15847 Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure)

Name of the Procedure:

Excision, Excessive Skin and Subcutaneous Tissue, Abdomen
Common name(s): Abdominoplasty, Tummy Tuck
Technical terms: Lipectomy, Umbilical Transposition, Fascial Plication

Summary

An abdominoplasty, commonly known as a tummy tuck, is a surgical procedure designed to remove excess skin and subcutaneous tissue from the abdominal area. The procedure may also involve repositioning the navel (umbilical transposition) and tightening the abdominal muscles (fascial plication) to create a smoother and firmer abdomen.

Purpose

This surgical procedure aims to:

• Address sagging or loose skin in the abdominal area, often resulting from significant weight loss, pregnancy, or aging.
• Improve the appearance and contour of the abdomen.
• Strengthen and flatten the abdominal muscles.

Indications

• Excessive, loose, or sagging abdominal skin.
• Weakened or separated abdominal muscles (diastasis recti).
• Patients who are in good general health and have realistic expectations.
• Typically, candidates should be non-smokers and have maintained a stable weight.

Preparation

• Patients may be instructed to avoid eating and drinking (fasting) for a specific period prior to the surgery.
• Medication adjustments might be necessary, especially if the patient is on blood thinners or other medications that could affect surgery.
• Pre-operative physical examination and possibly imaging tests or blood work may be required.

Procedure Description

1. Anesthesia: General anesthesia is typically administered to ensure the patient is asleep and pain-free during the procedure.
2. Incision: A horizontal incision is made between the pubic hairline and the navel.
3. Skin and Tissue Removal: Excess skin and subcutaneous tissue are excised.
4. Umbilical Transposition: The navel is repositioned to a more natural location on the tightened abdomen.
5. Fascial Plication: The abdominal muscles are sutured and tightened.
6. Closure: Incisions are closed with sutures, skin adhesives, or surgical tape.

Duration

The procedure typically takes around 2 to 5 hours, depending on the complexity and extent of surgery.

Setting

An abdominoplasty is usually performed in a hospital or an accredited surgical center.

Personnel

• Plastic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical assistants

Risks and Complications

• Common risks: Infection, bleeding, and reaction to anesthesia.
• Rare risks: Blood clots, poor wound healing, and significant scarring.
• Complications could include seromas (fluid accumulation) and changes in skin sensation.

Benefits

• A flatter and more toned abdominal appearance.
• Improved confidence and body image.
• Results may be visible immediately, with further improvements over a few months as swelling decreases.

Recovery

• Post-operative care includes wearing a compression garment to reduce swelling.
• Patients may need to manage pain with prescribed medication.
• Limited physical activity and avoiding heavy lifting for several weeks.
• Follow-up appointments to monitor healing and address any concerns.

Alternatives

• Non-surgical options like laser treatments or body contouring (limited effectiveness for significant excess skin).
• Liposuction might be considered but does not address loose skin or muscle tightening.
• Pros of alternatives: Less invasive, quicker recovery.
• Cons of alternatives: Less dramatic results, may not address all concerns.

Patient Experience

Patients may experience discomfort, swelling, and bruising post-operation. Pain management ensures comfort. Full recovery can span several weeks to months, with most returning to normal activities within 6 weeks.