments
• medications you are currently on, including vitamins and supplements
• past reactions to medications
• any allergies you have

As a result of this discussion, your medical practitioner will be able to assess the risks and possible complications of the surgery for you. They will also be able to tell you what preparations you will need to make to ensure your recovery from surgery is as smooth as possible.

Abdominoplasty – what happens during surgery

All surgery, including abdominoplasty, must be performed within licensed and accredited facilities. A registered anaesthetist must be present to treat you for any adverse reaction you may have to the anaesthetic. You can check if your anaesthetist is registered by searching on the AHPRA website.

There are two types of abdominoplasty:

• full abdominoplasty – which removes excess skin and tightens underlying muscles across the whole abdominal area, including around the navel
• partial abdominoplasty – which removes excess skin below the navel and tightens the lower abdominal muscles only.

The operation is usually performed under general anaesthetic. The length of the operation will depend on the extent of the surgery, but it could take up to three hours.

Generally, a full abdominoplasty involves:

• The medical practitioner makes a horizontal, curved incision (cut) near the pubic hairline, which runs from one hip to the other.
• The skin and fatty tissue are lifted from the underlying tissue.
• The medical practitioner stitches and tightens slack or separated abdominal muscles.
• Excess fat is removed.
• Excess skin is trimmed.
• The navel is repositioned.
• The wounds are closed with stitches, tape or clips

All surgery must be performed within licensed and accredited facilities with a registered anaesthetist (this can be checked on the AHPRA website) present to treat you for any adverse reaction you may have to the anaesthetic.

Immediately after abdominoplasty

After the operation, you can expect:

• a drain in the wound to help prevent fluid build-up
• bruising and swelling
• probable numbness in the skin between the navel and the wound
• pain and discomfort
• inability to stand up straight, to begin with
• a 'tugging' sensation at your abdomen
• dressings or bandages on your abdomen
• a compression garment to help keep the swelling down.

Potential complications of abdominoplasty

All surgery carries some degree of risk. Some of the possible complications of abdominoplasty include:

• wound infection for which treatment with antibiotics might be required
• pain and discomfort around the incision sites
• haematoma (an accumulation of blood around the surgical site that may require drainage)
• visible and prominent scars, including keloid and hypertrophic scars – these are raised, thickened scars that form over healed incisions
• numbness around operated sites – in most cases this is temporary and will improve over many months
• areas of skin that do not heal and may require a skin graft
• difficulty in bending forward due to the tightened skin
• excess fluid accumulation under the skin (seroma) around an operated site, that may require one or more drainage procedures with a needle
• the need for a blood transfusion (in the unlikely event of a large amount of blood loss during surgery)
• blood clots, which may become life-threatening if they move to the lungs
• nausea and vomiting from the general anaesthetic.

This is not a complete list. Your medical history or lifestyle may put you at increased risk of other complications. For example, people who are obese and who have abdominoplasty are more likely to get a chest infection. Speak to your medical practitioner for more information.

Self-care at home after abdominoplasty

Be guided by your medical practitioner, but general self-care suggestions include:

• rest as much as possible
• follow all instructions on looking after your wound
• avoid strenuous exercise or heavy lifting for at least one month
• report any bleeding, severe pain or unusual symptoms to your medical practitioner.

Your medical practitioner may advise you to:

• wear compressive stockings on your legs for seven to ten days after the operation to prevent deep vein thrombosis
• wear a compression garment over the surgical site for several weeks.

Long-term outlook following abdominoplasty

Be aware that having an abdominoplasty will not stop you gaining weight in the future.

Scarring will be permanent but should fade in time. Be patient – it may take around a year or so. Some puckering on the outside edge of the scar might remain.

Alternatives to abdominoplasty

Other options include:

• eating a healthy, low-fat diet
• getting regular exercise
• wearing foundation garments to flatten the tummy area
• talking to a counsellor or psychologist – this may help you overcome your concerns about your appearance.

Where to get help

• Your GP (doctor)
• A medical practitioner specially trained and experienced in performing cosmetic surgery
• Cosmetic surgery hub and hotline, Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 361 041
• Cosmetic surgery, Department of Health and Aged Care, Australian Government
• Private Hospitals Unit, Department of Health Email privatehospitals@health.vic.gov.au
• Australian Society of Plastic Surgeons Tel. (02) 9437 9200
• Royal Australasian College of SurgeonsTel. (03) 9249 1200
• Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 419 495