Cosmetic Surgery of the Abdominal Wall

In the field of abdominal wall correction, no single technique can be applied to all cases. It is important to carefully analyse the lesions and take multiple parameters into account: skin condition, extent of fat excess, tone of the abdominal muscles, general morphology, as well as the patient's request and expectations. The most suitable strategy for each case is then determined.

Schematically, when faced with a request for surgical correction of the abdominal wall, two scenarios may be observed: either isolated abdominal liposuction will be considered, or an abdominoplasty will be required.

• Isolated abdominal liposuction

It is indicated when the sole problem is fat excess.

In this case, please refer to the information sheet on liposuction.

• Abdominoplasties

Whenever significant skin lesions exist (loss of tone, notable distension, significant stretch marks, scars, etc.) and/or muscle wall alterations (laxity, diastasis, hernias, etc.), isolated liposuction will be insufficient and an abdominoplasty will be required.

Abdominoplasty remains a fairly major procedure in plastic surgery, but it has greatly benefited from numerous technical improvements in recent years: lighter anaesthetic techniques, so-called "high superior tension" techniques, quilting methods, improved suturing practices, advances in dressings and compression garments. This expertise has significantly reduced risks, lightened postoperative recovery, improved result quality and optimised scar discretion, thus opening indications to "lighter" cases that might previously have been declined.

The aim of such a procedure is to remove the most damaged skin (distended, scarred or striated) and to retighten the surrounding healthy skin.

Simultaneously, treatment of localised fat excess by liposuction and treatment of underlying abdominal muscle lesions (diastasis, hernia) may be performed.

Whenever excess body weight exists, it should be corrected as much as possible (partially or totally) before the surgical procedure (weight contract concept). Conditions for the procedure will be better in terms of both safety and quality of results.

The most commonly performed abdominoplasty involves removing a large skin fusiform, corresponding to all or part of the region between the navel and the pubis, according to a design adapted to the lesions.

The overlying healthy skin, generally located above the navel, is redraped downward to reconstitute an abdominal wall with good-quality skin.

The navel is preserved and repositioned normally through an incision made in the lowered skin.

Most often, this scar is located at the upper edge of the pubic hair and extends more or less far into the groin folds. Its length is largely predictable before the procedure and the patient must be very clearly informed of it, as this "scar trade-off" remains one of the main drawbacks to be accepted.

In the presence of less significant lesions, a more localised abdominoplasty may sometimes be proposed, with a reduced scar trade-off.

In these cases, health insurance coverage cannot be envisaged.

A standard preoperative assessment is carried out in accordance with prescriptions.

The anaesthetist will be seen in consultation no later than 48 hours before the procedure.

Smoking increases the risk of postoperative complications for any surgical procedure. Stopping smoking 6 to 8 weeks before surgery eliminates this additional risk. If you smoke, discuss this with your surgeon and your anaesthetist.

Discontinuation of oral contraception may be required, particularly in cases of associated risk factors (obesity, poor venous condition, coagulation disorders).

No medication containing aspirin should be taken in the 10 days prior to the procedure.

Skin preparation (antiseptic soap type) is usually recommended the evening before and the morning of the procedure.

It is essential to fast (no food or drink) for 6 hours before the procedure.

• Type of anaesthesia: Abdominoplasty practically always requires general anaesthesia, during which you sleep completely.

• Hospitalisation: The hospital stay varies from 2 to 5 days.

Each surgeon adopts a technique of their own, which they adapt to each case to achieve the best results. However, common basic principles can be identified:

The incision lines, which correspond to the future scar lines, have already been mentioned: they depend on the location and amount of damaged skin. In practice, the scar will be longer the greater the amount of tissue to remove.

Excess fat may be extracted by liposuction and distended muscles are tightened.

The remaining skin (above the navel) is redraped downward and may benefit from "quilting" designed to reattach it to the underlying muscular wall, thus improving retightening (particularly of the upper portion) and closing off the undermined space to limit the risk of effusion.

At the end of the procedure, a shaping dressing is fashioned, with or without a compression garment.

The duration of the procedure varies between 90 minutes and 3 hours, depending on the extent of work required.

Dressings should be planned for approximately two weeks after the procedure. Wearing a support garment is recommended for 2 to 4 weeks, day and night.

Pain is variable but generally manageable with appropriate treatment, mainly consisting of tension and abdominal muscle soreness.

A work stoppage of 2 to 4 weeks should be expected.

The scar is often pink during the first 2 to 3 months, then typically fades after the 3rd month, progressively over 1 to 3 years. It should not be exposed to sun or UV light before 3 months.

Sports activity can be progressively resumed from the 6th postoperative week.

Regarding the scar, its optimal positioning generally allows it to be easily concealed in standard underwear or swimwear.

It should be understood that, while it generally fades well over time, it can never completely disappear. In this regard, it should be remembered that while the surgeon performs the sutures, the scar itself is the patient's doing.

The goal of this surgery is to bring about an improvement, not to achieve perfection. If your expectations are realistic and you are prepared to accept the scar trade-off, the result obtained should give you great satisfaction.

In any case, this is a major and delicate surgery for which the quality of indication and rigour of the surgical procedure do not in any way protect against a certain number of imperfections or even complications.

Most often, a correctly indicated and performed abdominoplasty provides a real benefit to patients, with a satisfactory result conforming to expectations.

However, it is not uncommon for localised imperfections to be observed, without constituting real complications:

• These imperfections notably concern the scar, which may sometimes be too visible, adherent, asymmetric or elevated. This scar may, in some cases, become widened, thickened or even keloid.
• The navel may be imperfectly exteriorised and have lost some of its natural appearance.
• Small lateral skin excesses are sometimes noted.
• Some irregularities from liposuction may persist.
• Finally, in cases of excessive tension at suture edges, an upward migration of pubic hair may be observed.

These result imperfections are generally amenable to complementary treatment: surgical "touch-up" performed under local or deepened local anaesthesia from the 12th postoperative month, as a day case.

An abdominoplasty, although performed for partly aesthetic motivations, remains a genuine surgical procedure, which implies the risks associated with any medical act, however minor.

A distinction must be made between complications related to anaesthesia and those related to the surgical procedure.

Regarding anaesthesia, during the consultation, the anaesthetist will personally inform the patient of the anaesthetic risks. Having recourse to a fully competent Anaesthetist practising in a truly surgical setting (recovery room, resuscitation facilities) means that the risks incurred have become statistically very low.

Indeed, techniques, anaesthetic products and monitoring methods have made immense progress over the past thirty years, offering optimal safety, especially when the procedure is performed electively and on a healthy person.

Regarding the surgical procedure: by choosing a qualified and competent Plastic Surgeon, trained in this type of intervention, you minimise these risks as much as possible, without however eliminating them entirely.

Indeed, complications can arise following an abdominoplasty, which is the most major procedure in plastic and cosmetic surgery.

Among the possible complications, the following should be mentioned:

• Thromboembolic events (phlebitis, pulmonary embolism), although generally rare, are among the most feared. Rigorous preventive measures must minimise their incidence: anti-thrombosis stockings, early mobilisation, possible anticoagulant treatment.

• Haematoma, in fact quite rare, may warrant evacuation to avoid secondary deterioration of the aesthetic quality of the result.

• Infection, in fact infrequent, requires surgical drainage and antibiotic treatment. It may sometimes leave unsightly sequelae.

• It is not uncommon to observe, from the 8th postoperative day, lymphatic effusion related to lymph drainage and fat seepage. Compression and rest are the best prevention. Such effusion must sometimes be aspirated, and it generally resolves without particular sequelae.

• Skin necrosis is sometimes observed, usually limited and localised. Significant necrosis is in fact rare. It is much more frequent in smokers, especially if smoking cessation has not been strictly observed.

• Prevention of necrosis relies on a well-established indication and an adapted, prudent surgical technique, avoiding excessive tension at suture level.

• Sensory changes of the wall, notably decreased sensation predominantly in the sub-umbilical region, are frequently observed: normal sensation usually returns within 3 to 12 months following abdominoplasty.

• Finally, delayed healing phenomena may be observed, particularly in patients whose skin is very damaged or scarred, which prolong postoperative recovery.

Plastic and cosmetic surgery of the abdominal wall has made decisive progress that now allows, in many cases, the proposal of an adapted technique and therapeutic strategy, thus resolving — whether through simple liposuction, a mini-abdominoplasty (localised abdominoplasty), or a more extensive procedure (extended abdominoplasty) — the main aesthetic problems posed by the abdomen.

Overall, risks should not be overestimated, but one should simply be aware that a surgical procedure, even an apparently simple one, always involves a small element of uncertainty.

Choosing a qualified Plastic Surgeon ensures that the practitioner has the training and competence required to prevent these complications, or to treat them effectively should they arise.

These are the information elements we wished to provide as a complement to the consultation. We advise you to keep this document, re-read it after the consultation and reflect on it at your leisure.

This reflection may raise new questions for which you will need additional information. We are at your disposal to discuss them again at a future consultation, by telephone, or even on the day of the procedure itself, when we will in any case see each other before the anaesthesia.