Recently, our own Dr. Hall-Findlay took some time out of her day to shoot a video to thoroughly explain the process & experiences every patient has during recovery from Tummy Tuck surgery. In this video, Dr. Hall-Findlay covers a lot of ground on what patients can expect, ranging from pain management, mobility, what patients can wear, what patients should eat, and even when patients can return to normal physical activities. Dr. Hall-Findlay also touches on some sensitive subjects, including when patients can use the bathroom again normally, emotional reactions to surgery, and how long patients should wait after surgery before having intercourse. This comprehensive look at abdominoplasty recovery addresses so many of the common patient questions that come up in the first hours after surgery, and what patients will need to know through the first several weeks of recovery. Below, is the video, and FAQs related to the video for those who would like to read this at their leisure. If you’re considering a tummy tuck procedure, this is will help you learn what to expect during recovery from surgery…
What do you mean by “drainless” abdominoplasty?
Here at Banff Plastic Surgery, we use what is called a “drainless” abdominoplasty or tummy tuck. We use quilting sutures which not only mean that we do not need to use drains, but quilting also helps prevent some of the swelling that is inevitable after surgery. These quilting sutures are also sometimes called “progressive tension advancement sutures”. They not only prevent swelling (seroma formation) but they help keep the tension off the incision so that it heals better and with a less obvious scar.
I have heard that many patients have a lot of pain after a tummy tuck. Is this true?
Recovery can be difficult (which is why we think the word “tuck” is a bit misleading). We do, however, have a unique program of pain management. This involves a “multimodal” approach which includes a variety of medications both before and after surgery. We also use TAP blocks where we put in a long-acting local anesthetic in the layer between the muscles where the nerves travel. We do this under ultrasound control once you are under anesthetic. This works so well that many patients wake up in recovery without any pain. Our anesthetists take pride in making the whole experience as comfortable as possible.
Why then do patients often stay at least one night after surgery at the Mineral Springs Hospital in Banff?
Recovery is still not easy and, although you still do not have much pain after the TAP block wears off, we still need to use the multimodal approach to help you recover. The bed is flexed at the waist and knees so that you can be more comfortable. It can be difficult getting in and out of bed and it is nice to have the bed siderails to hang onto. It is good to have some nursing help that first night when you get up to go to the bathroom.
We give you some usual medications (Tylenol and anti-inflammatories) that are surprisingly effective when taken regularly. We then supplement these with narcotics as needed but patients do recover better when opioid use is kept to a minimum.
What is it like the first couple of days after an abdominoplasty?
That first night will involve getting in and out of bed to go to the bathroom and perhaps taking some short walks. It will hurt a bit when you pull yourself out of bed and many patients worry that they will damage the results when you pull on the siderails. That is not a concern.
You should sit at the side of the bed before you get up to give yourself a bit of time just to get your equilibrium so that you do not get lightheaded when you go to the bathroom. You will be given an incentive spirometer to help you take deep breaths and fill your lungs with air. This is important to prevent you from getting pneumonia – especially if you have had breast surgery as well. Patients tend to protect their incisions by avoiding deep breaths. It can help to hold a pillow over your tummy when you take a deep breath – especially when you cough.
How much will I be able to move around during that first week?
It can take a few days for you to be able to stand up straight. So the evening after a tummy tuck, you’re just getting out of bed to go to the bathroom and back. The next day we want you to sit in the chair, move around, and try out different positions. (If we just put you to bed for two or three days with no surgery, your back would hurt). So you need to get out of bed, move around, sit in different places, sit on the edge of the bed, sit in the chair and take short walks. In fact, we’d rather you get up twenty times a day for a minute than once a day for twenty minutes.
I have heard that sometimes you use blood thinners after tummy tuck surgery.
During surgery and after surgery you have what we call intermittent compression devices on your legs. These pump intermittently to help keep the blood flowing in your veins so that you don’t get blood clots. We don’t want them to prevent you getting out of bed. You can take these off when you get up by undoing the connection or even unwrapping them completely. Either way, it is important to keep your toes wiggling and moving your legs to prevent developing a blood clot.
If you move around well, then we are less concerned that you might develop blood clots in your legs (deep vein thrombosis). These clots can break off and travel to your lungs (pulmonary embolus) and this could be fatal. So, if you do not move around well, then we will consider the use of blood thinners for a week. Some patients who have clotting abnormalities (Leiden V etc) will need blood thinners for longer.
Do I need compression garments after surgery?
The quilting sutures actually act as internal compression. When you wake up from surgery, you’ll have bandages over your abdomen that are held in place by what we call a “belly band” (we took those from the pregnancy patients who use the belly band when the zipper on their pants cannot be done up anymore). We use the belly band just to hold the bandages in place, not for compression.
We will ask you to wear compressive garments if we perform a lot of liposuction. We think it’s better for you to be comfortable because compression really doesn’t make that much difference for the final result. For example, patients who use compression will look better at two weeks than those patients who do not; but at six weeks, you would both look the same. It is really about comfort more than anything else. That said, some people actually feel more comfortable with compression.
There is some swelling however that can be helped with compression. When you first wake up in the morning, you will actually look pretty good because any swelling that occurs in the abdomen can work its way around your back during the night. But, as you get up and move around more, the swelling will occur above the hip-to-hip scar because the incision blocks the swelling from escaping with gravity. Because of this, we’d like you to take a couple of times during the day where you can lie down to help that swelling move away. The swelling above the incision gets worse the more active you are, especially toward the end of the day. It is this swelling that occurs in the few weeks after surgery when compression can help make you more comfortable.
What should I wear after surgery?
The nurses from the Banff Plastic Surgery office will provide you several garments. You will be given a pair of yoga pants to wear home. These come up high because we don’t want you to wear anything that really digs into your waist (in order to avoid interference with blood supply to the lower abdominal skin). The nurses will also give you some Spanx. Some people find these a bit too compressive in the first couple of weeks and they keep them for later. The nurses will also give you a body suit for week two and three. It has hooks at the crotch so that you can go to the bathroom and still leave it on. You can also attach it to your bra strap so that it doesn’t roll down. Some patients like the Spanx, some patients like the body suit, and some patients don’t like either. Some patients will instead have garments at home that they can use for a bit of compression.
What should we do for the incisions?
You will have paper tape on the lower abdominal incision and this tape actually stays on for about three or four weeks. You can start having a shower the day after surgery and the tape will stay on. It sometimes looks a little bumpy underneath because there’s often a little bit of blood that collects under the tape.
There is some skin glue on the belly button but no tape. We usually use some ointment to keep any crusted blood soft so that it can be easily cleaned. Make sure that you take the tube of antibiotic ointment home with you. Some patients develop a rash from the ointment indicating an allergy. The sutures around the navel take longer to disappear than the lower ones and patients can feel the stitch ends for several months. We only suggest removing them if they start to fester.
How Will I Feel After Tummy Tuck Surgery?
Some patients will find it a bit emotional during the recovery period. If you find the day after surgery that you burst into tears in the afternoon don’t be surprised. That first week can be a bit of an emotional roller coaster. Recovery can be frustrating because you will find that your body will not let you get back to normal as fast as you would like.
When can I drive?
You are not allowed to drive as long as you are taking any narcotics (Tylenol #3, Emtec with codeine, Percocet or oxycodone). You will usually be able to drive again by the second week after surgery.
What will it be like once I get home?
Once you go home it is important to have help – but not so much help that you don’t get out of bed! We still want you to move around frequently for short periods. We also do not want you to do any sudden heaving lifting because you need to treat the fascial plication (muscle tightening) much like a hernia repair – nothing too strenuous for 6-8 weeks. It will take time to ease back into a fitness program after that.
You can lift slowly and carefully but if you have young children, it is best to get them to climb up to you rather than you lifting them (let them climb up into the car seat and then you can buckle them in).
Don’t worry if you feel a “pop” suddenly when you make a twisting movement once you get home. That’s probably one of your quilting sutures giving way. It may even result in some pain in the area. The quilting sutures are supposed to dissolve, but sometimes one just might let go. There are about 30-50 quilting sutures so losing one will not make a difference.
Can I use hot packs or ice packs for comfort or swelling?
Patients will find that they don’t have any sensation in the skin between the belly button and the pubic area. You need to be really careful not to use ice packs or heating packs because we don’t want you to burn or freeze the skin when you don’t have any sensation. That patch of numbness will get smaller but will never disappear completely. The numbness sometimes goes down the leg a little bit and that can be temporarily annoying for patients but the numbness doesn’t interfere with sexual feeling.
When can I have sex again?
Some patients are too afraid to ask us when they can start having sex again. It will mainly depend on when you feel comfortable enough. We don’t want you to raise your blood pressure either lifting heavy objects or having sex for the first couple of weeks because we don’t want you to pop a blood vessel and develop bleeding resulting in a collection of blood called a hematoma (sometimes a hematoma is large enough that we recommend taking you back to surgery – not an emergency). Most people wait three or four weeks before having sexual intercourse.
With a tummy tuck, we almost always perform some liposuction, usually in the area around the hips, and often in the mons or pubic area. The bruising from the sides will tend to go down the legs but the bruising from the mons or pubic area goes underneath so your vaginal lips may get a bit swollen. One side may be more swollen and bruised than the other – don’t worry.
How can I prevent constipation after surgery?
Everybody gets constipated after a tummy tuck due to the narcotics that are used during surgery. We suggest that you take Lax-a-Day before your procedure because it makes recovery much more pleasant. Patients are often reluctant to take stool softeners before surgery but rest assured that no one has an accident.
Some patients will not have a bowel movement for several days after surgery. If it bothers you a lot, the nurses can give you a suppository or a Microlax enema. We don’t want you to take anything that irritates your intestines: no prune juice, no irritating laxatives, no gas- forming foods like bran. You will know yourself what causes bloating, so avoid those foods.
I have been told that it is important to massage the scar. Is that true?
We like patients to massage their scar to keep it from sticking to the layers underneath. C-section scars often end up with an overhang because the scar becomes adherent. In order to avoid that, we ask you to start massaging the scar about three or four weeks after surgery when the tape comes off. We then ask you to massage the scar about three or four times a day (a good time is whenever you go to the bathroom). You need to massage the whole scar (but especially the area above the mons) going across it about three or four times at each session. It is best to continue the massage for about three or four months. There is no magic with three or four – it just makes it easier to remember.
At first, the incision will be too tender to apply much pressure but with time we want you to make sure that you are able to actually move the skin over the layers underneath. The massage should be more aggressive than what you would use when just applying a skin cream. The incision will feel like bubblewrap at first and it will feel lumpy for about 9 months. Each little lump is where a suture is trying to dissolve and they can feel quite firm.
Learn More About Tummy Tuck Surgery
Banff Plastic Surgery started with Dr. Elizabeth Hall-Findlay and she was joined in 2015 by Dr. Susan MacLennan. Both surgeons are originally from Canada but both completed their plastic surgery residency in the United States. The practice has become an internationally recognized teaching centre.
Dr. Elizabeth Hall-Findlay has had extensive training in both aesthetic (cosmetic) and reconstructive surgery in both Canada and the United States. Dr. Hall-Findlay completed her plastic surgery residency in San Francisco and New York City. She is a fellow of the Royal College of Physicians and Surgeons of Canada (FRCSC) and she is certified by the American Board of Plastic Surgery.
Dr. Susan MacLennan was trained at Dartmouth and Cincinnati and was a member of the faculty practising at the University of Vermont for 15 years. She came back to Canada and joined Banff Plastic Surgery in 2015. Both surgeons perform a “drainless” abdominoplasty or tummy tuck.