I would like information regarding the safety of Abdominoplasty,
otherwise known as a "tummy tuck."  I have found statistics about risk,
however, all of them were compiled based on Doctor's responses to
surveys, I am looking for more objective statistics.  I was told that
tummy tucks are low in the risk category compared to most other
cosmetic surgeries, is this true?  What accredidations should a top
notch doctor have?  (I am not interested in info about "mini-tummy tucks")

Hello Julie ~

As with any surgery, abdominoplasty is usually performed under a
general anesthetic, and all operations and all types of anesthesia
have some risks dependent upon many factors including the type of
surgery and the medical condition of the patient. It is very important
to discuss the anesthesia with your physician

In addition, abdominoplasty, although it may be considered "elective"
surgery, is still considered major surgery, and there are risks
involved with any surgery, including infection and problems healing.

Specifically with reference to a tummy tuck (or abdominoplasty),
Online Surgery has an excellent discussion of some of the risks
involved, and some of the effects afterwards. You can read about them
here:
 - http://www.onlinesurgery.com/procedures/tummy_tuck.php

To try to quantify the occurrence of any of the risks is difficult to
do, and it often differs form one geographic region to the next, and
in some cases, even in one hospital to the next within the same city.

A good surgeon should discuss all aspects with you, including whether
or not you are good candidate for a tummy tuck.


The second question, 

What to look for in a plastic surgeon:

1. Board Certified ~
Does the doctor have Board Certification by the American Board of
Plastic Surgery? (This is a real board recognized by the American
Board of Medical Specialties). A list of their criteria can be found
here:
 - http://www.plasticsurgery4u.com/definition_plastic_surgery.html

2. Training and expertise ~
How many of these procedures has the doctor done?

3. Continuing education ~
Is the doctor up to date on the latest procedures and equipment used?

4. Previous patients ~
What does his work on previous patients look like (most have a series
of "before" and "after" pictures they can show you).

5. Accreditation ~
Is the doctor accredited by local hospitals to perform surgery?

6. Patient Education ~
Is the doctor willing to discuss the benefits and the problems which
can occur in an open way?

7. Personal Comfort ~
Do you feel comfortable with this doctor?

From the website, Plastic Surgery 4 You.
 - http://www.plasticsurgery4u.com/important_information.html

and basically the same information recommended by the California
Society of Plastic Surgeons
 - http://www.ca-soc-plasticsurgeons.org/csps-choosing-a-surgeon.html


Hope this helps,
Serenata

---

Request for Answer Clarification by julie99-ga on 03 May 2003 15:59 PDT

Hi,
Thank you for the information you have provided.  Although, I feel
like the bulk of my question ("I have found statistics about risk,
however, all of them were compiled based on Doctor's responses to 
surveys, I am looking for more objective statistics.  I was told that
tummy tucks are low in the risk category compared to most other 
cosmetic surgeries, is this true?") has not been answered.  While
there may be a variance in safety between state to state, hospital to
hospital, there should be some percentages that reflect overall safety
of this procedure (i.e. 5% of people report clotting, 2% experience
loss of feeling, 1% have died, whatever these may be...)  I was
looking for those statistics to then tell me how safe the surgery was
in relation to other popular procedures (i.e. liposuction, breast
augmentation etc.)

---

Clarification of Answer by serenata-ga on 03 May 2003 18:10 PDT

Julie ~

You are talking major abdominal surgery. The risk is, at best,
subjective.

If you ask a plastic surgeon who performs abdominoplasty routinely,
you will no doubt be told approximately the same thing I told you in
my answer. (Or at least you would assume he would discuss all the
risks involved).

It should be a relatively straight forward procedure.

Would I have one done purely for cosmetic reasons? My answer is no. I
have a friend who died post-surgery from a "routine" tummy tuck. The
autopsy showed that septicemia had set in, and the 'slight' infection
that showed outwardly was totally unrelated to the virulent infection
that killed her rather quickly (about 36 hours after the first symptom
appeared).

 - Compared to open heart surgery, it would be considered low risk.
 - Compared to an open reduction of a fracture on an extremity, it
would be considered high risk.
 - Compared to neurosurgery, it's low risk.
 - Compared to a face lift, it's high risk. 

Consider the procedure - incising the abdomen, removing muscle and fat
tissue and then suturing it closed ... those muscles and skin tissue
have to heal. But there is little activity you do, whether sitting,
lying down or ambulatory, that does not involve those muscles in some
manner.

If you're a fast healer and don't form grotesque scars or keloids, if
you don't smoke, and do exercise regularly, eat all the right foods
and your blood levels and cholesterol levels are in great shape, not
to mention no history of allergies or heart disease, stroke or any
other health issues,  then the risk is much lower than if you have
even one of those factors.

Add any of those factors, and the risk increases exponentially.
Knowing what you know, and the risks (whether high or low), perhaps
you should be asking if that is an acceptable risk, and that is
something that no Google Answers Researcher can tell you - but
something you will have to determine with a qualified physician and/or
surgeon.

I hope this helps,
Serenata

---

Clarification of Answer by serenata-ga on 04 May 2003 11:06 PDT

Hi again, Julie ~

One more clarification for you.

I asked among my fellow Google Answers Researchers for some help, and
have gotten some good feedback, too.

Some of those articles listed below were among the articles they
recommended I direct to your attention.

I think their intention is that you have as much information as
possible, from whatever source, so you can make informed decisions
with your surgeon.

I hope the information helps,
Serenata

Thank you for taking the time to post the clarification.  Your
responses were prompt and helpful.  The articles suggested by "jxc-ga"
were very useful.

"Tuck that Tummy!" - Abdominoplasty Support & Discussion Forum -
discuss & learn about abdominoplasty surgery & talk to real
abdominoplasty & tummy tuck patients for information and support.
http://www.tuckthattummy.com/

Dear julie99-ga:

While I understand your concern and desire for hard numbers, the fact
is that even where numbers are tabulated, they may or may not apply to
your particular circumstances.

Excepting liposuction (which I assume is what you mean by mini-tummy
tuck) you can perform a number of major procedures with similar
results. Complication rates can also vary widely depending on the type
of procedure, individual surgeon, anaesthetist or anaesthetic
technique and even the nursing care that you get. Even with all those
factors being the same, risks vary between individual patient groups.
If you want hard figures then ask your plastic surgeon for his
particular statistics.

Otherwise a brief MEDLINE search revealed these articles which might
placate your concerns slightly. Note that they do not mention the
specific technique used, nor the immediate postoperative
complications, and you may wish to obtain the original article through
your local library to examine further.

Authors
Chaouat M.  Levan P.  Lalanne B.  Buisson T.  Nicolau P.  Mimoun M.
Institution
Plastic, Aesthetic, Reconstructive, and Burn Surgery Unit, Rothschild
Hospital, Paris, France. marcchaouat@worldonline.fr
Title
Abdominal dermolipectomies: early postoperative complications and
long-term unfavorable results.[comment].
Comments
Comment in: Plast Reconstr Surg. 2001 Oct;108(5):1449-51; PMID:
11604669
Source
Plastic & Reconstructive Surgery.  106(7):1614-8; discussion 1619-23,
2000 Dec.
Abstract
A retrospective study was done on a population of 258 women who had
undergone surgery for abdominal dermolipectomy between January of 1991
and May of 1996. The postoperative complications and flaws seen at
long-term follow-up are discussed. The surgical techniques used, with
or without lipoaspiration, were the infraumbilical plasty and full
plasties with horizontal or inverted T scars. Six types of
postoperative complications were noted: hemorrhage in 1.2 percent,
lymphorrhea in 10.9 percent, infection in 7 percent, skin necrosis in
6.6 percent, secondary dehiscence of the scar in 2.3 percent, and
thromboembolic accidents in 1.2 percent. No significant difference was
found in the rate of necrosis development between patients who did and
did not undergo lipoaspiration. However, a statistically significant
difference was seen in the rate of skin necrosis between the T-type
plasty (35.5 percent) and the other two procedures (1.43 percent for
infraumbilical plasties and 4.60 percent for full plasties with
horizontal scar). With regard to the flaws found at long-term
follow-up, the rate of above-scar fat folds and/or dog-ears was 27.9
percent, and the rate of defective scars was 26 percent. No
significant difference was found with regard to the rate of flaws. The
rate of all secondary surgical procedures was 29.1 percent, but
performance of secondary procedures depended on the willingness of the
patient and on the surgeon's judgment. Abdominoplasty procedures
involve a high risk of early complications. The rate of skin necrosis
is clearly augmented in cases of T-type plasty. The need for secondary
surgical correction is frequent, and the patient should be reminded of
this possibility during preoperative consultation.

Authors
Vastine VL.  Morgan RF.  Williams GS.  Gampper TJ.  Drake DB.  Knox
LK.  Lin KY.
Institution
Department of Plastic Surgery, University of Virginia,
Charlottesville, USA.
Title
Wound complications of abdominoplasty in obese patients.
Source
Annals of Plastic Surgery.  42(1):34-9, 1999 Jan.
Abstract
The records of 90 patients who underwent an abdominoplasty at the
University of Virginia Health Sciences Center were analyzed to
determine the effect of obesity on the incidence of complications
after this surgery. The study patients were divided into three
groups-obese, borderline, and nonobese-based on the degree to which
their preoperative weights varied from their ideal body weight. A
history of previous bariatric surgery was also analyzed to determine
what impact that might have on subsequent abdominoplasty. Results
showed that 80% of obese patients had complications compared with the
borderline and nonobese patients, who had complication rates of 33%
and 32.5% respectively (p = 0.001). Previous gastric bypass surgery
had no significant effect on the incidence of postabdominoplasty
complications. Based on these findings the authors conclude that
obesity at the time of abdominoplasty has a profound influence on the
wound complication rate following surgery, regardless of any previous
weight reduction surgery.

Authors
Floros C.  Davis PK.
Institution
Department of Plastic Surgery, Queen Mary's Hospital, London.
Title
Complications and long-term results following abdominoplasty: a
retrospective study.
Source
British Journal of Plastic Surgery.  44(3):190-4, 1991 Apr.
Abstract
A 6-year retrospective series of 133 abdominoplasties was studied and
type and incidence of complications are presented. From this series a
group of 34 patients was re-examined between 4 and 10 1/2 years
postoperatively and conclusions were made from this long-term
follow-up. A high incidence of injury to the lateral cutaneous nerve
of the thigh was recorded. A blood transfusion was required in 19% of
the cases, the average hospitalisation was 12.4 days and the
complication rate ranged between 24% in those who did not attend
review and 65% in those who were re-examined. Objectively judged, 55%
of the patients had excellent or good results, but subjective patient
satisfaction was nearly 90%.

MEDLINE <1966 to April Week 4 2003> 
Search Terms
1 - abdominal lipectomy.mp. 
2 - apronectomy.mp. 
3 - abdominoplasty.mp. 
4 - pitanguy.mp. 
5 - 1 and 2 and 3 and 4 
6 - 1 or 2 or 3 or 4 
7 - POSTOPERATIVE COMPLICATIONS/ 
8 - 6 and 7 
9 - from 8 keep 5, 14, 20, 39, 52, 54 

Results of your search: from 9 [from 8 keep 5, 14, 20, 39, 52, 54]
keep 1-6

Citations available: 6
Citations displayed: 1-6 

1. Talisman R.  Kaplan B.  Haik J.  Aronov S.  Shraga A.  Orenstein A.
Measuring alterations in intra-abdominal pressure during
abdominoplasty as a predictive value for possible postoperative
complications. [Journal Article] Aesthetic Plastic Surgery. 
26(3):189-92, 2002 May-Jun.
UI : 12140697 

2. Chaouat M.  Levan P.  Lalanne B.  Buisson T.  Nicolau P.  Mimoun M.
Abdominal dermolipectomies: early postoperative complications and
long-term unfavorable results.[comment]. [Journal Article] Plastic &
Reconstructive Surgery.  106(7):1614-8; discussion 1619-23, 2000 Dec.
UI : 11129195 

3. Vastine VL.  Morgan RF.  Williams GS.  Gampper TJ.  Drake DB.  Knox
LK.  Lin KY. Wound complications of abdominoplasty in obese patients.
[Journal Article] Annals of Plastic Surgery.  42(1):34-9, 1999 Jan.
UI : 9972715 

4. Kuzon WM Jr.  Crawford R.  Binhammer P.  Fielding C.  Knowlton R. 
Levine R. Effect of electrosurgical technique on wound healing and
early complication rate following abdominal dermolipectomy. [Clinical
Trial.  Journal Article.  Randomized Controlled Trial] Annals of
Plastic Surgery.  37(3):245-50, 1996 Sep.
UI : 8883720 

5. Floros C.  Davis PK. Complications and long-term results following
abdominoplasty: a retrospective study. [Journal Article] British
Journal of Plastic Surgery.  44(3):190-4, 1991 Apr.
UI : 1827355 

6. Dillerud E. Abdominoplasty combined with suction lipoplasty: a
study of complications, revisions, and risk factors in 487
cases.[comment]. [Journal Article] Annals of Plastic Surgery. 
25(5):333-8; discussion 339-43, 1990 Nov.
UI : 2147821 

regards,

jxc-ga