Great news for women! The Australian Society of Plastic Surgeons (ASPS) has confirmed that Australian women, who suffer the physical consequences of pregnancy, may be able to have reconstructive correctional surgery funded by Medicare later next year.
ASPS advised that MSAC, the independent committee who provides advice to the Government on whether a medical service should be publicly funded, has recommended creating a new Medicare item number for abdominoplasty with repair of rectus diastasis (tummy muscle split) after pregnancy!
Although this endorsement from MSAC goes a long way to ensuring it’ll be back on the Medicare schedule there is still a way to go – these things take time!
Read more to find out what this news might mean for you and how you can prepare in advance for the item number becoming available.
An Abdominoplasty (Tummy Tuck) is a surgical procedure to remove excess skin and fat over the lower abdomen and to repair separated muscles after pregnancy or significant weight loss. It is done when diet and exercise can do no more to improve the tone of the muscles or the contour of the tummy. Keep in mind that an abdominoplasty is not a substitute for weight loss. The result of an abdominoplasty is a firmer, flatter, more shapely tummy.
The operation involves making a cut as low as possible in the bikini line and extending it from hip to hip. The skin and fat is lifted off the muscles of the abdominal wall up to the level of the rib cage. The belly button is cut around and left attached to the abdominal wall. If the muscles are separated (most commonly as a result of past pregnancy) then these can be brought together again with sutures (stitches) which strengthens the abdomen and improves the shape of the waistline. The skin and fat is then pulled down and the excess removed. A new hole is made for the belly button to pop out of. Drain tubes are placed in the wound to remove any blood or fluid. The skin is closed using buried and absorbable sutures and the wound is dressed. The surgery is performed under a full general anaesthetic and will take approximately 2 hours.
Your initial consultation will take about 60 minutes. During this time Natasha will assess your suitability for abdominoplasty and discuss the potential risks and benefits to you. Photographs will be taken to be stored on your file as a visual record of your abdomen pre- surgery.
These photographs will be taken so as not to include your face or identify you in any way and may be used for educational purposes for other people interested in abdominoplasty surgery or for doctors training to be plastic surgeons. Please let Natasha know if you would prefer not to have your photos used in this way. If you wish, there is opportunity to meet with Natasha again at a second consultation to clarify any further points or questions.
The first post operation follow-up appointment is within 2 weeks of surgery. All follow up appointments for 6 weeks after surgery are included in your surgical fee. Natasha will let you know when she should see you during this time but there would usually be two or three consultations during this period.
Consequences of surgery are things which occur in everyone who undergoes the operation. They are not complications and are to be expected. They include:
Tightness
Tightness in the abdomen and possibly a temporary worsening of the symptoms of heartburn or reflux. The tightness will slowly improve with time.
Bruising and swelling
Bruising and swelling is present for the first few weeks after surgery as is a normal part of healing.
Scar
A long scar from hip to hip and another scar around the belly button. The lower abdomen scar can be wide as it is a scar that has formed with the skin under tension. The scar will be red and raised in the 3 months after surgery and then will slowly improve over about a year. The scar will never completely disappear. The actual appearance of the scar is very individual and depends on the wound healing properties of each individual’s skin.
“Dog Ears”
There is often some gathering of the skin or a small projection of skin and fat at the furthest edges of the scar, called “dog ears”. These will improve with time but may need a small revision under local anaesthetic a year after surgery if they are still obvious then.
Numbness
Reduced sensation or numbness of the skin of the abdomen especially below the belly button. This occurs as the nerve supply to the skin is necessarily interrupted when it is lifted off the abdominal wall. This area of numbness will become smaller with time but may not completely resolve.
All surgery comes with the risk of complications. The complications specifically associated with abdominoplasty include:-
Bleeding
Bleeding into the abdomen after surgery is known as a haematoma, which is like a big blood clot. This can occur in hospital or even in the initial weeks after discharge. It can require another surgery to wash out the clot and to control the bleeding vessel. If bleeding during or after surgery is severe it may require a blood transfusion but this is an uncommon occurrence.
Wound infection
Infection can present as fever, redness, pain or ooze from the wound. It can usually be treated with a course of oral antibiotics and some dressings. More severe infection may need hospitalization and intravenous antibiotics.
Seroma
Seroma is a collection of fluid in your abdomen that may collect after the drain tubes have been removed. If the seroma is large or uncomfortable it may need to be drained.
Wound dehiscence or “opening up”
Small areas of the wound opening up are not uncommon after abdominoplasty as the wound is closed under significant tension. Usually this just means the wound requires dressing for a bit longer.
Deep Vein Thrombosis
This presents with pain in the calf area and swelling of the foot and ankle. It is diagnosed on ultrasound and is treated with blood thinners. Rarely a clot in the leg can spread to the lung and become life threatening.
More severe scarring
Some unfortunate patients heal with thick, raised and itchy scars despite an uncomplicated post surgery course. If this occurs you can discuss treatment options with Natasha.
Ensure that your hospital forms sent from our rooms have been completed and returned to the hospital.
Please ensure that you have contacted the anaesthetist’s rooms to obtain a quote and payment instructions for the surgery.
Natasha’s “out of pocket” fee is payable prior to the surgery and covers the surgery, in hospital care and six weeks of post-operative care.
If you are a smoker you must stop smoking at least 6, but preferably 12, weeks prior to the surgery. Smoking is detrimental to wound healing and can complicate anaesthetics and cause coughing after surgery, which increases the risk of bleeding into the abdomen.
Take all your usual medications including on the day of surgery but certain medications may need to be avoided up to one week prior to surgery. These include anti-inflammatory medications, products containing asprin or other blood thinners such as warfarin or plavix or the new warfarin substitutes. Make sure Natasha is aware if you are taking any of these medications so that a plan can be made to stop them in a safe and timely way prior to surgery.
Avoid any vitamins, supplements, fish oils or herbal medications for two weeks prior to surgery as these can also sometimes thin the blood.
Make sure you have a suitable elastic abdominal binder to be worn for 6 weeks after surgery. These can be purchased from Natasha’s rooms.
Note the fasting time on your admission letter. If you need to fast from 7am you may have a light breakfast before this time. Do not chew gum or suck sweets once fasting has begun. Fasting means avoiding food and all liquids including water.
Take your usual medications with a sip of water on the day of surgery.
Remove all clear and coloured nail polish. Artificial nails without polish are not a problem.
Bring your current medications into hospital with you.
Only take necessary items with you such as toiletries, medications, pyjamas and something to read. The hospitals will not take responsibility for the loss of valuables.
Bring your abdominal binder.
At the hospital, check in at admissions.
You will be escorted to your room and will be given a gown to change into.
The nurse will check your admission forms and take your blood pressure etc.
The nurse will fit a firm pair of anti-embolic stockings to be worn in the operating room and during your hospital stay. These stockings help to prevent deep vein thrombosis.
If you are menstruating you will not be allowed to wear a tampon during your surgery because of the risk of toxic shock syndrome but you are allowed to wear a pad with hospital briefs.
The anaesthetist will see you to discuss your anesthetic.
Natasha will see you to finalise the consent and to answer any last minute questions.
You will be taken to recovery where one of the nurses will be looking after you to check you are well and comfortable.
You may have a patient controlled analgesia (PCA) pump in the initial period following surgery and after that tablets are sufficient for pain relief.
Dressings will cover your wounds.
You may have a urinary catheter.
You will have 1-2 drain tubes.
You will have 2 pillows under your knees to take the pressure off your abdomen whilst in bed. You may feel “tight” in the abdomen for some weeks after surgery but this will improve quickly in the first few days after surgery.
You may have something to eat and drink approximately 4 hours after the surgery. Report any nausea to the nurse as vomiting can strain the abdomen and initiate bleeding as well as be unpleasant for you.
Keep your dressing intact until you see Natasha for your review appointment.
At your first post operation review Natasha will check your wounds and redress them with tape or, if needed, small dressings.You can replace the tapes as instructed by Natasha.You may shower as often as you wish even if there is a small area where the wound has opened up a bit.
Avoid swimming and public baths until all wounds are fully healed.
All sutures are placed beneath your skin and are dissolving. Sometimes you might see or feel a small “spike” of stitch sticking out of your skin: don’t worry about this. Natasha may trim this at your next visit.
Wear your anti-embolic stockings until you see Natasha for the first post operation visit.
The scar will initially look good and then may get reddened and a bit thick over the next few weeks. This is completely normal. Scars look their worst at the 3-month mark and then slowly improve until a year or even more after surgery. Avoid tanning the scar at salons or outside as it may darken the scar and make it more noticeable.
For the first 4 weeks:
• No driving
• No lifting
• Protect your abdomen by rolling onto your side to sit up
• Wear your abdominal binder for 6 weeks in total
• If you work in an office you may be ready to return to work by 4 weeks.
You should avoid heavy lifting for 6 weeks. You can do some light walking exercise after 3-4 weeks but avoid strenuous exercise for 6 weeks.
If you have any complication (such as bleeding, infection, seroma or wound healing problems) returning to normal activities may take longer.
Most importantly, if you have any problems or concerns ring Natasha’s rooms on 9988 7765. Please don’t worry about being a “bother”: that is what we are here for. Natasha is also contactable after hours if needed.