Abdominoplasty
(Tummy Tuck)

What to expect after the Tummy Tuck surgery?

Most of my patients having a full Tummy Tuck (Abdominoplasty) will spend at least two days in hospital. Most patients are medically fine to go home at this stage, although some may benefit from another day or two in hospital.

Now what happens after surgery?

• You will wake from surgery in a hospital bed with the head of the bed elevated and one or two pillows under your knees all designed to keep your hips in a flexed position. This is to ensure you have minimal tension on your surgical wounds.
• All your wounds are stitched up using several layers of internal dissolving sutures. Although, often some stitches around your belly button are visible and will need to be removed after one week.
• All your wounds are covered using waterproof dressings.
• You will have a body suit or compressive garment on.
• One or two plastic tubes, or drains, are usually placed and come out from, or just below your wounds usually in your pubic region.
• You also have a catheter in place, which is basically a tube going into your bladder, so you don’t have to worry about getting up and trying to go to the toilet.
• You have at least one drip in place to give you intravenous fluids, pain control medication and antibiotics.
• You will also have special massage devices on both legs designed to minimise the chance of any clots in your leg veins.
• You will also have a nasal prongs or oxygen mask designed to give you supplemental oxygen.

All these tubes and drains etc., are all in place to keep you as comfortable as possible and so that we can monitor you.

Many women claim they find the experience and discomfort like that after a caesarean, with the first 24 hours being the least pleasant. You’re attached to all these tubes, largely confined to bed, sometimes feeling a little nauseous, and not the most comfortable in the world. This is when most patients question their sanity and wonder why they’ve done this to themselves and paid for it as well.

However, before you leave the hospital, all your drips, drains and catheters have been removed and you’re up walking around, albeit a little slowly and slightly hunched over.

Rest assured, this is normal, fortunately very short lived, and settles down.

What follow-up appointments do I need?

Following your surgery, and once you have been discharged from hospital, you will attend our practice for your first post-operative review with one our amazing post-operative nurses. Generally speaking, your first appointment will be scheduled no later than the day following your hospital discharge.

Within your first post-operative appointment, one of our friendly and caring post-operative nurses will inspect your wounds and administer LED light therapy, aimed at optimising your recovery.

Our post-operative nurses will continue to see you, at least three times per week for the following few weeks, and of course, will be available to answer any questions, in-between your in-clinic appointments.

We keep a careful eye on you and ensure you are reaching the correct recovery milestones during the crucial early post-operative period. We ultimately do all that we can to help you achieve an optimal outcome and that you are comforted and reassured during this phase.

How much does a Tummy Tuck (Abdominoplasty) hurt?

All invasive surgeries promise some pain and Tummy Tucks are no exception.

Your Specialist Anaesthetist will manage and oversee all your pain medication and treatments whilst in hospital and when discharged home. Most patients having a full Tummy Tuck (Abdominoplasty) stay in hospital for a minimum of two days. This is how long it takes before most people are medically well enough to be discharged. When you do go home after surgery your Anaesthetist will provide you with the appropriate pain medication scripts to keep you as comfortable as possible.

The main reason people are in hospital is to keep them comfortable and manage pain.

The first 24 hours is generally the worst, and this is when you’re lying in your hospital bed wondering why on earth you did this to yourself and start to question your sanity! This is normal, and fortunately goes away pretty quickly, and before too long you start to appreciate your results!

A common question is “What can Tummy Tuck pain be compared to?”

Like all surgical procedures, everyone has a different experience. However, it is often described as a significant tightness across the abdomen. Many women who’ve had a caesarean would say a caesarean is worse than a Tummy Tuck (Abdominoplasty), whilst others may say it’s worse than a caesarean. Either way, it’s similar.

In the beginning when you stand up, you’ll feel tight and will need to walk a little hunched over and shuffle along.

All drains, catheters, drips etc will be removed prior to discharge from hospital.

As a very general guide, you will feel like you can’t straighten up for about two weeks. So don’t force yourself to straighten up it, will happen when it wants to happen.

Also, with any chest or abdominal surgery, any straining will cause significant pain. So, anything that causes you to strain your abdomen such as coughing, sneezing etc will be uncomfortable. Therefore, avoid these as much as possible and firmly hold your belly when doing so.

Finally, it is painful taking deep breaths so naturally you will be taking short shallow breaths. Because of this it’s important that every hour on the hour you take two or three nice slow deep breaths to expand your lungs and minimise the chance of any chest problems.

What is the best way to sleep after a Tummy Tuck (Abdominoplasty)?

Whilst in hospital your bed is positioned with the head of the bed tilted up and a pillow under your knees, ensuring that your hips are flexed and there is minimal tension on the wound site.

The best sleeping position at home, should mimic your hospital bed. Sleep on your back with your upper body elevated to create a slight bend and prop your knees up slightly too. Using pillows or sleeping in a recliner is the easiest way to achieve this position. This position allows you avoid placing pressure or strain on your wounds and reduces the risk of a postoperative complications.

For stomach or side-sleepers, the thought of sleeping on your back may be challenging. If you are desperate to sleep on your side, we advise you to wait for at least two weeks and ensure your hips remain flexed. In this position, we also advise that you use extra pillows or rolled-up towels close either side to prevent you from tossing and turning.

Sleeping safely after your Tummy Tuck means no sleeping on your stomach for as long as possible, that being at least three weeks or so. After this, let your body guide you as to what is most comfortable.

Will I be constipated after a Tummy Tuck (Abdominoplasty)?

Bowel troubles, such as constipation and bloating, are common after abdominoplasty and can cause unwanted strain on the abdominal muscles.

Post-operative bowel issues are typically a side effect of pain medication and decreased mobility. To avoid severe constipation and the associated discomfort, we will prescribe you a stool softener while you’re at the hospital. We also encourage patients to consume lots of fluids and fibre, in combination with supplements such as Metamucil, both before and after the surgery to prevent constipation.

Severe constipation, leading to infrequent and difficult stools, can strain the abdominal muscles and cause trauma to your wounds. So, it is essential that you are monitoring the situation carefully.

Are compression garments necessary after a Tummy Tuck (Abdominoplasty)?

A Tummy Tuck compression garment is an elasticised cloth that stretches around your midsection. It is fitted tightly over your midsection, applying constant even pressure to that area. This will typically cover from the area below breasts down to hips and pelvic area. You’ll wake up with this garment after surgery.

Compression garments after Tummy Tucks are designed for several reasons. Compression garments accelerate the healing process, assist in draining fluids and swelling away from the wound, and alleviate the pain associated with the abdominoplasty. They also provide external support for the internal tightening and protect against complications such as infections, scarring and seroma (fluids collecting and filling a pocket under the skin).

It takes approximately six weeks for the sutured abdominal muscles to become solid, therefore the repair should be supported during this period. We advise our patients to wear the compression garment continuously for the six weeks, only coming off for brief periods of bathing.
After six weeks, patients are no longer required to wear them. However, many of our patients choose to continue wearing the compression garment as it offers physical and psychological support while they are gradually returning to regular physical activities.
Some degree of swelling is to be expected after the procedure, even months later. So, after you stop wearing your garment at six weeks, you may experience an increase in, albeit temporary, swelling. For this reason, many people continue to wear compression garments beyond six weeks to control fluctuating swelling.

When can I start driving after a Tummy Tuck (Abdominoplasty)?

You won’t be able to drive for some time after your Tummy Tuck, even after the anaesthetic has worn off. You are permitted to drive when you are off your pain medication, can sit straight without abdominal tightness, and can comfortably manoeuvre a car – this is typically after the two-week post-operative mark.

Your pain threshold and healing progress will determine when you can drive again. If you think you are ready to get behind the wheel, you should first assess that you are comfortable in the car. Assess whether you can wear a seatbelt, sit comfortably, open the door, use the controls, complete a head check, and imagine if you were to make a sudden stop or sharp turn to avoid an accident – would you be able to?

When can you go back to work after a Tummy Tuck (Abdominoplasty)?

It typically takes four weeks for most patients to return to work after tummy tuck surgery. However, there are some occupations that may require less downtime and others that may require more. So how quickly you can get back to work is going to depend on the type of work you do. However, we do offer some general guides to follow.

Sedentary office-based employees may be well enough to return to work after three weeks. If you have a more physically demanding job that requires you to be on your feet or undertaking lifting, then a longer recovery period of four weeks may be required. In most cases, we recommend that patients should plan to take three weeks of at home to recover. At six weeks, you’re welcome to attempt more strenuous work activities, but try and just use common sense and let your body guide you. You will still be feeling some discomfort at six weeks, so common sense prevails.

When can I walk after a Tummy Tuck (Abdominoplasty)?

We encourage patients to begin walking with assistance the day after the abdominoplasty procedure, although they will be slightly bent in a semi-flexed position and slowly shuffling along. In approximately two weeks, they are gradually able to stand up straighter and walk easier. It is important that you avoid straining your abdominal muscles, so be cautious and do not over-exert yourself.

When advised by a surgeon, walking is considered the best protection against certain complications and even assists with wound healing. Avoiding walking may increase your risk of infection, blood clots and lung issues like pneumonia, as well as constipation and bowel issues.

When can you start exercising after a Tummy Tuck (Abdominoplasty)?

During the first couple of weeks after Tummy Tuck surgery, you will be experiencing pain, discomfort and fatigue that will most likely deter you from wanting to exercise. And, resuming exercise too soon after surgery can lead to complications, including wound injuries and infections, or worse.

With this in mind here are some general guidelines:

• We will try to get you up and walking the day after surgery, although it’s more like a slow shuffle in the beginning.
  As you continue to become more comfortable, you will be discharged from hospital and encouraged to walk around gently at home.
• After about two weeks, once you feel like you can actually stand up straight, feel free to increase the walking distance, but no power walking or running.
• Avoid any physical activities that cause you to strain or activate your core muscles for the first six weeks.
• At six weeks, you can then slowly return to doing normal training and physical activities. We say slowly because you will still be experiencing a considerable amount of pain and discomfort when exercising.

So, at six weeks:

• You can certainly ride a stationary bike at the gym to burn some calories.
• You can also gradually progress to light cardiovascular exercise, such as jogging and weights.
• You can gradually increase the length, frequency and intensity of physical activity.
• You can gradually introduce abdominal exercises and weightlifting activities that engage your core. Although most people will struggle with any of this.

After approximately twelve weeks, most patients are able to undertake abdominal exercises and more intense weight training.

When you reintroduce any activities, do so gradually, and listen carefully to your body to avoid strain.

When can I have sex after a Tummy Tuck (Abdominoplasty)?

The question about returning to sexual activity after surgery is very common.

Basically, you can’t do anything that causes you to strain or activate your core muscles for the first six weeks.

Also, because of the size of the wounds and the healing required you don’t want to be doing anything that gets your heart rate or blood pressure up too much.

Of course, the level of physical activity one undertakes during sex varies for each individual and often each time you’re having sex.

So, with all this in mind some generalisations can be made.

• Realistically you’re probably not going to be even thinking about for the first week at least.
• However officially, you should avoid any sexual activity for the first two weeks. Anything that gets your heart rate and blood pressure up is not ideal and any potential pressure etc on your abdominal wall and pubic area will potentially compromise your wound healing.
• When you do return to having sex, as previously stated, don’t undergo any sexual activity for the first six weeks that involves you being too active or activating your core muscles. So basically, up until the six weeks post op period, you are taking on a very passive role during sex!
• Your partner also needs to avoid any significant grabbing or handling of your surgical wounds and abdominal wall for the first six weeks. This could compromise wound healing, and in the early stages it could potentially cause bleeding issues and increased swelling.
• After six weeks, you can do what you like without any fear that you’re going to compromise your results. Obviously you will still be a little sore here and there but just let your body guide you.  Ultimately common sense will tell you what’s right and wrong at this stage.

What happens if I gain weight after a Tummy Tuck (Abdominoplasty)?

While the Tummy Tuck procedure assists in creating a more contoured form, it does not prevent you from gaining weight.

Severe weight fluctuations can compromise the results of your surgery. That’s why it is best to achieve a stable weight for a period prior to the procedure.

The early post-operative period is when many patients can easily put on weight if they’re not careful. Many of our patients are training quite a lot before surgery and are very strict with their diet. In fact, that’s one of the reasons why they’re getting surgery, because diet and exercise can’t get rid of the excess skin.

However, after surgery when you’re unable to do any significant exercise for the first six weeks, and sitting around a lot more potentially eating more, you are at a high risk of putting on weight.

So, the best way to avoid this is to make some serious conscious efforts to control your diet and start walking as soon as you are able. The last thing you want is to get through the first six weeks and realise that you’ve put on 5-10kgs.

Whilst its very reversible, it can put a downer to what should otherwise be a very good time for you.

What will my belly button look like after a Tummy Tuck (Abdominoplasty)?

People often think that with a Tummy Tuck the surgeon creates a new belly button. This is not the case. You keep your original belly button, although there will be a scar within and around it.

Traditionally, a small incision will be made around the belly button in order for it to be released from the skin surrounding it. Having the belly button staying attached to the muscle beneath it and remaining in position, is standard practice for the Tummy Tuck procedure. Only the skin around your navel will be moved and repositioned.

The skin above the belly button is lifted off the muscle and is then pulled down over the top of the belly button and stitched to the pubic skin.
Then towards the end of the operation, an incision is made in the skin where the belly button lies underneath, and the belly button is brought back to the outside and stitched into position.

Surgeons use all manner of techniques or incisions to deliver the belly button. Ultimately you want the most natural appearing belly button with the least visible scar possible.

Dr Dona has refined his technique over the years. For the majority of patients, they end up with a more defined appearing belly button and a minimally noticeable scar.

How long until you see your Tummy Tuck (Abdominoplasty)results?

Patients are understandably keen to see the outcome of their Tummy Tuck, however like every operation, you have to be patient to appreciate the end result. Please bear in mind that the initial results will be obscured by swelling and your inability to stand completely upright until internal healing is complete.

Of course, those who have significant concerns prior to surgery and require major reconstructive surgery, will almost immediately be able to see a dramatic change after surgery. This is despite all the swelling and discomfort.

However, certainly by six weeks once you slowly start to get back to doing your normal activities, you’ll be noticing much more.

Most of the swelling and pains and tightness should have resolved by 6 months. This is when you could say life has largely gotten back to normal and you’ve forgotten you’ve had surgery, except for the fact that you’re now very different.

However, it takes at least 12 to 24 months for scars to fully mature.  Scars are initially bright red and noticeable, but ideally, they will end up as a fine white line. Of course, scars never disappear completely. Also, scars do not always heal nicely and can sometime develop thickening including keloid scars.