OTHER

“Abdominal Defects.” Medical and Scientific Information On-line, Inc. [cited April 8, 2003]. <http://www.cpdx.com/cpdx/abdwall.htm>.

National Birth Defects Prevention Network. January 27, 2003[cited April 8, 2003]. <http://www.nbdpn.org>.

Monique Laberge, Ph.D.

AbdominoplastyDefinition

Also known as a tummy tuck, abdominoplasty is asurgical procedure in which excess skin and fat in the ab-dominal area is removed and the abdominal muscles aretightened.

Purpose

Abdominoplasty is a cosmetic procedure that treatsloose or sagging abdominal skin, leading to a protrudingabdomen that typically occurs after significant weightloss. Good candidates for abdominoplasty are individu-als in good health who have one or more of the aboveconditions and who have tried to address these issueswith diet and exercise with little or no results.

Women who have had multiple pregnancies oftenseek abdominoplasty as a means of ridding themselvesof loose abdominal skin. While in many cases diet andexercise are sufficient in reducing abdominal fat andloose skin after pregnancy, in some women these condi-tions may persist. Abdominoplasty is not recommendedfor women who wish to have further pregnancies, as thebeneficial effects of the surgery may be undone.

Another common reason for abdominoplasty is toremove excess skin from a person who has lost a largeamount of weight or is obese. A large area of overhang-ing skin is called a pannus. Older patients are at an in-creased risk of developing a pannus because skin loseselasticity as one ages. Problems with hygiene or woundformation can result in a patient who has multiple hang-ing folds of abdominal skin and fat. If a large area of ex-cess tissue is removed, the procedure is called a pan-niculectomy.

In some instances, abdominoplasty is performed si-multaneously or directly following gynecologic surgerysuch as hysterectomy (removal of the uterus). One studyfound that the removal of a large amount of excess ab-dominal skin and fat from morbidly obese patients dur-

PERIODICALS

Kurchubasche, Arlet G. “The fetus with an abdominal wall de-fect.” Medicine & Health/Rhode Island 84 (2001): 159–161.

Lenke, R. “Benefits of term delivery in infants with antenatallydiagnosed gastroschisis.” Obstetrics and Gynecology 101(February 2003): 418–419.

Sydorak, R. M., A. Nijagal, L. Sbragia, et al. “Gastroschisis:small hole, big cost.” Journal of Pediatric Surgery 37 (De-cember 2002): 1669–1672.

White, J. J. “Morbidity in infants with antenatally-diagnosedanterior abdominal wall defects.” Pediatric Surgery Inter-national 17 (September 2001): 587–591.

ORGANIZATIONS

American Academy of Pediatrics. 141 Northwest Point Boule-vard, Elk Grove Village, IL 60007-1098. (847) 434-4000.<http://www.aap.org>.

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KEY TERMS

Abdomen—The portion of the body that lies be-tween the thorax and the pelvis. It contains a cavi-ty with many organs.

Amniotic membrane—A thin membrane that con-tains the fetus and the protective amniotic fluidsurrounding the fetus.

Anesthesia—A combination of drugs administeredby a variety of techniques by trained professionalsthat provide sedation, amnesia, analgesia, and im-mobility adequate for the accomplishment of thesurgical procedure with minimal discomfort, andwithout injury, to the patient.

Gastroschisis—A defect of the abdominal wallcaused by rupture of the amniotic membrane or bythe delayed closure of the umbilical ring. It is usual-ly accompanied by protrusion of abdomen organs.

Hernia—The protrusion or thrusting forward of anorgan or tissue through an abnormal opening intothe abdominal sac.

Omphalocele—A hernia that occurs at the navel.

Peritonitis—Inflammation of the membrane liningthe abdominal cavity. It causes abdominal painand tenderness, constipation, vomiting, and fever.

Short bowel syndrome—A condition in which di-gestion and absorption in the small intestine areimpaired.

Ultrasound—An imaging technology that thatallow various organs in the body to be examined.

Umbilical ring—An opening through which theumbilical vessels pass in the fetus; it is closed afterbirth and its site is indicated by the navel.

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Abdominoplasty (tummy tuck) surgery. Portions of the lower abdominal tissues have been removed and the navel reposi-tioned.The remaining skin flaps will be sutured. (Photography by MM Michele Del Guercio. Reproduced by permission.)

of all plastic surgery procedures. Female patients ac-counted for 97% of all abdominoplasties. Most patientswere between the ages of 35 and 50 (58%), with pa-tients under 35 accounting for 20% and patients over 50accounting for 22%. Eighty-two percent of all plasticsurgery patients during 2001 were white, 7% were His-panic, 5% were African American, and 5% were AsianAmerican.

DescriptionThe patient is usually placed under general anesthesia

for the duration of surgery. The advantages to generalanesthesia are that the patient remains unconscious duringthe procedure, which may take from two to five hours tocomplete; no pain will be experienced nor will the patienthave any memory of the procedure; and the patient’s mus-cles remain completely relaxed, lending to safer surgery.

Once an adequate level of anesthesia has beenreached, an incision is made across the lower abdomen.For a complete abdominoplasty, the incision will stretchfrom hipbone to hipbone. The skin will be lifted off theabdominal muscles from the incision up to the ribs, witha separate incision being made to free the umbilicus

ing gynecologic surgery results in better exposure to theoperating field and improved wound healing.

Contraindications

Certain patients should not undergo abdominoplas-ty. Poor candidates for the surgery include:

• Women who wish to have subsequent pregnancies.

• Individuals who wish to lose a large amount of weightfollowing surgery.

• Patients with unrealistic expectations (those who thinkthe surgery will give them a “perfect” figure).

• Those who are unable to deal with the post-surgicalscars.

• Patients who have had previous abdominal surgery.

• Heavy smokers.

Demographics

According to the American Academy of PlasticSurgeons, in 2001 there were approximately 58,567 ab-dominoplasties performed in the United States, relatingto 4% of all plastic surgery patients and less than 0.5%

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(belly button). The vertical abdominal muscles may betightened by stitching them closer together. The skin isthen stretched back over the abdomen and excess skinand fat are cut away. Another incision will be madeacross the stretched skin through which the umbilicuswill be located and stitched into position. A temporarydrain may be placed to remove excess fluid from beneaththe incision. All incisions are then stitched closed andcovered with dressings.

Individuals who have excess skin and fat limited tothe lower abdomen (i.e., below the navel) may be candi-dates for partial abdominoplasty. During this procedure,the muscle wall is not tightened. Rather, the skin isstretched over a smaller incision made just above thepubic hairline and excess skin is cut away. The incisionis then closed with stitches. The umbilicus is not reposi-tioned during a partial abdominoplasty; its shape, there-fore, may change as the skin is stretched downward.

Additional procedures

In some cases, additional procedures may be per-formed during or directly following abdominoplasty. Li-posuction, also called suction lipectomy or lipoplasty, isa technique that removes fat that cannot be removed bydiet or exercise. During the procedure, which is generallyperformed in an outpatient surgical facility, the patient isanesthetized and a hollow tube called a cannula is insert-ed under the skin into a fat deposit. By physical manipu-lation, the fat deposit is loosened and sucked out of thebody. Liposuction may be used during abdominoplasty toremove fat deposits from the torso, hips, or other areas.This may create a more desired body contour.

Some patients may choose to undergo breast aug-mentation, reduction, or lift during abdominoplasty.Breast augmentation involves the insertion of a silicone-or saline-filled implant into the breast, most often behindthe breast tissue or chest muscle wall. A breast reduc-tion may be performed on patients who have largebreasts that cause an array of symptoms such as backand neck pain. Breast reduction removes excess breastskin and fat and moves the nipple and area around thenipple (called the areola) to a higher position. A breastlift, also called a mastopexy, is performed on womenwho have low, sagging breasts, often due to pregnancy,nursing, or aging. The surgical procedure is similar to abreast reduction, but only excess skin is removed; breastimplants may also be inserted.

Breast reconstruction

A modified version of abdominoplasty may be usedto reconstruct a breast in a patient who has undergonemastectomy (surgical removal of the breast, usually as a

treatment for cancer). Transverse rectus abdominis my-ocutaneous (TRAM) flap reconstruction may be per-formed at the time of mastectomy or as a later, separateprocedure. Good candidates for the surgery includewomen who have had or will have a large portion ofbreast tissue removed and also have excess skin and fatin the lower abdominal region. Women who are not ingood health, are obese, have had a previous abdomino-plasty, or wish to have additional children are not consid-ered good candidates for TRAM flap reconstruction.

The procedure is usually performed in three separatesteps. The first step is the TRAM flap surgery. In a pro-cedure similar to traditional abdominoplasty, excess skinand fat is removed from the lower abdomen, thenstitched into place to create a breast. The construction ofa nipple takes place several months later to enable to thetissue to heal adequately. Finally, once the new breasthas healed and softened, tattooing may be performed toadd color to the constructed nipple.

Costs

Because abdominoplasty is considered to be an elec-tive cosmetic procedure, most insurance policies will notcover the procedure, unless it is being performed formedical reasons (for example, if an abdominal hernia isthe cause of the protruding abdomen).

A number of fees must be taken into considerationwhen calculating the total cost of the procedure. Typically,fees include those paid to the surgeon, the anesthesiolo-gist, and the facility where the surgery is performed. If li-posuction or breast surgery is to be performed, additionalcosts may be incurred. The average cost of abdominoplas-

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WHO PERFORMSTHE PROCEDURE AND

WHERE IS IT PERFORMED?

Abdominoplasty is usually performed by a plas-tic surgeon, a medical doctor who has complet-ed specialized training in the repair or recon-struction of physical defects or the cosmetic en-hancement of the human body. In order for aplastic surgeon to be considered board certifiedby the American Board of Plastic Surgery, he orshe must meet a set of strict criteria (including aminimum of five years of training in generalsurgery and plastic surgery) and pass a series ofexaminations. The procedure may be performedin a hospital operating room or a specializedoutpatient surgical facility.

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ty is $6,500, but may range from $5,000–9,000, depend-ing on the surgeon and the complexity of the procedure.

Diagnosis/Preparation

There are a number of steps that the patient andplastic surgeon must take before an abdominoplasty maybe performed. The surgeon will generally schedule aninitial consultation, during which a physical examina-tion will be performed. The surgeon will assess a num-ber of factors that may impact the success of the surgery.These include:

• the patient’s general health

• the size and shape of the abdomen and torso

• the location of abdominal fat deposits

• the patient’s skin elasticity

• what medications the patient may be taking

It is important that the patient come prepared to askquestions of the surgeon during the initial consultation.The surgeon will describe the procedure, where it will beperformed, associated risks, the method of anesthesia andpain relief, any additional procedures that may be per-formed, and post-surgical care. The patient may also meetwith a staff member to discuss how much the procedurewill cost and what options for payment are available.

The patient will also receive instructions on how toprepare for abdominoplasty. Certain medications should

be avoided for several weeks before and after the surgery;for example, medications containing aspirin may inter-fere with the blood’s ability to clot. Because tobacco caninterfere with blood circulation and wound healing,smokers are recommended to quit for several weeks be-fore and after the procedure. A medicated antibacterialsoap may be prescribed prior to surgery to decrease levelsof bacteria on the skin around the incision site.

Aftercare

The patient may remain in the hospital or surgical fa-cility overnight, or return home the day of surgery afterspending several hours recovering from the procedureand anesthesia. Before leaving the facility, the patient willreceive the following instructions on post-surgical care:

• For the first several days after surgery, it is recom-mended that the patient remain flexed at the hips (i.e.,avoid straightening the torso) to prevent unnecessarytension on the surgical site.

• Walking as soon as possible after the procedure is rec-ommended to improve recovery time and prevent bloodclots in the legs.

• Mild exercise that does not cause pain to the surgicalsite is recommended to improve muscle tone and de-crease swelling.

• The patient should not shower until any drains are re-moved from the surgical site; sponge baths are permitted.

• Work may be resumed in two to four weeks, dependingon the level of physical activity required.

Surgical drains will be removed within one weekafter abdominoplasty, and stitches from one to twoweeks after surgery. Swelling, bruising, and pain in theabdominal area are to be expected and may last from twoto six weeks. Recovery will be faster, however, in the pa-tient who is in good health with relatively strong abdom-inal muscles. The incisions will remain a noticeable redor pink for several months, but will begin to fade by ninemonths to a year after the procedure. Because of their lo-cation, scars should be easily hidden under clothing, in-cluding bathing suits.

Risks

There are a number of complications that may ariseduring or after abdominoplasty. Complications are moreoften seen among patients who smoke, are overweight,are unfit, have diabetes or other health problems, or havescarring from previous abdominal surgery. Risks inher-ent to the use of general anesthesia include nausea, vom-iting, sore throat, fatigue, headache, and muscle sore-

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QUESTIONS TO ASKTHE DOCTOR

• How long have you been practicing plasticsurgery?

• Are you certified by the American Board ofPlastic Surgeons?

• How many abdominoplasties have you per-formed, and how often?

• What is your rate of complications?

• How extensive will the post-surgical scars be?

• What method of anesthesia will be used?

• What are the costs associated with this pro-cedure?

• Will my insurance pay for part or all of thesurgery?

• Do you provide revision surgery (i.e., if I ex-perience suboptimal results)?

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GALE ENCYCLOPEDIA OF SURGERY 11

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Abdominoplasty

Incision

A.

Skin

Fat

B.

C.

Externaloblique

Sutures

D.

In an abdominoplasty, or tummy tuck, an incision is made in the abdomen (usually from hip bone to hip bone). Excess skinand fat is removed (B).The muscles may be tightened (C).The navel will be placed into the proper position (D), and the majorincision closed beneath it. (Illustration by GGS Inc.)

ness; more rarely, blood pressure problems, allergic reac-tion, heart attack, or stroke may occur.

Risks associated with the procedure include:

• bleeding

• wound infection

• delayed wound healing

• skin or fat necrosis (death)

• hematoma (collection of blood in a tissue)

• seroma (collection of serum in a tissue)

• blood clots

• pulmonary embolism (a blood clot that travels to thelungs)

• numbness to the abdominal region or thighs (due todamage to nerves during surgery)

Normal resultsIn most cases, abdominoplasty is successful in provid-

ing a trimmer abdominal contour in patients with excessskin and fat and weak abdominal muscles. A number of fac-tors will influence how long the optimal results of ab-dominoplasty will last, including age, skin elasticity, andphysical fitness. Generally, however, good results will belong-lasting if the patient remains in good health, maintainsa stable weight, and exercises regularly. One study survey-ing patient satisfaction following abdominoplasty indicatedthat 95% felt their symptoms (excess skin and fat) were im-proved, 86% were satisfied with the results of the surgery,and 86% would recommend the procedure to a friend.

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Morbidity and mortality ratesThe overall rate of complications associated with

abdominoplasty is approximately 32%. This percentage,however, is higher among patients who are overweight;one study placed the complication rate among obese pa-tients at 80%. Rates are also higher among patients whosmoke or are diabetic. The rate of major complicationsrequiring hospitalization has been reported at 1.4%.

Alternatives

Before seeking abdominoplasty, an individual willwant to be sure that loose and excess abdominal skin andfat cannot be decreased through a regimen of diet andexercise. Abdominoplasty should not be viewed as an al-ternative to weight loss. In fact, some doctors would sug-gest that a patient be no more than 15% over his or herideal body weight in order to undergo the procedure.

Liposuction is a surgical alternative to abdomino-plasty. There are several advantages to liposuction. It isless expensive (an average of $2,000 per body area treat-ed compared to $6,500 for abdominoplasty). It also is as-sociated with a faster recovery, a need for less anesthesia,a smaller rate of complications, and significantly smallerincisions. What liposuction cannot do is remove excessskin. Liposuction is a good choice for patients with local-ized deposits of fat, while abdominoplasty is a betterchoice for patients with excess abdominal skin and fat.

Resources

PERIODICALS

Hensel, J. M., J. A. Lehman, M. P. Tantri, M. G. Parker, D. S.Wagner, and N. S. Topham. “An Outcomes Analysis andSatisfaction Surgery of 199 Consecutive Abdominoplasties.”Annals of Plastic Surgery, 46, no. 4 (April 1, 2001): 357–63.

Vastine, V. L., et al. “Wound Complications of Abdominoplastyin Obese Patients.” Annals of Plastic Surgery, 41, no. 1(January 1, 1999): 34–9.

ORGANIZATIONS

American Academy of Cosmetic Surgery. 737 N. MichiganAve., Suite 820, Chicago, IL 60611. (312) 981-6760.<http://www.cosmeticsurgery.org>.

American Board of Plastic Surgery, Inc. 7 Penn Center, Suite400, 1635 Market St., Philadelphia, PA 19103-2204. (215)587-9322. <http://www.abplsurg.org>.

American Society of Plastic Surgeons. 444 E. Algonquin Rd.,Arlington Heights, IL 60005. (888) 4-PLASTIC. <http://www.plasticsurgery.org>.

OTHER

“2001 Statistics.” American Society of Plastic Surgeons, 2003[cited April 8, 2003]. <http://www.plasticsurgery.org/public_education/2001statistics.cfm>.

“Abdominoplasty.” American Society of Plastic Surgeons, 2003[cited April 8, 2003]. <http://www.plasticsurgery.org/public_education/procedures/Abdominoplasty.cfm>.

Gallagher, Susan. “Panniculectomy: Implications for Care.”Perspectives in Nursing, 2003 [cited April 8, 2003].<http://www.perspectivesinnursing.org/v3n3/panniculectomy.html>.

“Training Requirements.” American Board of Plastic Surgery,July 2002 [cited April 8, 2003]. <http://www.abplsurg.org/training_requirements.html>.

“Tummy Tuck.” The American Society for Aesthetic PlasticSurgery, 2000 [cited April 8, 2003]. <http://www.surgery.org/q1>.

Zenn, Michael R. “Breast Reconstruction: TRAM, Unipedi-cled.” eMedicine, December 13, 2001 [cited April 8, 2003].<http://www.emedicine.com/plastic/topic141.htm>.

Stephanie Dionne Sherk

ABO blood typing see Type and screen

Abortion, inducedDefinition

Induced abortion is the intentional termination of apregnancy before the fetus can live independently. Anabortion may be elective (based on a woman’s personalchoice) or therapeutic (to preserve the health or save thelife of a pregnant woman).

PurposeAn abortion may be performed whenever there is

some compelling reason to end a pregnancy. An abortionis termed “induced” to differentiate it from a sponta-neous abortion in which the products of conception arelost naturally (also called a miscarriage).

An abortion is considered to be elective if a womanchooses to end her pregnancy, and it is not for maternalor fetal health reasons. Some reasons a woman mightchoose to have an elective abortion are:

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KEY TERMS

Abdominal hernia—A defect in the abdominal wallthrough which the abdominal organs protrude.

Morbidly obese—A term defining individuals whoare more thatn 100 lb (45 kg) over their ideal bodyweight.

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