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 during

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.)
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.
)
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:

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% 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 (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.

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.


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 silicone- or 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 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 abdominoplasty 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:

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 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:

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 soreness;

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.)
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.
)
more rarely, blood pressure problems, allergic reaction, heart attack, or stroke may occur.

Risks associated with the procedure include:

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.

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

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 .

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/panniculectomy.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

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.

QUESTIONS TO ASK THE DOCTOR




Also read article about Abdominoplasty from Wikipedia

User Contributions:

1
Susan
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Oct 26, 2006 @ 1:13 pm
I found the information very useful,a great help.
The images were also good because they showed you a oval shape being cut from hipbone to hipbone,(most images show one line going from hipbone to hipbone)This made it clearer to me how the operation would be done.
thankyou Susan
2
Monique
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Dec 10, 2006 @ 4:04 am
I found the article very informative and non biased. I felt I could make and informed decision about the procedure based on the information I received.
3
Paula
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Dec 28, 2006 @ 6:18 pm
I found this information very useful thanks. i have a question why is it advised not to have kids after this surgery
4
Deborah
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Feb 8, 2007 @ 10:10 am
I was so impressed with this site. It provided answers for most, if not all my concerns. I will be going for the surgery in a couple of weeks and I am frightened but this site provided alot of information. With the knowledge I received, it also provided comfort.
Thank you
5
Katherine
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Feb 26, 2007 @ 10:22 pm
If you had a C-section, is a portion of your tummy tuck covered by medical?
6
katherine
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Feb 26, 2007 @ 10:22 pm
Is a portion of the tummy tuck covered under medical if you have had 2 c-sections?
7
Jill Stamper
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Mar 7, 2007 @ 1:13 pm
I am a 47 yr old women in terrific health and fitness. I had a full abdominoplasty three months ago and have numbness to my left outer thigh. Is this normal and can doctors see these nerves when being cut? And will it go back to normal?
8
Haleh
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Mar 8, 2007 @ 11:23 pm
Thank You! The information were very helpful. I am 5'1" and 143 Ibs. I need lipo suction in love handle area (Flanks), my tummy and also between my legs and my inner knees. Could they do all the areas at one time Anesthesia or not?
9
alvina
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Mar 11, 2007 @ 11:23 pm
i am a 18 year old with a stretch marks over my tummy i gave bith to a 9 lbs 4 oz baby boy he will be 3 years i never got the chance to live like any other teenager i want to look sexy or to be able to go by the beach and wear a sexy bathing suit please help me i would like to have atummy tuck and want to know the best prices available
10
alvina
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Mar 11, 2007 @ 11:23 pm
i want to do a tummy tuck am 18 and my tummy looks like a 30 yr old i have a great bod weigh 125 lbs i don't deserve to be like this help me
11
Irene Prada
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Mar 20, 2007 @ 9:09 am
I am 49 , I has an abdominoplasty done last Monday March 12th. I am from Costa Rica and it was done by one of the best surgeons here Dr. Annabelle Salas Pereira. I feel great, I recommend this surgery to any strong healthy person. No problem at all . Today 10 days after the surgery I feel excellent. It was only the second day when I arrived home from the hospital that I had trouble finding the best position for my body. After that day , each day is a lot better than the day before. I looked in the mirror and I look great ! it's like someone else!! This is the best thing I've ever done !
12
Donna
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Apr 2, 2007 @ 9:21 pm
I am 3 weeks post op now and I feel great. I'm very happy with the results of my surgery and would recommed it to anyone that is healthy and in good shape. I worked really hard at being physically and emotionally strong before my surgery. I felt this was the best way to recover and now I know it was worth it. I can hardly wait to get back to the gym. It was less painful than I thought too, only a little uncomfortable at times, but not painful. Get some good magazines get caught up on your movie watching. Without the help of my family I couldn't have done this.
13
candis
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May 15, 2007 @ 8:08 am
I just had an abdominoplasty 3 weeks ago and am feeling pretty good. I probably have been doing too much but being a mom of a 2 and 5 year old you do. I had two c-sections 8lb 14oz,23 1/2 inches long (two footer!) and a 9lb 6oz, 22 inches long. I gained 60lbs first pregnancy, lost it and then gained 70lbs second pregnancy, lost only 50. With this I had a lot of extra skin that as I lost weight it just hung lower and lower. I stayed at my mother-in-laws for a week while my husband took care of kids and home. I felt it would not be wise to be home with drains where a two year old does not understand and just wants to crawl and jump all over you, or be picked up. I came home after the first week(same day drains were removed)and with my situation of young ones it was difficult because i was advised not to lift anything over 5 pounds for two weeks. I am 3 weeks post op and every day gets better. Still trying not to lift too much. I am returning to work tomorrow which consists of mostly sitting. I would not have put if off for the world. I am very happy with the results and when all the swelling goes down it will be even better. So regardless of all the hurdles it was worth it. If you are waiting for the right time as i was thinking of putting it off for this reason or that, it would never have gotten done. So for once, let it be all about you! You deserve it. I used this site to answer all/most of my questions and after reading and making an educated decision i chose to do it. I Wish you all a speedy recovery!
14
ida
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May 27, 2007 @ 12:00 am
Has anybody had a tummy tuck and a hernia repair and breast implants at the same time?
15
Joseph T. Black
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May 27, 2007 @ 3:15 pm
I have had a tummy tuck and due to my heart surgery which left me with no sternum.....the tightness of the tuck is mashing on my diaphram and making it hard to breath.....is there a reversible procedure for the tuck?

Joseph
16
Bechababy
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Jun 2, 2007 @ 8:08 am
I found the informatiion very useful. I read this prior to my abdominoplasty and it gave me a detailed picture of what the procedure is. I am now recovering from the surgery...the stitches will be removed in 2 days and I am excited to see my new look.
17
Susan
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Jun 4, 2007 @ 12:00 am
I am really glad that I found this site. I have a few questions for the people who have had a tummy tuck: Will you go down in your waist size after the surgery? I have a date for my surgery to be preformed (6-27-07)and the only sites I have found with before and after pictures, really only have the sizes of the patients remaining really the same. I was hoping to conform my waist size to a smaller one. Can anyone out there answer my question.. Also, how much swelling and bruising is there? Thank you everyone for the help.. Susan
18
Dr. Diyar
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Jul 21, 2007 @ 4:04 am
I is a very very good site for Plastic surgeons & patients as well, kindly I want to inform me about the up-to-date informations, please.
19
Tess
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Aug 3, 2007 @ 5:17 pm
Hi, I am scheduled for an extended tummy tuck on August 14, 2007. Can someone email me and give me all information. I really would like to talk with someone that has actually gone through with this surgery. I've did extensive research but haven't been able to be in contact with no one that actually had the surgery. Thank you in advance.
20
Tess
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Aug 3, 2007 @ 5:17 pm
My email address is Nit2stay@aol.com. I want someone to email me concerning a tummy tuck that has actually had the surgery.
21
Nikole Dunkley
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Aug 30, 2007 @ 9:09 am
I am proud to say that as of 8/21/07, I am a new memeber of the
Tummy Tuck Club. This has been the best thing I have ever done for MYSELF! I am only 9 days out of surgery... and I feel great! The minor discomfort I feel now only happens at end of the day. I would reccomend this surgery to any healthy person ready to make a life change. Life Change- meaning... eating the right things, exercising and staying positive. It is not easy... but in my experience, anything really worth having rarely is. Good Luck!
22
sharon
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Oct 25, 2007 @ 4:04 am
I found the information on this side very usefull..I copy the answer to ask my Dr at my appoitment..
23
Ila
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Nov 11, 2007 @ 6:18 pm
I had a back opertaion done six months ago. The proceedure was done through my abdomin. UCSF Medical Center has now said that my abdominal wall muscle has a wave in it. My belly button is now off to my right side and my abdomin is deformed. The specialists have never seen this and at this time are unable to help me. I am living with constant pain and pressure. Does anyone know how to correct this problem. PLEASE, I NEED HELP. Thank You, Ila
24
Tammy
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Jan 29, 2008 @ 7:19 pm
Hi,Thanks to everyone for all your information. I am a mother of 5 and would like to have a tummy tuck. No one has talked about the cost, I'm in Oklahoma and haven't really checked out doctors or prices, my husband said he called one for me because he knows how dissapointed I am with my tummy. He said they told him around $9000. with a large family thats a big expense. I know it would be worth it but wondering how much it was for all of you? Maybe you know of a good dr. in Ok.??? God Bless you all and congrats! Tammy
25
Nicky
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Mar 12, 2008 @ 12:00 am
Hi i am having a tummy tuck in 2 weeks. I am really scared about firstly the pain, secondly the recovery time. Also can someone who has had the surgery tell me how it was dress size wise? Thanks Nicky
26
sue
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Mar 30, 2008 @ 2:14 pm
pretty good site answered most of my questions and I like the pictures and descriptions
27
Cheryl
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May 19, 2008 @ 10:10 am
I had my tummy tuck an lipo suction about 2 months ago an now look and feel great. After the surgery for the intial 2 weeks is the hardest an after that it is all uphill from there. You need help for the first few days. The article was through and true. It gave detailed information but possible should stress the need for help/support after the surgery while you heal. This is a surgery i would strongly recommend.
28
Dee
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Jul 2, 2008 @ 12:00 am
I have been researching for a tummy tuck, and came across this site it answers a lot of questions for me but I have some questions about does your waist go down as in your pant size, how long before you can go back to work? I work in Restaurant and carry large trays.If you are swollen can you at least fit in your same clothes before surgery,for going back to work. Please email with any answers. zillydee@gmail.com Thanks for any help
29
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Jul 1, 2011 @ 8:20 pm
I am 2 weeks and 5 days s/p tummy tuck. I removed my drain after 2weeks due to out put less than 40ml. When I removed drainage tube , approx. 70ml oozzed out. Now my concern is swelling above drain site, feels muuching to palpation and noticable swelling. My surgery was down south of the border and I would rather not travel to be check, unless necessary. Will my system remove on its own or will I require I & D?
30
Kenya Anne
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Jan 17, 2017 @ 3:15 pm
The safest and most effective way to recontour your midsection would be by using the Somaluxe Firming Lotion. This would get rid of fat, loose skin and correct separated abdominal muscles to give you a flatter stomach. It may also be able to get rid of some of your stretch marks. No surgery. I have been using it for the last 6 months, and it took about 1 month till I saw results on my stomach.

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