Abdominoplasty

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KEY TERMS
Abdomen—The portion of the body that lies between the thorax and the pelvis. It contains a cavity with many organs.
Amniotic membrane—A thin membrane that contains the fetus and the protective amniotic fluid
surrounding the fetus.
Anesthesia—A combination of drugs administered
by a variety of techniques by trained professionals
that provide sedation, amnesia, analgesia, and immobility adequate for the accomplishment of the
surgical procedure with minimal discomfort, and
without injury, to the patient.
Gastroschisis—A defect of the abdominal wall
caused by rupture of the amniotic membrane or by
the delayed closure of the umbilical ring. It is usually accompanied by protrusion of abdomen organs.
Hernia—The protrusion or thrusting forward of an
organ or tissue through an abnormal opening into
the abdominal sac.
Omphalocele—A hernia that occurs at the navel.
Peritonitis—Inflammation of the membrane lining
the abdominal cavity. It causes abdominal pain
and tenderness, constipation, vomiting, and fever.
Short bowel syndrome—A condition in which digestion and absorption in the small intestine are
impaired.
Ultrasound—An imaging technology that that
allow various organs in the body to be examined.
Umbilical ring—An opening through which the
umbilical vessels pass in the fetus; it is closed after
birth and its site is indicated by the navel.
PERIODICALS
Kurchubasche, Arlet G. “The fetus with an abdominal wall defect.” Medicine & Health/Rhode Island 84 (2001): 159–161.
Lenke, R. “Benefits of term delivery in infants with antenatally
diagnosed gastroschisis.” Obstetrics and Gynecology 101
(February 2003): 418–419.
Sydorak, R. M., A. Nijagal, L. Sbragia, et al. “Gastroschisis:
small hole, big cost.” Journal of Pediatric Surgery 37 (December 2002): 1669–1672.
White, J. J. “Morbidity in infants with antenatally-diagnosed
anterior abdominal wall defects.” Pediatric Surgery International 17 (September 2001): 587–591.
ORGANIZATIONS
American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (847) 434-4000.
<http://www.aap.org>.
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“Abdominal Defects.” Medical and Scientific Information Online, Inc. [cited April 8, 2003]. <http://www.cpdx.com/
cpdx/abdwall.htm>.
National Birth Defects Prevention Network. January 27, 2003
[cited April 8, 2003]. <http://www.nbdpn.org>.
Monique Laberge, Ph.D.
Abdominoplasty
Definition
Also known as a tummy tuck, abdominoplasty is a
surgical procedure in which excess skin and fat in the abdominal area is removed and the abdominal muscles are
tightened.
Purpose
Abdominoplasty is a cosmetic procedure that treats
loose or sagging abdominal skin, leading to a protruding
abdomen that typically occurs after significant weight
loss. Good candidates for abdominoplasty are individuals in good health who have one or more of the above
conditions and who have tried to address these issues
with diet and exercise with little or no results.
Women who have had multiple pregnancies often
seek abdominoplasty as a means of ridding themselves
of loose abdominal skin. While in many cases diet and
exercise are sufficient in reducing abdominal fat and
loose skin after pregnancy, in some women these conditions may persist. Abdominoplasty is not recommended
for women who wish to have further pregnancies, as the
beneficial effects of the surgery may be undone.
Another common reason for abdominoplasty is to
remove excess skin from a person who has lost a large
amount of weight or is obese. A large area of overhanging skin is called a pannus. Older patients are at an increased risk of developing a pannus because skin loses
elasticity as one ages. Problems with hygiene or wound
formation can result in a patient who has multiple hanging folds of abdominal skin and fat. If a large area of excess tissue is removed, the procedure is called a panniculectomy.
In some instances, abdominoplasty is performed simultaneously or directly following gynecologic surgery
such as hysterectomy (removal of the uterus). One study
found that the removal of a large amount of excess abdominal skin and fat from morbidly obese patients dur7
Abdominoplasty
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Abdominoplasty
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Abdominoplasty (tummy tuck) surgery. Portions of the lower abdominal tissues have been removed and the navel repositioned. The remaining skin flaps will be sutured. (Photography by MM Michele Del Guercio. Reproduced by permission.)
ing gynecologic surgery results in better exposure to the
operating field and improved wound healing.
Contraindications
Certain patients should not undergo abdominoplasty. Poor candidates for the surgery include:
• Women who wish to have subsequent pregnancies.
• Individuals who wish to lose a large amount of weight
following surgery.
• Patients with unrealistic expectations (those who think
the surgery will give them a “perfect” figure).
• Those who are unable to deal with the post-surgical
scars.
• Patients who have had previous abdominal surgery.
• Heavy smokers.
Demographics
According to the American Academy of Plastic
Surgeons, in 2001 there were approximately 58,567 abdominoplasties performed in the United States, relating
to 4% of all plastic surgery patients and less than 0.5%
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of all plastic surgery procedures. Female patients accounted for 97% of all abdominoplasties. Most patients
were between the ages of 35 and 50 (58%), with patients under 35 accounting for 20% and patients over 50
accounting for 22%. Eighty-two percent of all plastic
surgery patients during 2001 were white, 7% were Hispanic, 5% were African American, and 5% were Asian
American.
Description
The patient is usually placed under general anesthesia
for the duration of surgery. The advantages to general
anesthesia are that the patient remains unconscious during
the procedure, which may take from two to five hours to
complete; no pain will be experienced nor will the patient
have any memory of the procedure; and the patient’s muscles remain completely relaxed, lending to safer surgery.
Once an adequate level of anesthesia has been
reached, an incision is made across the lower abdomen.
For a complete abdominoplasty, the incision will stretch
from hipbone to hipbone. The skin will be lifted off the
abdominal muscles from the incision up to the ribs, with
a separate incision being made to free the umbilicus
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Individuals who have excess skin and fat limited to
the lower abdomen (i.e., below the navel) may be candidates for partial abdominoplasty. During this procedure,
the muscle wall is not tightened. Rather, the skin is
stretched over a smaller incision made just above the
pubic hairline and excess skin is cut away. The incision
is then closed with stitches. The umbilicus is not repositioned during a partial abdominoplasty; its shape, therefore, may change as the skin is stretched downward.
Abdominoplasty
(belly button). The vertical abdominal muscles may be
tightened by stitching them closer together. The skin is
then stretched back over the abdomen and excess skin
and fat are cut away. Another incision will be made
across the stretched skin through which the umbilicus
will be located and stitched into position. A temporary
drain may be placed to remove excess fluid from beneath
the incision. All incisions are then stitched closed and
covered with dressings.
WHO PERFORMS
THE PROCEDURE AND
WHERE IS IT PERFORMED?
Abdominoplasty is usually performed by a plastic surgeon, a medical doctor who has completed specialized training in the repair or reconstruction of physical defects or the cosmetic enhancement of the human body. In order for a
plastic surgeon to be considered board certified
by the American Board of Plastic Surgery, he or
she must meet a set of strict criteria (including a
minimum of five years of training in general
surgery and plastic surgery) and pass a series of
examinations. The procedure may be performed
in a hospital operating room or a specialized
outpatient surgical facility.
Additional procedures
In some cases, additional procedures may be performed during or directly following abdominoplasty. Liposuction, also called suction lipectomy or lipoplasty, is
a technique that removes fat that cannot be removed by
diet or exercise. During the procedure, which is generally
performed in an outpatient surgical facility, the patient is
anesthetized and a hollow tube called a cannula is inserted under the skin into a fat deposit. By physical manipulation, the fat deposit is loosened and sucked out of the
body. Liposuction may be used during abdominoplasty to
remove fat deposits from the torso, hips, or other areas.
This may create a more desired body contour.
Some patients may choose to undergo breast augmentation, reduction, or lift during abdominoplasty.
Breast augmentation involves the insertion of a siliconeor saline-filled implant into the breast, most often behind
the breast tissue or chest muscle wall. A breast reduction may be performed on patients who have large
breasts that cause an array of symptoms such as back
and neck pain. Breast reduction removes excess breast
skin and fat and moves the nipple and area around the
nipple (called the areola) to a higher position. A breast
lift, also called a mastopexy, is performed on women
who have low, sagging breasts, often due to pregnancy,
nursing, or aging. The surgical procedure is similar to a
breast reduction, but only excess skin is removed; breast
implants may also be inserted.
Breast reconstruction
A modified version of abdominoplasty may be used
to reconstruct a breast in a patient who has undergone
mastectomy (surgical removal of the breast, usually as a
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treatment for cancer). Transverse rectus abdominis myocutaneous (TRAM) flap reconstruction may be performed at the time of mastectomy or as a later, separate
procedure. Good candidates for the surgery include
women who have had or will have a large portion of
breast tissue removed and also have excess skin and fat
in the lower abdominal region. Women who are not in
good health, are obese, have had a previous abdominoplasty, or wish to have additional children are not considered good candidates for TRAM flap reconstruction.
The procedure is usually performed in three separate
steps. The first step is the TRAM flap surgery. In a procedure similar to traditional abdominoplasty, excess skin
and fat is removed from the lower abdomen, then
stitched into place to create a breast. The construction of
a nipple takes place several months later to enable to the
tissue to heal adequately. Finally, once the new breast
has healed and softened, tattooing may be performed to
add color to the constructed nipple.
Costs
Because abdominoplasty is considered to be an elective cosmetic procedure, most insurance policies will not
cover the procedure, unless it is being performed for
medical reasons (for example, if an abdominal hernia is
the cause of the protruding abdomen).
A number of fees must be taken into consideration
when calculating the total cost of the procedure. Typically,
fees include those paid to the surgeon, the anesthesiologist, and the facility where the surgery is performed. If liposuction or breast surgery is to be performed, additional
costs may be incurred. The average cost of abdominoplas9
Abdominoplasty
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QUESTIONS TO ASK
THE DOCTOR
• How long have you been practicing plastic
surgery?
• Are you certified by the American Board of
Plastic Surgeons?
• How many abdominoplasties have you performed, and how often?
• What is your rate of complications?
• How extensive will the post-surgical scars be?
• What method of anesthesia will be used?
• What are the costs associated with this procedure?
• Will my insurance pay for part or all of the
surgery?
• Do you provide revision surgery (i.e., if I experience suboptimal results)?
be avoided for several weeks before and after the surgery;
for example, medications containing aspirin may interfere with the blood’s ability to clot. Because tobacco can
interfere with blood circulation and wound healing,
smokers are recommended to quit for several weeks before and after the procedure. A medicated antibacterial
soap may be prescribed prior to surgery to decrease levels
of bacteria on the skin around the incision site.
Aftercare
The patient may remain in the hospital or surgical facility overnight, or return home the day of surgery after
spending several hours recovering from the procedure
and anesthesia. Before leaving the facility, the patient will
receive the following instructions on post-surgical care:
• For the first several days after surgery, it is recommended that the patient remain flexed at the hips (i.e.,
avoid straightening the torso) to prevent unnecessary
tension on the surgical site.
• Walking as soon as possible after the procedure is recommended to improve recovery time and prevent blood
clots in the legs.
ty is $6,500, but may range from $5,000–9,000, depending on the surgeon and the complexity of the procedure.
Diagnosis/Preparation
There are a number of steps that the patient and
plastic surgeon must take before an abdominoplasty may
be performed. The surgeon will generally schedule an
initial consultation, during which a physical examination will be performed. The surgeon will assess a number of factors that may impact the success of the surgery.
These include:
• the patient’s general health
• the size and shape of the abdomen and torso
• the location of abdominal fat deposits
• the patient’s skin elasticity
• what medications the patient may be taking
It is important that the patient come prepared to ask
questions of the surgeon during the initial consultation.
The surgeon will describe the procedure, where it will be
performed, associated risks, the method of anesthesia and
pain relief, any additional procedures that may be performed, and post-surgical care. The patient may also meet
with a staff member to discuss how much the procedure
will cost and what options for payment are available.
The patient will also receive instructions on how to
prepare for abdominoplasty. Certain medications should
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• Mild exercise that does not cause pain to the surgical
site is recommended to improve muscle tone and decrease swelling.
• The patient should not shower until any drains are removed from the surgical site; sponge baths are permitted.
• Work may be resumed in two to four weeks, depending
on the level of physical activity required.
Surgical drains will be removed within one week
after abdominoplasty, and stitches from one to two
weeks after surgery. Swelling, bruising, and pain in the
abdominal area are to be expected and may last from two
to six weeks. Recovery will be faster, however, in the patient who is in good health with relatively strong abdominal muscles. The incisions will remain a noticeable red
or pink for several months, but will begin to fade by nine
months to a year after the procedure. Because of their location, scars should be easily hidden under clothing, including bathing suits.
Risks
There are a number of complications that may arise
during or after abdominoplasty. Complications are more
often seen among patients who smoke, are overweight,
are unfit, have diabetes or other health problems, or have
scarring from previous abdominal surgery. Risks inherent to the use of general anesthesia include nausea, vomiting, sore throat, fatigue, headache, and muscle soreGALE ENCYCLOPEDIA OF SURGERY
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Abdominoplasty
Abdominoplasty
Skin
Incision
Fat
B.
A.
Sutures
External
oblique
C.
D.
In an abdominoplasty, or tummy tuck, an incision is made in the abdomen (usually from hip bone to hip bone). Excess skin
and fat is removed (B). The muscles may be tightened (C). The navel will be placed into the proper position (D), and the major
incision closed beneath it. (Illustration by GGS Inc.)
ness; more rarely, blood pressure problems, allergic reaction, heart attack, or stroke may occur.
Risks associated with the procedure include:
• bleeding
• wound infection
• delayed wound healing
• skin or fat necrosis (death)
• hematoma (collection of blood in a tissue)
• seroma (collection of serum in a tissue)
• blood clots
• pulmonary embolism (a blood clot that travels to the
lungs)
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• numbness to the abdominal region or thighs (due to
damage to nerves during surgery)
Normal results
In most cases, abdominoplasty is successful in providing a trimmer abdominal contour in patients with excess
skin and fat and weak abdominal muscles. A number of factors will influence how long the optimal results of abdominoplasty will last, including age, skin elasticity, and
physical fitness. Generally, however, good results will be
long-lasting if the patient remains in good health, maintains
a stable weight, and exercises regularly. One study surveying patient satisfaction following abdominoplasty indicated
that 95% felt their symptoms (excess skin and fat) were improved, 86% were satisfied with the results of the surgery,
and 86% would recommend the procedure to a friend.
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Abortion, induced
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KEY TERMS
Abdominal hernia—A defect in the abdominal wall
through which the abdominal organs protrude.
Morbidly obese—A term defining individuals who
are more thatn 100 lb (45 kg) over their ideal body
weight.
Morbidity and mortality rates
The overall rate of complications associated with
abdominoplasty is approximately 32%. This percentage,
however, is higher among patients who are overweight;
one study placed the complication rate among obese patients at 80%. Rates are also higher among patients who
smoke or are diabetic. The rate of major complications
requiring hospitalization has been reported at 1.4%.
Alternatives
Before seeking abdominoplasty, an individual will
want to be sure that loose and excess abdominal skin and
fat cannot be decreased through a regimen of diet and
exercise. Abdominoplasty should not be viewed as an alternative to weight loss. In fact, some doctors would suggest that a patient be no more than 15% over his or her
ideal body weight in order to undergo the procedure.
Liposuction is a surgical alternative to abdominoplasty. There are several advantages to liposuction. It is
less expensive (an average of $2,000 per body area treated compared to $6,500 for abdominoplasty). It also is associated with a faster recovery, a need for less anesthesia,
a smaller rate of complications, and significantly smaller
incisions. What liposuction cannot do is remove excess
skin. Liposuction is a good choice for patients with localized deposits of fat, while abdominoplasty is a better
choice for patients with excess abdominal skin and fat.
Resources
American Board of Plastic Surgery, Inc. 7 Penn Center, Suite
400, 1635 Market St., Philadelphia, PA 19103-2204. (215)
587-9322. <http://www.abplsurg.org>.
American Society of Plastic Surgeons. 444 E. Algonquin Rd.,
Arlington Heights, IL 60005. (888) 4-PLASTIC. <http://
www.plasticsurgery.org>.
OTHER
“2001 Statistics.” American Society of Plastic Surgeons, 2003
[cited April 8, 2003]. <http://www.plasticsurgery.org/
public_education/2001statistics.cfm>.
“Abdominoplasty.” American Society of Plastic Surgeons, 2003
[cited April 8, 2003]. <http://www.plasticsurgery.org/
public_education/procedures/Abdominoplasty.cfm>.
Gallagher, Susan. “Panniculectomy: Implications for Care.”
Perspectives in Nursing, 2003 [cited April 8, 2003].
<http://www.perspectivesinnursing.org/v3n3/pannicul
ectomy.html>.
“Training Requirements.” American Board of Plastic Surgery,
July 2002 [cited April 8, 2003]. <http://www.abplsurg.
org/training_requirements.html>.
“Tummy Tuck.” The American Society for Aesthetic Plastic
Surgery, 2000 [cited April 8, 2003]. <http://www.surgery.
org/q1>.
Zenn, Michael R. “Breast Reconstruction: TRAM, Unipedicled.” eMedicine, December 13, 2001 [cited April 8, 2003].
<http://www.emedicine.com/plastic/topic141.htm>.
Stephanie Dionne Sherk
ABO blood typing see Type and screen
Abortion, induced
Definition
Induced abortion is the intentional termination of a
pregnancy before the fetus can live independently. An
abortion may be elective (based on a woman’s personal
choice) or therapeutic (to preserve the health or save the
life of a pregnant woman).
PERIODICALS
Hensel, J. M., J. A. Lehman, M. P. Tantri, M. G. Parker, D. S.
Wagner, and N. S. Topham. “An Outcomes Analysis and
Satisfaction Surgery of 199 Consecutive Abdominoplasties.”
Annals of Plastic Surgery, 46, no. 4 (April 1, 2001): 357–63.
Vastine, V. L., et al. “Wound Complications of Abdominoplasty
in Obese Patients.” Annals of Plastic Surgery, 41, no. 1
(January 1, 1999): 34–9.
ORGANIZATIONS
American Academy of Cosmetic Surgery. 737 N. Michigan
Ave., Suite 820, Chicago, IL 60611. (312) 981-6760.
<http://www.cosmeticsurgery.org>.
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Purpose
An abortion may be performed whenever there is
some compelling reason to end a pregnancy. An abortion
is termed “induced” to differentiate it from a spontaneous abortion in which the products of conception are
lost naturally (also called a miscarriage).
An abortion is considered to be elective if a woman
chooses to end her pregnancy, and it is not for maternal
or fetal health reasons. Some reasons a woman might
choose to have an elective abortion are:
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