Ask most people which part of their bodies they most want to hide and they'll say it's their tummies. Both men and women tend to accumulate fat in the abdominal area and the result is unsightly rolls.
For women who have had children, the problem is complicated by stretched and weakened abdominal muscles.
Marjorie is a good example. She has had three children, all more than nine pounds at birth. She's looked after herself and regularly works out, but her tummy simply won't go away. Now at 56, she has a little bulge that persists. "I don't understand why it just won't go. I don't necessarily want to wear a bikini," she says, "but I'd like to wear a slim-fitting dress without the fold of skin and fat spoiling the line."
Marjorie's problem is not unusual and she is, in fact, a perfect candidate for abdominoplasty, a surgical procedure that usually costs about $7,000.
Commonly referred to as a tummy tuck, this procedure removes excess skin and fat from the middle and lower abdomen and tightens the muscles of the abdominal wall. It can dramatically reduce a protruding abdomen.
"We see the best results with women who have been pregnant," says Dr. Walter Peters, professor of plastic surgery at the University of Toronto. "There is always a scar, but we try to make sure the scar isn't too visible. I've even had women bring in their bikini so that the incision can be placed within the bikini area."
Some people scar more than others, he says, adding: "Most plastic surgeons do a great job. But about five per cent of the population will have a thicker scar. It's genetic."
It's important to note that the procedure is not a cure for obesity or weight problems. Peters cautions that before having abdominoplasty, patients should lose any weight they want to get rid of. He can't, for example, liposuction the abdominal fat away, then stitch up. Apparently liposuction can't be done just prior to surgery except in peripheral areas as it would remove blood supply and interfere with recovery.
Indeed, most surgeons prefer not to operate on obese patients. Being significantly overweight can increase the chances of complications, such as bleeding, and recovery time drastically. Smokers too, have a greater risk of complications and poor healing.
Marjorie had some questions so I posed these to Peters:
Suppose I gain some weight after the surgery?
Peters: Your skin is stretched but it will accommodate the weight gain. Some people who have been obese do fall back a little and it's not a problem. But I should add that the result with people who have lost a lot of weight is not as nice. The skin is so badly stretched and it requires a hip-to-hip incision.
The dangers of plastic surgery have been in the news lately. What are the risks?
Peters: People use the word tummy tuck. We prefer the term abdominoplasty, which reflects the more major nature of this operation. Because it is major surgery, there are always risks. These include a hematoma or bleeding -- after all, you've created a huge pocket under the skin. And with bleeding, there's a risk of infection. We always keep patients in overnight with two drains which have to be emptied by the patient when they go home. We show them how to do this. After five days, they return and the drains are removed. In 25 years, I've never had an infection set in, but it could happen.
How long does it take and can you do several procedures at the same time?
Peters: It takes three to four hours to do a good job and repair the muscles. We do only one procedure at a time because there is a bigger risk of complications when you add more procedures.
What about pain?
Peters: There is bruising and some pain in the early stages. If there has been muscle separation and these have to be repaired, there's a little more discomfort. But it's not terrible pain. And it varies. Some people get up and go home, others are off work for three or four weeks. The more fit and healthy the patient, the more likely they are to recover quickly.
Are there any after effects?
Peters: A numbness in the lower abdomen has been reported by some patients. This may go away after a year and not come back. In others, this could persist. And of course, there's scarring. If you tend to be a poor scar former, you may want to think about this procedure.
