From Make Me Heal

Contents 1 Muscle Repair 2 Sutures and Closure 3 Scar Placement 4 Compression Garments & Binders 5 Drains 6 Time Off Work 7 Definitions

Muscle Repair

Most women who are seeking a tummy tuck will require some muscle repair. Childbirth, weight gain, and aging all contribute. The fascia which holds the muscles together to form a strong core is actually what is repaired, not the muscles. To understand what the fascia is, think about the gristley part of a steak. The part between the meat and the fat. That is what the PS's sew back together to draw the muscles back in. For those who need MR, it can be what causes the most dramatic changes in appearance. Most women having a FTT will have roughly the same amount of skin removed, the area between the pubic mound to just above the belly button. The main difference between a good TT and a great TT is in the details of the MR and the incisions. Having the muscles pulled in nice and tight is what brings in the waist line and the sides, so as to 'frame' the body that the skin will drape over.

Here's an picture of muscle repair while in surgery:

So how do you know which Drs do the better job? Here's a few tips.

• First educate yourself by looking at tons of pics. You can find many right here on MMH -Pictures. Compare one persons results with the other. Visit the Tummy Tuck Message Boards, and follow the recoveries of women. Who was standing straight at what point, how do their results compare with others? What was their initial body type in comparison to yours? Learn to look at pictures with a discerning eye, that's how you'll be able to judge the work of the PS when you visit for a consult. I like to compare a good TT with getting a good paint job. If you take an old rusty car to Maaco and get the $199 special, you'll still be thrilled with the results in comparison to the befores. But if you take the same car to the custom shop, and they remove the bumpers and rebadge and do extra body work, you would be able to tell the difference when compared side by side. In PS, surgeons usually charge about the same in a given geographic area, so make sure you're getting the custom job.

• Ask your PS what his philosophy on MR is.. He won't be able to gaurantee you what he'll be able to do for you until he gets into surgery, but he should be able to tell you what he 'usually' does. Is he aggressive? How close - in mm's - will he try and pull them together? Some PS still don't do any MR, and some do only a modest amount. They have their reasons. There's a longer recovery time, more pain for the patient. It also takes them longer in surgery to do a good job, as it usually requires more layers of stitches to do it tighter and have it hold. Discuss your Dr's techniques and his philosophy with him to make sure your expectations are on the same page. Your case may be one where MR is either not required or where he can't be as aggressive for very real reasons. Make sure you have all the info you need to make the right choice.
  
  

Sutures and Closure

Most Dr's will use disolvable internal sutures. Where they vary most is in how they close the incision. Here's the most common types:

• Steri-strips or tape. This is placed over the incision to help the 'top' close cleanly. Your Dr will usually advise you not to shower for several days up to a week, to allow the incision to close before exposing to water.

• Glue. If your insicison has been sealed with glue, then you will be able to shower on or about day 2, as the glue will prevent water from touching the incision. Within a week or so, the glue will begin to peel off.

• There are still a few Dr's that use staples. There is some risk that the staples will cause extra scarring, tho alot of women have done just fine. And the staples will have to be removed during the first week.
  
  

Scar Placement

As with everything else, this largely is a preference determined by the PS, depending on your body type, the amount of skin to be removed, and the natural fold of the skin. If you get an Extended TT (ETT), then your incision will go all the to the back of your hips. If you have a mini TT (MTT), then your scar will be low and much smaller than most. You may or may not be able to have much say over where the scar is placed, as doing it other than the way the PS recommends could give less than satisfactory results and cause issues such as 'dog ears'.

• Where does he recommend the inisicion be placed?

• Will it be the smiley face shape or a more straight line?

• Can you wear your favorite panties or swim suit to help determine the placement?

• How far back will the inicision go?
  
  

Compression Garments & Binders

Many patients use specialized compression garments for their procedures or a binder for at least some period of time. A compression garment is crucial for healing as it accelerates the healing process and allows you to return to daily life sooner by minimizing swelling, improving blood circulation, providing support and comfort to surgical areas, and by flushing the body out of potentially harmful fluids. A garment or binder helps close the space that was created when seperating the skin/fat from the fascia, which keeps fluid from collecting. This is to help prevent complications such as a seroma or a hematoma.

Depending on the doctor, you may need to wear both a Stage One garment for the first 1-2 weeks of post-op (garment is designed to be less tight and bigger due to your swelling and has zippers for ease) and then switch to wearing a Stage Two garment (smaller and tighter since you have less swelling) during 2-8 weeks post-op or longer. Wearing garments for both stages gives you continuous compression, which speeds recovery. Some doctors may ask you to wear one garment. And then there are some - especially in Great Britian - who don't use a binder or garment at all.

Choosing the right garment can have a significant impact on your healing. It is not recommended to sacrifice your cosmetic results by wearing a non-medical garment from your local store that is not specifically made for a cosmetic medical procedure (such as over-the-counter girdles, athletic shorts, body suits, tights, shapewear, sports bras) because they are not designed for continuous wear during recovery. Wearing a non-medical garment can be bad for healing, as you can slow down your recovery, worsen your swelling and other symptoms, and increase your post-op discomfort.

• Will you wake up in a garment or binder after surgery? If so, what kind? How long will you need to wear this garment or binder?

• If you're to provide your own garment or binder, what does your doctor recommend?

• If you're having a combination of procedures, such as a "breast augmentation" or liposuction, how will that affect the garment you should wear? You can find Multiple Procedure Garments that are specifically made for combination procedures.

• Can or should you wear a stage 2 garment, and if so, when can you switch from the stage 1 garment, and how long should you remain in it?
  
  

Drains

Almost all Drs use drains of some type. This is because the lymph system has been disrupted with the skin removal and incision. The drains are put in to assist the body in removing the fluids, so as to reduce swelling and prevent a build up that could cause a seroma or a hematoma. There are some new techniques available now, where drains aren't required. One is a procedure where a sort of 'glue' is made from your own blood to seal the pocket, and another is called pregressive tension sutures, which also closes that pockets. Since they're both pretty new at this point, alot of Dr's are taking a wait and see approach before using this technique for themselves.

• Where does the Dr put the entry points for the drains? In the incision directly? Or in the pubis area? Will there be a seperate scar?

• How long does he typically leave the drains in? Will he remove one first and then the other? Does it depend on the amount of fluid being drained?

• Is there a max length of time that he'll leave a drain in? If it extends for longer than anticipated, does he prescribe antibiotics so as to prevent infection?
  
  

Time Off Work

The amount of time for recovery depends alot on the amount of MR, as well as the general health and condition of the patient. It seems that most Dr's will recommend at least 2 weeks before returning to work, depending on the type of work you do. Even with a desk job. Sitting can be harder than standing, because of the pressure it puts on the MR. If you return to work at a desk job, make sure you get up often and move around to prevent the muscles from cramping up. During lunch, I would often go out to my car and lean the seat all the way back, so I could rest the muscles mid-day.

• How long before you can return to work full time?

• How soon before you can resume household duties? I recommend at least 6 months off from this activity. ; )

• How soon before you can take care of small children if you have them?

• How long before you can resume exercise? Walking? Weights?

• How soon can you drive?

Definitions

seroma

A mass or swelling caused by the localized accumulation of serum within a tissue or organ.

hematoma

A localized swelling filled with blood resulting from a break in a blood vessel.

fascia

A sheet or band of fibrous connective tissue enveloping, separating, or binding together muscles, organs, and other soft structures of the body.

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