Items To Obtain Prior To Surgery
- Hibiclens soap (at any pharmarcy, Walmart, or Target in first aid section).
- Abdominal pads or thick gauze for after surgery.
- Antibiotic ointment
- Cotton tip applicators
- Alcohol wipes or alcohol fluid and gauze pads
- Arnica gel tabs (these are on line). This helps with discomfort, bruising and swelling after surgery.
- Absorbent pads for bed (urinary section of store). There may be oozing after surgery and these pay help protect bedding.
- Stool softener to take following procedure to aid with constipation. (Colace recommended)
- Compression stockings. You can purchase these on Amazon, at Target or any store which carries compression stockings.
Two Weeks Before Surgery
• Do not take any products containing aspirin, ibuprofen (Advil, Motrin), non-steroidal anti-inflammatory medication or Vitamin E. Tylenol is acceptable.
• Refrain from all nicotine products, including cigarettes, pipe tobacco, chew or Nicotine patch. Nicotine interferes with healthy circulation and may affect the result of your surgery. It also places you at higher risk of complication when receiving anesthesia.
One Week Before Surgery
• Do not drink alcohol for 1 week before and after surgery.
• Finalize your transportation to and from the office. You cannot drive following the procedure.
The Day Before Surgery
• You will receive a phone call informing you of your arrival time for surgery.
• DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT. (This includes water and gum chewing). Surgery may be cancelled if this is not followed. A fasting state is required in order to receive sedation for surgery. The only exception is medication, which we instruct you to take with a sip of water the morning of surgery.
• Ensure you have plenty of good healthy foods and beverages on stock for after your surgery. Plenty of protein, fruits and vegetables are always a good idea.
• Pick up your prescribed medicines and place them in a bag to bring with you the day of surgery.
• Anesthesia may call you the night before to go over your history and provide any additional instructions especially if you are taking certain medications
• Wash with hibiclens soap the night before surgery. Also plan to wash your hair that evening or morning of procedure.
• Relax and breathe! Last minute jitters are normal.
• Wash with hibiclens soap the morning of surgery. Wash all areas that will be worked upon.
• Nothing to eat or drink unless instructed otherwise
• Do not wear cosmetics, jewelry of any kind, contact lenses, hair clips or body piercings (If there is something you cannot remove, let the admitting nurse know right away.) Wear comfortable, clean, loose-fitting clothing: Do not wear jeans or any tightfitting bottom; rather have a pair of loose, drawstring sweatpants to wear home. You may wear a robe. Wear slip on, flat shoes with a slip proof sole; no heels. Wear clean cotton socks, as the operating room can feel cool. For your comfort, wear a zip or button front top.
• Do not take aspirin (or products containing aspirin) or Ibuprofen (Advil®, Motrin®, Midol®) for 2 weeks after surgery. Also do not begin herbal supplements until 2 weeks after surgery. Arnica, Bromelin and Vitamin C are okay to take.
• Phentermine or appetite suppressants should not be taken until 6 weeks after surgery as these supplements increase heart rate and blood pressure and can interfere with your recovery
Abdominoplasty Post-Surgery Instructions
• A responsible adult must provide transportation for you after surgery (public transportation is not permissible). He/she must stay with you overnight and after surgery until the morning following the procedure. If you are having several procedures, you may need or prefer assistance for 1-2 days following your procedure.
• Follow up appointments are made for the next day, at one week, possibly 2 weeks, and then generally one month, 3 months, 6 months and one year. You will most likely need a driver for the first couple of appointments but most patients are able to drive themselves to later appointments. Please ensure that you have ride availability to your follow up appointments.
• Avoid making major decisions or participating in activities that require judgment for 24 hours.
• Do not drive for approximately 10-12 days and while you are taking pain medication. DO NOT DRINK ALCOHOL WHILE TAKING PAIN MEDICATIONS or muscle relaxer. This can be a deadly combination. Only take the pain medication if needed. The quicker you can wean off of the pain medication, the better you will feel and heal.
• Avoid any activities that cause pain or discomfort.
• Take a stool softener with pain medication to prevent constipation.
• Limit your activities for the first 24 hours after surgery. Walk for short distances during the first 24 hours after surgery. You should try to keep a flexed position in the torso at all times for the first 2 weeks. This keeps tension off the wound and reduces the chance of a widened scar. By the end of the second week, gradually begin to stand more upright. Keep your hips flexed while in bed to prevent excess tension at the surgical site.
• Sleeping position: While resting in bed, keep a pillow under your legs and at least 2 – 3 pillows behind your back. This position (reclining chair position) minimizes the tension upon your new abdominal closure. Sleep on your back with your hips flexed in a reclining chair position. Keep your head elevated about 30 degrees and leave your knees slightly flexed. These instructions aid in the quality of your scar. Sleep in this position for 3 weeks. After 3 weeks, you may sleep flat on your back. You may resume side sleeping after 6 weeks
• Take deep breaths to fully inflate your lungs 10 times every hour (while awake) for the first few days after surgery. This is necessary to prevent post operative pneumonia or atelactasis (lung collapse).
• Pump legs while lying down to prevent blood clots. Do frequent pedal presses or foot pumps while sitting as well. It is encouraged to begin walking as soon as you can even it is a few steps. You will be wearing supportive stockings consistently for the first 2 weeks after surgery. Wear Knee High TED hose until resumption of normal activity (usually 2 weeks).
• Resume activities slowly. You may feel tired for the first few days. Avoid heavy lifting, bending and straining for 4-6 weeks. You may resume all activity after six weeks.
• Take all medications as instructed. You will be given a narcotic. Try to wean off this medicine after a few days. Most patients can change to Tylenol without major issues. If you are sleeping, you should not be awakened to take narcotics or muscle relaxants. These medications can make you even sleepier and over-sedated. Over-sedation can be dangerous and must be avoided.
• Swelling and bruising are normal. It is expected to take between 3-6 months to see your final results.
• Fluids and good nutrition are important following surgery. Consume non-carbonated, nonalcoholic, caffeine-free beverages including fruit juices, sports drinks, water, and yogurt drinks. You should drink at least 8 ounces of fluid every 2-3 hours. Nausea is common after surgery, so start with soft, bland, nutritious food for the first 24 hours.
• If you have not urinated after 6 hours of being home from surgery, please contact our office.
• After surgery it is common that you will have a drain at the surgical site. Drains help to remove excess fluid from the abdomen. The amount of drainage will determine how long the drain will be left in place. This will be slightly bloody at first but should begin to lighten up over the week. When the bulb is halfway full, remove the bulb from the tubing, record amount, and wipe off the tubing with an alcohol wipe prior to replacing. If you do not have alcohol wipes, you can wet a gauze with alcohol fluid in order to clean the top. The bulb must be squeezed prior to placing back on tubing to maintain suction. If your bulb is filling rapidly with bright red blood and you have to empty more the 4 or 5 times a day, please contact Dr. Allen immediately (336 404 4267). Empty drains on a schedule. You can choose to empty the drains and record the value three times a day (every 8 hours), 4 twice a day (every 12 hours), or if not producing too much fluid, once a day at the same time. It is normal for your drain sites to leak fluid for the first few days. Do not be alarmed if this happens. You can place ABD pads or maxi pads on groin at drain site to collect draining fluid. It is normal for over-activity to result in more drainage. It is normal for stringy clots to appear in your drain bulb.
• You may change the absorbent gauze pads that are placed at the surgical site as needed to help keep the incision clean and dry.
• You may shower (but not bathe) in 2 days after surgery even if the drains are intact. You can wear an old belt, ribbon or rope around your waist or shorts in the shower to hold your drains in place. Do not allow the showerhead to face the surgical area for the first week—the pressure of the water on your incision might be painful. Allow the water to strike your back and trickle forward. You may use a cup or Tupperware® to splash the surgical area with water while showering. You may wash the surgical area with soap (any kind) and water (lukewarm, never hot). Do not use surgical soaps to wash the area as these are drying to the skin. Use regular soap. Remove all your garments, dressings (including the yellow sticky gauze) when showering. When out of the shower, blow dry incisions on a cool setting or gently pat dry. Apply new dressings (ABD pads along surgical area to cover incisions) and usual compression garments.
• Make sure someone is with you at your first shower. You may feel light-headed when you first come out of the garment. THIS IS NORMAL! Make the shower a quick one.
• A surgical garment and/or a binder will be applied immediately after surgery. This is to be worn continuously unless changing or showering. You should change your garment daily and wash but do not place in dryer. After showering, the garment must be placed back on and worn for at least six weeks. You may want to use a funnel to direct the flow of urine when using the bathroom to keep the garment as clean as possible. If you find that the binder or garment is making you itchy, you may wear a tight under- shirt under your binder. If you find you do not like the garment in which you given, you may purchase an alternative garment online. Some patients find more comfortable options depending on his/her body type. You may also consider purchasing an additional corset or waist trainer for maximum compression. Recommend The Vanna Belt or the Bellafit corset or waist trainer.
• You will notice some surgical tapes placed over your incision. If they get wet from showering, you may help them to dry by using a blow dryer (cool setting). Leave tapes in place as they will fall off on their own.
Exercise And Sexual Activity
• No overheating for the first 3 weeks (spas, exercising in the sun, etc).
• At 2-3 weeks, you can consider passive or less vigorous sexual activity that will not cause abdominal movement or contraction.
• You may go for a light stroll when you feel comfortable but do not plan on a long walk. Cardio may resume at 4 weeks following surgery.
• Do not lift anything heavier than 10 lbs. for the first 6 weeks.
• Abdominal muscle exercises are discouraged for 3 months after surgery to protect the abdominal wall plication suture.
• You may begin swimming 4 weeks post-operatively if healing is complete.
What To Expect
• Moderate swelling of your abdomen is to be expected. You may find that your clothes may not fit as easily as before. Be patient. The swelling will gradually subside and you will be back to normal in 3 – 6 months. Swelling will be at its worst between 3 – 5 days. Swelling starts to subside at 6 weeks but may take 6 months to resolve.
• Bruising is a normal expectation following surgery. Bruising could be apparent for as long as 3 – 4 weeks afterwards. The bruises will move down your body as they are absorbed.
• Because of the removal of tissue from your abdomen, there is a certain amount of tightness that is to be expected. This will slowly relax within 6 months.
• Infrequently after surgery, you may have fluid build-up in the abdomen after the drains are removed. If this happens, you will notice a fullness or sloshy feeling in your abdomen. If you feel this area is enlarging rather than going down, please call the office. You may have what is called a seroma or fluid collection which needs to be drained.
• A large and swollen pubic area will occur postoperatively and will subside by 6 months from surgery.
• You will temporarily gain weight after surgery. This is caused by water retention, which is a normal hormonal response to the stress of surgery. Your face and hands may even swell due to this fluid retention. Don’t be concerned with this. Indeed, we advise that you do not even trouble yourself by checking your weight after surgery. The fluid will be mobilized and excreted by your kidneys in 1-2 weeks after surgery.
• It takes 6 MONTHS FOR FINAL RESULTS to appear. In the interim, you may notice:
- Incision asymmetry
- Abdominal asymmetry
- Umbilical asymmetry or malposition
- Pleating along incisions
- Swelling that changes from day-to-day
- The swollen genital or mons area is common
- Be patient please and try not to focus on these issues before the 6-month period.
• A burning sensation (raw, sensitive) or sharp shooting pains along the abdomen and incision line is normal and indicative of nerve regeneration. These “neuralgias” will burn out by 9 months.
• Numbness is expected to resolve by 9 months on average.
Emotional Exepectations Following Surgery
• It is not unusual for patients to undergo significant emotional “ups and downs” after any type of surgery. Factors such as underlying stress, medications, and/or psychological tendencies can result in patients experiencing a “postoperative depression” that generally resolves after a few weeks. Having a partner, family member, or friend who is supportive can help with this process. Understanding the stages of emotional “ups and downs” can help patients stay calm and recover from this emotional process faster:
- Phase 1: Being Out of It – Swelling and discomfort is most severe over the first few days after surgery. Pain medications also can make you disoriented and emotional.
- Phase 2: Mood Swings – Having just had surgery, patients are adjusting to a sudden change in their appearance with much anticipation. The presence of bruising, swelling, and asymmetries will distort a patient’s results thereby concealing the final outcome. Mood swings (especially sadness), worry and depression are common emotions as a result. Patients may even ask, “What have I done?” or think that “I never should have done it.”
- Phase 3: Being over critical – During the second week, patients will probably be feeling a lot better. The swelling and muscle cramping/spasms will be decreasing and sutures will be out. Because of anticipation, it is natural for patients to look critically at their new body worrying about symmetry, scars, and so on. At this point, it’s normal to wonder if they have achieved their goal and what they paid for. This is too soon to tell and most concerns are resolved with time.
- Phase 4: Happy at last – Finally, about 3 – 6 months out of surgery, patients will probably start liking how they look and are feeling much better. They may be in the mood to check out some bathing suits or outfits to show off their new figure.
Depression. Your body (including your brain) is exposed to great amounts of physiologic and mental stress after surgery. This is caused by a number of factors. Your hormone and steroid levels are elevated and you are taking medications (especially the narcotic and muscle relaxants) that directly affect your physiology and psychology. Your sleep cycle is probably disrupted, so you are likely sleep deprived. All of these factors, combined with the emotions and expectations you have invested in your surgery, can lead to a brief “let down” or “depression” after plastic surgery. As healing occurs, and as your physiology, stress level and sleep return to normal, these thoughts usually disappear. If you feel mildly depressed, understanding that this is a natural phase of the healing process may help you cope. If this happens to you, we want you to discuss it with us, especially if depression is severe.
• Avoid direct sunlight to the incision for at least 1 year. Use a sunscreen with zinc oxide with SPF 30 or greater to help decrease the visibility of the scar.
• Your scars will continue to mature and settle. If your scars become raised, red, thickened, or wide contact our office. Early intervention is important to achieving well-healed scars. Use of silicone sheets may be recommended. Scars generally mature to fine incision lines in one to two years after surgery.
• In most cases, you should plan to remain within a reasonable traveling distance of our office for at least a few days after surgery, in case you develop a problem requiring emergent or urgent attention. This is not the time travel far away to visit relatives or to take a vacation.
• If you travel as a passenger at any time for the first month after surgery please take a travel break every 30 minutes or so at a gas station on the way and take a light walk in the convenience store for a few minutes or so to prevent blood clots in the legs. Be aware that you will not be able to fly for one week and after your first visit following your operation.