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Q: What can I do about my stretch marks?


A: Nonsurgical treatment is ineffective. Stretch marks on the lower abdomen can be eliminated with a tummy tuck. Stretch marks on the upper abdomen are moved down to the lower abdomen.


Q: Should I wait until I am done having children before having surgery?


A: It makes sense to wait until you are finished having children so that you don’t stretch the skin again and possibly stretch out the muscle repair too. For women who are unsure about future pregnancies, a judgment call needs to be made—the advantages of having the results now, against the possibility of having to do another tightening procedure later on. Of course, limiting weight gain with pregnancy will help. The abdominoplasty itself does not affect your ability to get pregnant or cause any problem with expansion of tissues during pregnancy. Many of my patients have gone on later to have pregnancies, but very few seem to return for revision of their tummy tucks.


Q: I’ve had previous abdominal surgery. What are the risks?


A: The abdominoplasty does not involve opening the abdominal cavity that contains the organs. Sometimes patients are concerned about adhesions— internal bands of scar tissue that can develop around organs and cause problems. Because the peritoneum is not entered, there is no risk of adhesions from an abdominoplasty.


Q: Do you use a pain pump?


A: Of course, this is not a “pain pump” (patients are having enough of that already) but a “local anesthetic pump” that delivers small amounts of local anesthetic into the surgical wound after surgery using a catheter and a pump. A pain pump sounds like a reasonable and humane measure to improve patient comfort. However, a study showed similar pain scores and use of prescription painkillers in patients with and without these pumps after abdominoplasty, so they don’t appear to be sufficiently beneficial to justify the added nuisance of looking after it, the expense, and occasional complications. Possible reasons for its ineffectiveness are a lack of penetration of the muscle fascia, and a compromised distribution in the wound due to gravity and suction drains used after surgery that may drain off the local anesthetic solution. I prefer to infuse the tissues with a long-lasting local anesthetic solution that penetrates the muscle and is slowly released by fat cells into the tissues. I call this a “physiological pain pump” (Swanson E. A physiological pain pump for abdominoplasty: An alternative to regional blocks and liposomal bupivacaine. Plast Reconstr Surg. 2015;136:714e–716e).


Q: Do you use that new long-lasting local anesthetic?


A: Liposomal bupivacaine (Exparel) is being used by some plastic surgeons. However, its diffusion into the tissues is limited. I prefer using bupivacaine in a “superwet” solution that permeates the tissues and is slowly released by the patient’s own fat cells (as described above).


Q: I have a belly button hernia. Can it be repaired simultaneously?


A: This can be repaired at the same time as the abdominoplasty. Also, excessively wide belly buttons can often be tightened into more attractive, smaller “innies.”


Q: Do you do many tummy tucks on men?


A: Not as many as women, of course, because of the effects of pregnancy. However, any patient, male or female, who has lost weight, or who otherwise has poor skin tone of the abdomen, can benefit.


Q: How much weight will I lose?


A: The weight of the abdominal tissue that is removed is typically in the range of 2–10 pounds, although I have removed as much as 15 pounds. Liposuction will remove additional fat, usually several pounds. This makes a major difference in body contour, much more than a similar amount of weight loss from dieting. Obviously, in patients who are overweight, results are best from a combination of weight loss from dieting and surgery to correct body disproportions.


Q: How long before I can straighten up fully?


A: This depends on the degree of existing skin laxity, how low the incision is placed, and how much skin is removed. Ironically, lean patients with less skin laxity (but still enough to be of concern), who want the scar as low as possible to keep it concealed, will have the greatest abdominal tightness. These patients may take a couple of weeks to straighten fully. Most patients take about a week before they can stand fully straight.


Q: It feels very tight. Should I be careful to avoid pulling on the incision?


A: Yes, especially during the first week. Avoid pulling too much because this may place too much tension on the incision. After a week, you can stretch a little more. The key is to do a little more each day. Your body is a good guide and will tell you when to back off.


Q: When can I return to exercising?


A: You won’t feel like exercising after surgery. You can start walking a mile or 2 in about 2 weeks and return to exercising a month after surgery. Abdominal exercises will take longer, about 6 weeks at a minimum.