"Abdominoplasty involves reshaping the front of the abdomen and refashioning the skin and the muscles underneath," says Melbourne plastic surgeon Mr Tim Brown. "There are two groups of patients who usually have the procedure. An ideal patient is a woman who's had children and looks after her general health, and who may have some stretch marks and loose skin. It is also suitable for women who have scars lower down on their abdomen from an appendectomy or Caesarean procedure. The second group of people are those who have had stomach stapling for obesity and therefore have a lot of loose skin because they have lost a large amount of weight."

Mr Brown suggests patients bring to their consultation underwear they'd like to wear so he can gauge the position of the scar. "The scar runs horizontally from hip to hip over the pubic region and I make it as low down as possible. Patients need to be prepared for this scar and for one around their belly button. When reshaping the belly button, it is also necessary to cut around the belly button and make a new hole."

Mr Brown says the second type of abdominoplasty involves the same scars plus a long vertical scar that runs from right on top of the abdomen between the ribs vertically downwards. This results in an inverted T-shape scar, and is called a "fleur de lis" abdominoplasty. Mr Brown specialises in this procedure.

"I also often combine liposuction with the abdominoplasty procedure," adds Mr Brown, "which can be a bit controversial. I use liposuction for sculpting around the flanks (sides) in women to give a more defined waist. Liposuction is controversial because too much fat removal can risk damaging blood supply so the stitching from the abdominoplasty doesn't heal properly. But if a fairly minimal amount of fat is removed with the liposuction then this is not a problem."

When women have children, many of them find that their rectus muscles (the two muscles down the middle of the abdomen) stretch too far apart. During the abdominoplasty procedure Mr Brown assesses whether this is the case once he has lifted all the skin. If the muscles have stretched too far apart he brings them back to a normal position. He says this tightening up gives a flatter appearance to the stomach.

BEFORE	AFTER abdominoplasty with Mr. Brown

BEFORE	AFTER abdominoplasty with Mr. Brown

It is also possible to perform a body lift along with an abdominoplasty procedure. "A body lift involves carrying on the horizontal incision right around the body and is used to re-suspend or lift up the tissues around the buttocks and thighs," explains Mr Brown. "This additional procedure is usually performed on patients who have experienced a large amount of weight loss. It is not a very commonly performed procedure though."

In relation to pre-procedure preparation, Mr Brown says patients need to be fit and healthy, and ideally have a normal body mass index or weight for height ratio. "An abdominoplasty is not a cure for being overweight," he says.

Surgery takes two to three and a half hours to perform and is done under a general anaesthetic. Because recovery can be quite uncomfortable, a two to three night stay in hospital is usually required. Patients can expect to take three weeks off before going back to work although Mr Brown says many people find two weeks is fine for recovery. They also need to wear a pressure garment for about three weeks and should avoid exercise for three months. The wounds heal in about 10 days.

As with any operation, patients need to be aware that there are the usual risks associated with anaesthesia and particularly deep vein thrombosis (DVT) to consider. "I prescribe patients some heparin to thin the blood and suggest they wear compression stockings on their legs," he explains. "I also recommend they get out of bed as soon as possible after the procedure and keep well hydrated. As with any surgery there is a small risk (two to five per cent) of bleeding. As with any operation, there is also the risk of infection from wounds breaking down and I give patients a dose of antibiotics when they’re first put to sleep to reduce this possibility. All of these risks are higher in smokers.

"It is also important for patients to have a good relationship with their surgeon," he adds. "Most plastic surgeons have fairly uniform results with surgery but if you don't really get on with your surgeon you should look elsewhere." 

Mr Brown says the most important thing in relation to an abdominoplasty is that the patient's expectations need to be realistic about what can be achieved and he emphasises that the procedure is not a cure for obesity. "If patients are obese I suggest they treat themselves as a project for six to eight months and take a look at their lifestyle, diet and exercise," he says. "Then they can consider abdominoplasty as part of this lifestyle change."