Abdominoplasties have a bad rap for being super painful and a hard recovery. After doing this surgery for 25 years, I have got some insider tips for you. See my other blogs on abdominoplasties here: BLOG. I am not saying tummy tucks aren’t a big deal, but it isn’t bad if you are prepared.
SURGICAL TECHNIQUE. This is something to research when picking a surgeon, but there are things we as a surgeon can do which aid your recovery. The two big ones that come to mind are 1. Using some kind of internal pain medication placed at the rectus muscle to lower pain. I use Exparel (a long acting numbing medication). Others use pain pumps placed internally (I used to use these but they have a catheter that comes through the skin with a reservoir- I find Exparel equally effective and less to deal with). The second thing surgeons do is close down the space created when you do a tummy tuck with progressive tension or quilting sutures. This cuts down on fluid build up, lowers the risk of seroma, and I found significantly shortens the time the drain is in.
So my top ten things to think about?
- PREP FOR IT. I wrote a blog on things to do at home prior to surgery, but for tummy tucks you cannot sleep flat, on your side, or on your tummy for 3-4 weeks. Get tons of pillows, a wedge pillow, those study pillows you bought for your kids that they don’t use. Some people will sleep in a Lazy-Boy recliner chair. If you are going to have to navigate around the house, consider walking poles or borrow a walker. You only need these things for the first 2 weeks.
- DON’T DO STUFF. Tummy tucks (and I always do some liposuction to sculpt the surrounding areas as well) are a big surgery. You need to not do things. That means no laundry, cooking, loading dishwashers, etc. The more you do will increase your pain, bruising and swelling; it will increase the risk of a bleed or tearing sutures; and you will delay your recovery.
- GARMENTS ARE IMPORTANT. LAYERING IS GREAT. I have tried every garment known to man, and the binder I give my patients is just strong and adjustable. I like you to have an easy time to go to the bathroom for that first week- I don’t want an accident, you will have a drain, and I don’t want you tugging or pulling out your sutures. But after the first week, I think adding a second layer underneath is good. Something like THIS or THIS (with upper thigh) are good to wear UNDER your binder, so you are wearing two layers: shapewear and an abdominal binder. As you become more active (weeks 2-4), you need garments even more. They protect you, keep you from getting swollen, and will keep you more comfortable. I think wearing the binder lower is important when you are standing/walking to keep from swelling just above your incision line. Need a break? do so when lying down at night, NOT during the day.
- ADJUST OFTEN. When wearing garments, you need to change and smooth them out every time you change position- standing, sitting, lying down. You don’t want it to dig into you anywhere and you need to make sure it isn’t rubbing on any scars. If it is rubbing or digging, you can also pad that area with gauze. Pay attention. Adjust. Move it up or down. It is a constant process.
- CLEANING IS IMPORTANT. You need to touch and clean your scars. Remove any scabs. If any area is red or irritated, you need to clean, use bacitracin, and pad it. Look at your scars- and you may need a mirror to do so. Is there any area that doesn’t look happy? I recommend showering daily. (For my patients, use the antibacterial soap I gave you at preop)
- SCAR CARE. You usually start this the first week out. The scar will look and feel elevated, bumpy, and yucky. This is normal and not how it will look in a few months. Talk to your doctor about their scar care regimen- kelocote? silicone tape? microneeding? exosomes? There are lots of new things out there. Given the size of the scar, you want to be an active particiapant in this. The prettier the scar, the less you will see it forever.
- YOU ARE NUMB. This means you cannot feel the skin between your belly button and your pubic area, so you need to look at it. If something is being rubbed raw, it may not hurt. You may not feel it. Use a mirror to evaluate how things are doing.
- BELLY BUTTON. Don’t forget it. You need to clean it (use a Qtip) and apply scar cream here. This is an area rubbed raw by garments and clothing. Pad it or use silicone tape over the scar treatment to protect it.
- PAIN CONTROL. You should be on Tylenol and Celebrex (the only NSAID that does not increase bleeding) while you are healing. It gives good background pain control in a non addictive, non narcotic way. This is something to discuss with your doctor. Exparel, muscle relaxants, pain pills- you need to come at the pain from different ways. And you will need the pain medication.
- BOWEL HABITS. You need to be on this. I recommend liquid diet (high protein shakes are great! to meet that 60-70 grams/day protein while healing) for the first few days until you pass gas. You should have a bowel movement by the time you are around 4-5 days out. Read my blog on how to poop HERE. But be on it. You do NOT want to strain to have a bowel movement. Dulclax suppositories are great to jump start things.
- PILLOW PRESSURE. If you need to cough, sneeze, or laugh, press a pillow against your abdomen. You do not want to tear stitches.
I am sure there are more things, but these are pearls I tell my patients over and over. Thought I’d write it down to just hand to them. And remember this is not forever. Every week is a like a dog year of improvement. By the time you are a month out, you will feel pretty normal, and you will keep improving.