The operation

Using a general anaesthetic (medically controlled unconsciousness) an incision is made across the lower abdomen (usually below the level of the belt-line). A second oval incision is made around the umbilicus (the belly button). The fat and skin of the abdominal wall is carefully separated from the surface of the abdominal wall muscles and pulled taught.

To get the best possible result, liposuction can be used to remove fat around the edges of the lower abdominal incision. The strap-like muscles of the abdominal wall are stitched closer together to help correct bulging. The excess skin (to the level of the umbilicus) is removed, and the wound closed. A new oval incision is made for the umbilicus.

The after-care

Pain is controlled using long-acting local anesthetic medication injected during the operation. Patients are usually comfortable enough to walk on the evening after the operation. Patents stay in hospital two nights after surgery, and return to the hospital, to have the dressings changed, at one week. Patients are encouraged to wear an abdominal binder (supplied by the hospital) for at least three weeks. The stitches are absorbable and below the skin surface, they do not need removal.

The scar runs across the lower abdomen and usually fades over the first year after surgery. Very occasionally the scar can become raised and red in the first few months.

The likely recovery time

Patients usually stay in hospital two nights and return for review at one and two weeks after surgery. Most patients return to driving at about three weeks, and (dependent upon their employment) return to work at six weeks.

The ideal weight for this procedure

Patients should have a healthy body mass index. The average height for women in the UK is currently 5ft 3 inches (161 cm). A healthy weight would be a body mass index of 27 or below, which would be a weight of just under 11 stone. Data suggests that the risks associated with surgery are significantly higher in patients with a body mass index of over 30 (a weight of more than 12 stone).

Patients who smoke should not have elective cosmetic surgery: the potential risks are much higher in smokers. If you are a smoker, you can use patches.

Women planning further pregnancies should considering delaying abdominoplasty surgery until after their family is complete.

The risks

Abdominoplasty is a large operation of at least three hours. Complications are relatively rare, but are more common in smokers and in patients with an unhealthy body mass index.

The skin, fat and soft tissues are released form their normal attachment and pulled taught. This can disrupt their normal blood supply. Very occasionally this can affect wound healing, and in very rare instances this could require further surgery.

Patients can bleed in the first day after surgery and require a second operation to stop this bleeding. This is a rare event, excess bleeding would be suggested by unexpected distension of the abdomen, oozing into the wound dressings, or pain.

Common complications include the build up of fluid below the skin and fat of the abdomen in the weeks after surgery. This can require drainage as an out-patient, using a syringe, in clinic.

The risks of systemic complications, such as thrombosis or pulmonary embolism, are minimized by the use of thrombo-embolic stockings, calf compression in theatre, injection of low-molecular weight heparin, warming in theatre and in recovery, and early mobilization (getting out of bed as soon as fit enough to do so with the support of the nurses).

Any patient who experience a rapid onset of calf-pain, or shortness of breath in the weeks after surgery, needs rapid assessment (usually best carried out by the emergency departmentof a local hospital) to exclude the possibility of a deep venous thrombosis (a clot in the calf veins) or a pulmonary embolism (a blood clot obstructing a lung blood vessel).

Mini-abdominoplasty

This is an operation to improve the shape of the abdomen without removal of the entire ellipse of skin and fat below the umbilicus.

Patients with a more modest bulge or overhanging skin in the lower abdomen can have a smaller operation often called a mini-abdominoplasty. An ellipse of skin and fat is removed from the lower abdomen. The umbilicus is not repositioned. The operation is shorter than a full abdominoplasty, and the recovery time is quicker.