Lipoabdominoplasty – Tummy Tuck with Liposuction

In a lipoabdominoplasty (tummy tuck with liposuction), excess skin and fatty tissue is removed using a combination of liposuction and abdominoplasty techniques in order to achieve a better abdominal contour. However, this is not a simple combination of both techniques, but an independent surgical concept. While a conventional tummy tuck consists of extensive detachment and tightening of the abdominal skin, which may be followed by liposuction of adjacent regions, lipoabdominoplasty begins with extensive liposuction of the abdominal region, followed by minimal detachment and removal of excess abdominal skin.

The advantages of lipoabdominoplasty lie in limited tissue trauma with protection of the blood and lymph vessels as well as the sensory nerves. This reduces the risks of extensive skin detachment in conventional abdominoplasty, such as blood and fluid accumulation (hematomas/seromas), circulatory disorders (necrosis) and loss of sensation of the abdominal skin, and shortens the healing time due to a smaller wound surface.

Lipoabdominoplasty (Abdominoplasty with liposuction)

Women with fat accumulation and loose skin on the abdomen can benefit from a lipoabdominoplasty. Changes to the abdomen are often age-related, but can also be caused by hereditary factors, weight fluctuations and severe weight loss. After pregnancies, the abdominal skin may be overstretched and sagging and abdominal muscles may have moved apart (rectus diastasis). In this case, the operation involves tightening the abdominal muscles using internal sutures. Skin tightening can also be used to remove stretch marks, particularly in the region below the navel. Lipoabdominoplasty improves the abdominal contour and often facilitates the selection of fitting clothes.

Considerations

When to consider lipoabdominoplasty:

• You want a tighter and flatter abdomen.
• You suffer from loose skin or skin folds on your abdomen.
• You have pronounced stretch marks on the lower abdomen and loose skin on the upper abdomen.
• You have fatty deposits on the abdomen that hang down (‘fat apron’).
• Your tummy bulges out and is disproportionate to the rest of the body.
• Your abdominal muscles are weakened (e.g. after pregnancy or weight loss)
• Your wellbeing and self-esteem are affected by the changes of your belly.

Lipoabdominoplasty is used to remove excess skin and fatty tissue on the abdomen that cannot be addressed by other means. The operation is generally possible at any age as long as there are no serious underlying illnesses that increase the risk of surgery significantly. The prerequisite for a tummy tuck with liposuction (lipoabdominoplasty) is a stable body weight, as significant weight fluctuations can impair the results of the operation. Planned weight loss should therefore be taken into account before a tummy tuck with liposuction (lipoabdominoplasty).

Scars on the abdomen due to previous operations must be considered in the surgical planning and can affect the performance of a lipoabdominoplasty if they are in an unfavorable position. Significant obesity can be a contraindication for lipoabdominoplasty or significantly increase the surgical risk and impair the expected result. Lipoabdominoplasty is not an adequate method for weight reduction, even if several kilograms of skin and fatty tissue can be removed in some cases. Severe lung diseases can limit the feasibility of lipoabdominoplasty.

Consultation

Careful planning is a prerequisite for a successful tummy tuck. This begins with your personal consultation at the AARE KLINIK for plastic surgery. It is helpful for your surgeon to know your wishes and ideas before the operation and to find out what expectations you have of your figure as a result of the procedure. This will give him or her a realistic idea of the medical possibilities and limitations of a tummy tuck with liposuction.

The abdomen is examined while standing and lying down, whereby the firmness and elasticity of the abdominal skin, the skin excess and the thickness of the fatty tissue are determined and the function of the abdominal wall muscles is assessed. The presence of abdominal wall hernias and an increase in fatty tissue in the abdominal cavity, which can make surgery more difficult or impair the surgical outcome, are also ruled out. During the physical examination, measurements and digital photographs are taken, which are then used to objectively analyse your abdomen on the screen and plan the operation.

The results of the physical examination and image analysis are used to develop a suitable treatment plan, which may include lipoabdominoplasty as well as additional liposuction of adjacent areas of the body.

All risks and possible complications of the respective procedure will be discussed with you and the agreed operation will be documented on a planning sheet.

In order to plan the operation, we need information from you about your medical history (previous illnesses and previous operations), current illnesses (high blood pressure, diabetes, thyroid dysfunction, etc.), allergies or intolerances and any medication you may be taking. These are used to assess the risk of surgery and anesthesia. Please bring all current and important medical findings with you to the consultation.

If you are planning to lose a significant amount of weight in the foreseeable future, this should be taken into account when planning a lipoabdominoplasty, as this can significantly affect the outcome of the operation. It is therefore usually advisable to wait until your weight has stabilized.

Procedure

Individual factors and personal preferences determine the choice of surgical procedure to improve the abdominal contour. As with conventional tummy tuck surgery, there are also various options for skin tightening in lipoabdominoplasty. A distinction is made between lifts of the lower abdomen without moving the navel (so-called small or mini lipoabdominoplasty) and lifts of the upper and lower abdomen in which the navel is moved (so-called large lipoabdominoplasty). The former is suitable for tightening the skin below the navel, while the latter also allows the skin above the navel to be tightened.

The excess skin is removed in the form of a transverse spindle and the remaining abdominal skin is tightened from top to bottom. The resulting transverse scar on the lower abdomen can later be easily concealed by clothing. The exact position of the scar varies from person to person and depends on the preferred clothing style and personal preferences. It usually runs from the upper edge of the pubic bone region to the side up to the pelvic bone, whereby the length depends on the extent of the skin to be removed. The advantages of a better abdominal contour must be weighed against the disadvantages of a longer scar in each individual case.

Stretch marks after massive weight loss can be removed as part of skin tightening or visually improved but cannot always be completely removed. The position of the navel can be maintained or slightly corrected.

Sagging abdominal muscles or abdominal muscles that have moved apart in the midline (rectus diastasis) can be stabilized and brought together using internal sutures. This serves to improve both the abdominal contour and the abdominal wall function.

In individual cases, endoscopically assisted lipoabdominoplasty can be performed on patients without significant excess skin, slight excess fat and sagging abdominal muscles with minimal scarring.

The various options will be discussed with you during the consultation and the procedure that will achieve the best possible result will be selected for you.

Lipoabdominoplasty is usually performed under general anesthesia on an outpatient basis or as part of a short inpatient stay in the AARE KLINIK. The operation usually takes 3-4 hours. In some cases, drains are inserted at the end of the operation to evacuate blood and wound secretions from the wound and are removed after a few days.

Risks

Lipoabdominoplasty is one of the most common operations performed by plastic surgeons. If correctly indicated and performed, serious complications such as infections, wound healing disorders or circulatory disorders of the abdominal tissue are rare. In individual cases, however, they may require longer follow-up treatment or a repeat operation. You will therefore be informed about all risks and possible complications during your consultation.

Minor complications, which usually heal without consequences, include bruising (hematomas), accumulation of wound fluid (seroma) and swelling. However, they may require repeated punctures, which are performed on an outpatient basis in the clinic. However, pronounced haematomas sometimes have to be surgically removed in order not to jeopardize further wound healing. Sensory disturbances of the abdominal skin occasionally occur but are usually only temporary.

The risk of more serious complications, such as circulatory disorders of the abdominal skin and wound healing disorders along the abdominal suture, is increased in smokers or patients with chronic diseases such as diabetes. Combination operations also increase the risk of complications.

In individual cases, a repeat operation may be advisable in order to treat complications such as extensive hematoma or wound healing disorders.

General risks

• Hematoma (bruising), bleeding and swelling
• Seroma (accumulation of wound fluid)
• Healing problems or infection
• Wound breakdown/dehicence (separation of wound edges)
• Injury of nerves or vessels
• Numbness in area of operation (temporary or permanent)
• Circulatory problem of breast skin or nipple (skin slough)
• Scars
• Slight asymmetry
• Unsatisfactory aesthetic result
• Secondary surgery
• Thrombosis or embolism

Overall, lipoabdominoplasty in the hands of an experienced plastic surgeon is a safe procedure with few complications and a high level of patient satisfaction. You can help minimize certain risks by following our recommendations before and after surgery.

Preparation

Our aim is to make the liposuction itself as well as the time before and after the surgery as pleasant as possible for you. You can support us and yourself by following a few rules of conduct.

It is advisable for smokers to stop smoking 2 weeks before and after the operation, as smoking can impair wound healing. Certain medications that increase the risk of bleeding, such as aspirin, non-steroidal anti-inflammatory drugs and some vitamin preparations and homeopathic remedies should also be discontinued 2 weeks before the tummy tuck with liposuction. You will receive precise instructions on this from us before the procedure.

Lipoabdominoplasty can sometimes be performed on an outpatient basis under general anesthesia. If this is the case, you should ensure that you can be picked up after the operation and cared for at home for the next 24 hours. For certain pre-existing conditions or combination procedures, inpatient treatment in hospital with an overnight stay may be advisable. This is the case, for example, if a lipoabdominoplasty is performed together with medically necessary procedures such as a hysterectomy or the closure of an abdominal wall hernia.

Day of surgery

Lipoabdominoplasty is usually performed on an outpatient or short inpatient basis at the AARE KLINIK or otherwise as an inpatient in a private hospital (Salem Hospital).

During the operation you will be given various medications to ensure your well-being. As a rule, lipoabdominoplasty is performed under general anesthesia, rarely under local anesthesia with sedation. For your safety, your heart rate, blood pressure, pulse and blood oxygen level will be monitored during the operation.

At the end of the operation, drains are sometimes inserted to prevent the accumulation of blood and wound secretions in the wound. In addition to the wound dressing, a compression girdle is applied to immobilize the wound and reduce swelling.

After the operation, you will be taken to the recovery room where you will continue to be monitored until you are fully awake and able to stand up. After just a few hours, you will be allowed to go home with an accompanying person. If you are operated on as an inpatient in hospital, you will be transferred from the recovery room to the ward, where you will stay until the next day. You should be able to stand up regularly and walk for a few minutes on the day of the operation to minimize the risk of thrombosis. The pain after lipoabdominoplasty is usually mild and can be compared to a strong muscle ache. It can be treated well with mild painkillers with a decongestant effect, which you can continue to take at home for the first few days.

After outpatient surgery, you should be taken home by someone who will look after you continuously for the first 24 hours. This person will receive all the necessary instructions from us for your aftercare as well as rules of conduct in the event of complications or unexpected events. On request, we can offer you short-term inpatient aftercare at the AARE KLINIK by a registered nurse in a single room.

After surgery

It is important to know that the recovery time after each operation varies individually. In the first few days after lipoabdominoplasty, you should take it easy physically and not stretch or bend your abdomen or lift anything heavy. However, you should stand up regularly from the first day after the operation and walk short distances to prevent the risk of thrombosis. You will also receive blood-thinning injections to prevent thrombosis. Even if you are not able to stand upright completely at first, you should avoid sitting for long periods during the first few days. As a rule, you will have to sleep on your back with your hips slightly bent and a pillow under your legs for a few days.

Only take the painkillers prescribed to you and do not take any medication containing aspirin or other anticoagulants. Wear the compression garment fitted to you continuously during the day and at night.

In the first 2-5 days after the procedure, you may experience a feeling of tension and slight soreness in the abdominal region. You should therefore take the painkillers prescribed for you. In the beginning, there is often a feeling of numbness in the lower abdomen. This is usually only temporary. However, it can take weeks to months, and in some cases even longer, for the sensation to normalize. Slight swelling and bruising on the abdomen usually disappear within 2 – 3 weeks. As a rule, you will be on your feet one to two days after the operation and will be able to carry out most of your daily activities again.

The dressings and any drains will be removed in the first few days after the operation, after which you will be able to shower normally again. However, you should avoid full baths and excessive heat (e.g. sauna) for several weeks until all swelling has subsided. Most skin sutures dissolve by themselves and do not need to be removed. Non-dissolvable sutures are removed after one week.

After removal of the skin sutures, we recommend starting intensive skin and scar care with moisturizing skin ointments and light massage. In individual cases, special follow-up treatment with silicone gel or silicone patches for 2-3 months may be advisable. Fresh scars should not be exposed to UV radiation for at least 6 months to prevent increased pigmentation.

Activities that require prolonged sitting can usually be resumed after 2-3 weeks. However, you should wear a compression garment for a total of 6-8 weeks and avoid physically strenuous and sporting activities for several weeks.

After the operation, you will be examined in the clinic at regular intervals and the healing progress will be assessed until the final surgical result is achieved.

Outcome

Swelling and bruising may persist for some time after the operation. The healing process is gradual and it takes several months before the results of the operation can be finally assessed. Scars may initially be red and swollen or appear darker pigmented. Their appearance often worsens even after a few weeks before they become flatter and paler. In some cases, bulging (hypertrophic) scars may require follow-up treatment with special silicone pads and cortisone injections.

Lipoabdominoplasty results in a flatter and firmer abdomen and improves the body contour. It can increase your own well-being and self-esteem and make it easier to wear certain clothing. The initially reddened and clearly visible scars fade over time. Nevertheless, scars can remain permanently visible, even if they can only be recognized as fine lines (Fig. 4b). The advantage of lipoabdominoplasty is that the scars are usually completely concealed by clothing.

The results of a lipoabdominoplasty are usually long-lasting. However, the ageing process as well as weight fluctuations, pregnancy and lifestyle can influence the result. If you are dissatisfied with the changes to the shape of your stomach after a few years, a new (lipo) abdominoplasty can restore a more youthful body contour.

Costs

Lipoabdominoplasty is generally an aesthetic procedure that is not covered by health insurance. An exception is a pronounced fat apron if this leads to functional complaints such as chronic infections, pain or a mechanical disability. In this case, the cost approval must be applied for from the health insurance company. The decision is made on a case-by-case basis by the health insurance company on the recommendation of the medical consultant. For patients with an abdominal wall hernia who also wish to have a lipoabdominoplasty, the costs for the medically indicated part of the operation, i.e. the hernia closure, are covered by health insurance.

In the case of aesthetic indications, the treatment costs must be borne by the patient herself. The costs for an aesthetically indicated lipoabdominoplasty are variable and mainly depend on the complexity of the operation and the facility where the operation is performed (AARE KLINIK or hospital). An exact cost estimate can therefore only be provided after a personal consultation.

The costs are composed of:

• Operation fee (incl. consultation and follow-up)
• Anaesthesia fee
• Technical costs (AARE KLINIK/hospital)
• Compression garment
• Medication
• Diagnostics (laboratory, ECG, etc.)

Meet PD Dr. med. Oliver Scheufler

PD Dr. Oliver Scheufler, board certified plastic, reconstructive and aesthetic surgeon and author of this website, is pleased to be at your service for a personal consultation. Besides his main occupation at the AARE KLINIK, Dr. Scheufler is also scientifically active and lectures at the University of Basel. He also was a visiting professor at Duke University (USA). Please do not hesitate to contact him if you wish a professional consultation!