Questions about Tummy Tuck:

Does it hurt?

Like any surgical procedure some discomfort is expected, and the first three days are the hardest. This is not the kind of surgery that you want to lay around in bed without moving. We want you to be active the next day, at least getting into a chair or going to the bathroom. The more you lay around the harder it will be to recuperate and the higher the chances of you developing a blood clot in you legs. We will give you plenty of medications so that this discomfort is minimized.

Can I still have children?

This is not a problem, the procedure entails that we tighten your stomach muscles, and remove excess skin/ fat. We never enter the abdominal cavity and therefore we remain superficial to your internal organs. If you think about it, many women who are in excellent shape and have very tight abdominal muscles are still able to have children. Therefore, your tummy tuck will not hinder you in any way from having children. On the other hand, if the operation is being performed to improve the quality of your skin and remove stretch marks, then perhaps you should wait until you are finished with childbearing since becoming pregnant may stretch the muscle out and have your stretch marks return.

Will I get fat again?

Remember, we are removing excess skin, fat and tightening the muscle. Since we cannot remove all the fat cells in your body you will still have the ability to loose and gain weight. Therefore, if you don't follow a diet or exercise program and don't watch what you eat, you can gain your weight back. I can tell you that most of our patients after undergoing the procedure, and see their new body shape, have a much easier time exercising and maintaining good eating habits.

When can I return to work? And when can I exercise?

Most patient return to work in 7-10 days, however, in the beginning, when you first return to work you will feel tired, especially after midday. This feeling will improve over a month's period. Returning to the gym will take about one month.

Can you remove all my stretch marks?

The answer to this question will depend on how the stretch marks relate to the belly button. The rule of thumb is that if they are all below the belly button then usually we can remove all of them. However, if they are above the belly button, then we may not be able to. The amount of stretch marks we will be able to remove will; depend on how much excess skin you have. It is important to note that if we are not able to remove all the stretch marks, the ones that remain will have a much better appearance than before. To this day we don't have any solution to stretch marks other than surgical removal. Laser has been attempted but they don't have consistent results.

Can you do liposuction at the same time?

This is a very controversial area and you will find many surgeons that are divided on this issue. The reason is because some feel that when liposuction is combined with a tummy tuck, it may compromise the blood supply to the tissues leading to poor circulation and tissue necrosis. Some surgeons have taken the attitude that they will not perform any liposuction so that they don't increase this chance. However there are those of us that believe that it can be done very safely and effectively if done properly. The truth of the matter is that having a good understanding of tissue anatomy and circulation does allow us to safely perform the combined procedures. The benefits are: that it is one surgery with one recovery period, and financially it is one fee. Also the results are unsurpassable when combined with liposuction. Nevertheless there may be an increased risk for necrosis, and it particularly should be done with caution in smokers, diabetics and obese patients since they already have poor circulation and healing. In these cases it could be done in two stages.

Can I do this as an outpatient or inpatient?

The operation can be performed safely on an outpatient basis, however, different surgeons will have different criteria on who is a candidate for this. Although every state is different, there has not been a national hard and fast rule as to who can be done on an outpatient basis and who needs to be done in a hospital. There have been some states that have taken a more proactive role in establishing some restrictions, but certainly these are not universal rules. The state of Florida for example, has instituted several rules for office-based surgeries.

• All patients who are ASA 3 need to be done in a hospital setting. The ASA is a classification system used by anesthesiologist to determine your general anesthetic risk factor. There is ASA 1,2,3,4 and 5. ASA 1 is a healthy person, an ASA 2 is someone who has mild to moderate systemic disease (i.e. controlled hypertension), ASA 3 The patient has severe systemic disease that impacts daily living (i.e. diabetes, uncontrolled hypertension), ASA 4 is life threatening disorders and not necessarily correctable by surgery.
• They have also asked that a procedure cannot exceed 8 hours in an office based setting (This is o.k. since the procedure takes between 2 and 3 hours.)
• They have also instituted the rule that if a tummy tuck is combined with liposuction you cannot remove more than one liter of fat at the same time. Although it is very safe to remove more than that, this is an arbitrary number Florida has used and if you plan on removing more than one liter then it needs to be done in a hospital setting.

Dr. Mendieta has instituted several patient safety measures in order to determine who is eligible for an outpatient procedure. The criteria are based on three factors:

1. One is your overall health; if you have any medical problems (i.e. Diabetes, Hypertension), then it is best performed in a hospital setting and expect to stay one or two nights.

2. The second is based on your BMI (Body Mass Index); this is a calculated number that tells us how overweight you are. The more over your ideal body weight you are, the higher you're BMI, and the higher the risk factor. The BMI therefore helps in determining if your procedure needs to be done in a hospital setting. For more detailed information on your particular case and to find out your BMI click here.

3. The third - if more than one liter of fat is expected to be removed at the same time as your tummy tuck, then it is done in a hospital setting.

I have thick and dark scars.

Scars are perhaps the biggest drawback of the operation. Every person heals differently and so the final scar will depend on your own body's healing process. There are several things that can be done to try and improve your final scar. Some of the things we recommend are silicone patches or some silicone based solution. There are some solutions like SCAR GUARD that contains vitamin E, silicone and steroids, all of which help with scaring. Also you can simply place surgical tape over the scar and keep doing this for a 3-month period. (Make sure it is not irritating your skin; if so discontinue using the tape). These are all suggestion and every surgeon may have a different regimen or philosophy, so consult with your physician.

By nature scars may actually appear to worsen during the first three to six months as they heal, but this is normal. The scar will continue to change for over a period of one to two years. Your final scar will not be established until that time. So you can expect it to take nine months to a year before your scars flatten out and lighten in color. While they'll never disappear completely, abdominal scars will not show under most clothing, even under bathing suits.

Some patients will develop thick scars and these can be either hypertrophic scars (thick scars) or Keloids (very thick scars). In these cases it may require several steroid injections to improve the scar as well as silicone patches and external pressure. Scar revision can be attempted but you would want to wait some time before doing this. If you have this type of scaring it is your own healing process and therefore as you can imagine, any scar revision will create the same sort of healing, so the scar can be just as worse as before or even worse. Usually hypertrophic scars have better results with scar revision than keloid scars. Laser can sometimes improve the color of the scar.

My poochiness has returned.

The reason for doing a tummy tuck is to remove excess skin, tighten your abdominal muscles and obtain a better body contour. When we tighten the abdomen we do so by placing sutures in the fascia of the muscle. The muscle itself does not have any support since this is a soft and mushy structure. The fascia is the covering on the muscle and it is the tissue that has the most strength, this fascia is like tendons sort of speak. This is why we place our sutures in the fascia in order to tighten the muscle. The fascia below the belly button is not as strong as that above, and this is why you will see more of recurrences in you're poochiness below the belly button than above. Your internal organs are all below these layers we have been talking about, so we never enter the abdominal cavity when we are performing a tummy tuck (abdominoplasty). With this understanding you can now appreciate that recurrence of your poochiness will be due to three factors:

1. Anything that increases the size of your internal abdomen will obviously place pressure on the muscle and fascia. As you can imagine, this will cause your muscle to stretch. So if you have gained weight or became pregnant after you're surgery then obviously your muscle will stretch, and have the poochiness return.

2. Another problem could be if your sutures break, loosens or tears through the fascia. This is more common in the first months after you surgery. It usually occurs if you have done something to increase the pressure in your stomach muscles, things like lifting heavy objects or had a bad persistent cough.

3. Now there are some circumstances where you have done neither and still the poochiness return. In these cases then either the sutures became loose or more than likely it is that you're fascia is weak and it stretches easily. If this is the case then sometime we can use an internal mesh to add support to your tissues. A mesh is a special material that we use to repair hernias and weakness in the fascia. This will work in some patients but what I have noticed is that even when a mesh is used, some tissues are so intrinsically weak that we are not able to support them. This is just a part of your anatomy, and no matter what we do, we will not be able to make it flat, and you will have to accept your poochiness.

I Have Dog-ears.

This occurs very commonly with Abdominoplasty, in order to try and minimize the scar on your body, the excision of skin is limited to a minimal point. However if you have excess loose skin that still needed to be removed, then when the healing process is over, you will have that excess skin and fat on the sides giving you this dog-ear appearance. This is why I council my patients that I cannot guarantee the length of the scar because the determination as to how much skin will be removed is made in the operating room. I don't want to have to limit the scar and then have an equally unattractive result after the surgery. The length of the scar therefore will depend on your anatomy, the quality of your skin, and the amount of loose skin you have.

The correction of a dog-ear will depend on what the problem is. Whether the problem is too much fat too much skin or both. If it is just fat then you can liposuction the area and it will improve, if the problem is skin then you will need to extend the scar and remove the excess skin. In my experience, I have almost always had to extend the scar and combine it with liposuction.

I look too square.

This is usually a problem when you were square to begin with and no liposuction was done to contour the side of the body. Not all surgeons believe in performing liposuction at the same time as a tummy tuck, since they feel it may have a higher risk for skin necrosis. Liposuction does not have to be done at the same time as your tummy tuck and it can be done at a second stage. The options are to evaluate your anatomy and see how much excess fat there is in the flank area. More than likely liposuction of that area can give you a very nice result with excellent contour.

My skin has no sensations.

This is normal and will last for to six months after your surgery, in some patients it may last as long as 1-2 years. Very rarely will a patient have permanent sensation loss, but it is possible.

I have a Seroma what are my options?

After your surgery drains will usually be left in place, this is to collect the fluid that your body produces. At first this fluid is red in color and as days go by it turns to a yellow color. The production of this fluid usually subsides after about 6-9 days and the drains can be removed. In very rare cases, the body continues to produce this fluid after the drains are discontinued. Since there is no way to get the fluid out it can accumulate and your body swells. If this happens you may need to have another drain placed and be kept in place for several days. This usually solves the problem, however, in a very small percentage of patients this problem may persist. The reason for the persistence is that the body forms an internal capsule and now the tissue cannot heal together. In order to allow this tissue to heal it now may require either irritating the capsule with sclerosing agents like tetracycline or it may require a re-operation in order to remove the capsule. This problem is very rare.

I have necrosis what are my options?

This complication is rare, it occurs when the circulation to the skin is poor and it results in tissue death (necrosis). The options are several and the treatment chosen will depend on your surgeons experience, philosophy and training.

1. You could do nothing and let the body heal itself. The healing process will go through many stages and it will take a long time depending on how extensive the necrosis is. It can take up to 3-6 months, in some cases less but in others longer. The wound will turn black in color and feel like leather, after, it will start to debride itself but will take a long time. It is ok to follow this option unless an infection develops, and by this I don't mean a superficial skin infection since this can be treated with antibiotics, but I mean a deep seeded infection. If this occurs, then surgical intervention will be required, and this is usually in the form of a wound detriment and either oral or IV antibiotics.

2. In small necrosis, the above option may be ok but not universally accepted. However, in larger necrosis it is sometimes better to remove the necrotic tissue with surgical debridement and then let the wound heal by itself. With this approach you may heal quicker since you are not waiting for the body to debride itself before it starts healing.

After the wound has been debrided, and it is now ready to start healing, it is when you will find many surgeons doing different things. Every surgeon has his own philosophy in treating these open wounds. There are many wound-healing ointments, solutions, dressing changes and devices that can accelerate the healing process. All of these will help, and the truth of the matter is that the body has an amazing way of healing itself and no matter what you do it will heal (it just takes time). The only time a wound stops healing is when an infection is present, you have very poor nutrition or there is not enough blood supply.

Some surgeons may even suggest using a skin graft to cover the open area. This in my opinion is not the best solution since you are placing another scar on a different part of the body to close a wound that would close anyways. Besides there are so many different and good healing options today that a skin graft would not be part of my treatment plan.

3. An option that some may follow is that once you have debrided the wound and it has started healing with nice healthy granulation tissue, then you can try and close the wound surgically. This is called tertiary closure. This will offer a much quicker recovery since the wound can theoretically be closed at that time of surgery. In my practice we have had excellent results with this method of closure. The only drawback to this approach is that there is a slightly higher chance of developing an infection, and if this is the case then you will need to reopen the wound. But then again you would only be at the same stage as if you had not tried to close the wound.

4. In larger wounds it may require several debridements and once the wound has started healing, you can close the wound in several stages. This is called serial closures. Since the wound may be too large to close in one surgery then you approximate it as much as you can and place some sutures or devices to help maintain the tension. Then, on another day when the skin has stretched you can again re-approximate the wound as much as you can, repeating the process until it is completely closed.

5. There are always new wound modalities that are being developed, I have been fortunate enough to be a part of a study of a new form of wound healing by using electromagnetic therapy. Although this device is not available nation wide, it has had some unbelievable and amazing results. Increasing the healing time by almost 50-60%. Wound that would take 4-5 months are being closed in 1-2 months.

You must remember that regardless of the modality used to treat your wound, it will almost always require a scar revision. Don't let the ugly appearance of the wound now scare you, since this will not be the final result. Once the healing process has taken place and the scar is revised the results are very good.