What Should I Really Expect? Recovering from Tummy Tuck Surgery
Posted January 31, 2023 in Board Certification, From the Desk of Dr. Stoeckel, Plastic Surgery Advice, Surgical Procedures, Tummy Tuck (Abdominoplasty)
Curious about Tummy Tuck Recovery? The following are common questions asked by patients, written and answered by our board-certified plastic surgeon, Dr. Stoeckel.
So, you have decided to move forward with abdominoplasty surgery. And now you are starting to get nervous about what to expect after the surgery. There are so many blog sites and so many stories about how bad it will be and how much help you are going to need to recover. Should I buy a walker? And a laz-y-boy recliner? And maybe even rent a hospital bed? And hire a home health nurse? Well, you can probably slow down and maybe not get too far ahead of yourself. Hopefully this will be helpful for both your planning and your peace of mind. Spoiler alert, I think that the walker, recliner, hospital bed, and recovery nurse are all a bit overkill.
Am I supposed to bend over at the waist and if so, for how long?
There are many surgeons who talk about walking bent over at the waist in hopes of taking some of the strain off the incision. While I do think that there is some evidence this can be helpful, I don’t think that flexion at the hip more than about 10 degrees is necessary or beneficial. Bending more at the waist will only engage your lower back muscles and make them extremely sore. It may also place your rectus muscles in a state of contraction that can cause unnecessary tightness in the weeks after surgery. So, bend at the waist about 10 degrees or less while walking. If you are laying down, placing a pillow under your knees will cause about a 5-10 degree of flexion in your hip which is all that is needed. And as for how long? Just until the tightness in the lower abdomen starts to lessen which is usually at about 1 week. (as long as you don’t spend that week jackknifed at the waist and your rectus muscles are in a state of contraction or spasm).
Should I buy a walker to help me get around?
The answer to this question is almost always no. (There may be a few exceptions.) Abdominoplasty surgery is serious and, in some ways, invasive. But it is not an assault on your legs, nor does it limit your heart or lungs. For most healthy patients, you should be able to be up and around doing normal daily activities the day after surgery. You may be a little slow getting out of bed, but once you are up and about, it really should not be necessary to require a walker for your balance or leg strength. I typically do not perform this surgery on patients that at a physical or strength disability before surgery. If you are an unusual exception to this rule, maybe a walker would be helpful for you. The only other patients that might require a walker would be patients that combine their abdominoplasty with high volume liposuction. High volume liposuction certainly can cause changes with your body’s ability to regulate your blood pressure and brain perfusion when standing. Some patients really do get a bit dizzy or woozy when moving around the first day or so after high volume liposuction. If you have had this type of liposuction along with the abdominoplasty, a walker might not be a bad idea.
Should I buy a recliner or use one that I already own to sleep in?
Many of my patients have told me that they liked recovering in a recliner. I think that using one after surgery certainly could be useful. Getting up and down out of a recliner probably is easier than getting in and out of a bed. There is probably a little less strain on the rectus muscles which is the sorest part of the surgery. So, if you can effectively rest and sleep in a recliner, using it makes sense. But realize that it is not a necessity for normal recovery. I personally would not go and buy one just for the first 3-4 days after surgery. But if I had one in a convenient place in the house, then maybe I would try it out. Renting a hospital bed for recovery is just one step further that you really do not need to take. Laying in your normal bed with a pillow under your knees really is all you need.
Should I hire a home health nurse for my recovery?
There are probably quite a few nice and helpful nurses out there that could use the work. But hiring one would be helping them more than they would be helping you. There really isn’t any nursing care required for this surgery. The incisions are covered with tape that do not need to be changed. The compression garment is something that you should be able to put on and take off without assistance. Getting up and out of bed will probably be a little challenge the first few times, but you can do it on your own. My patients do not require any bedrest and I don’t want them to be lazy. The best way to avoid a DVT and the best way to feel like your recovery is going well is to be up and about as much as possible on your own. You shouldn’t drive while taking narcotic pain medication, so you may need a driver for a few days, but you don’t need a nurse to help out. (Unless you just want to pay someone interesting to talk to during your recovery.)
Then what should I buy or have at home?
- I tell my patients to buy a 10 lb bag or birdseed or rice. It is placed in a pillowcase and then the heavy pillow is used to put pressure on the abdomen and pelvis after surgery. This will limit the movement of the body if you cough, sneeze, or laugh and minimize the discomfort associated with those activities. It will also place pressure on the region of the genitalia which is often prone to significant swelling for some patients. Using the heavy pillow in this area may keep you from feeling the need to call me to inquire about your oddly bruised and swollen lady parts.
- You can also get some water or Gatorade drinks in the fridge, a good book or new game on your iPad, and a charger for you phone. I want you up and about, but you are allowed to take it easy a little bit.
- Have your prescriptions already picked up from the pharmacy just in case you get sore or have some nausea.
- A companion. You really should have someone with you for the first 24 hours after surgery. You don’t need them for nursing care really. But you should have someone that could get you back to my office or the ER in case of an emergency. It sometimes does come in handy to have someone that can run to the store to get something you might need. And they might want to watch that Netflix program with you.
- Loose fitting clothes. Pajamas or sweatpants will be your friends during the early recovery period.
How bad will the first day after surgery really be?
This is a difficult question to answer because it is true that everyone is a little different in how they experience surgical pain and recover from surgery. So, this answer is for most people, but not necessarily everyone. You may be completely awake and feel completely normal when you get in the car to drive home. Or you may still be a bit groggy from the anesthesia. Your chances are about 50:50. The groggy feeling should wear off by the first night. The abdomen will be sore. There is no escaping it. It will feel sore when you sit up, when you sit down, when you cough and sneeze and laugh. The severity of the discomfort will make most patients want to use the narcotic pain medication for 3-4 days. The pain medicine will make the soreness tolerable but not gone. You will be able to walk around and take care of yourself. You will most likely have already eaten and be watching a TV show on the couch when I call you for your first check-in the evening of surgery. You can handle it. It won’t be that bad. Take the pain medication as needed and the nausea medication as needed. Eat and drink what you want. Use the heavy pillow when lounging. Take it easy, but don’t feel like you must avoid getting up and around a little bit at home. You can take a shower the next morning if you are up to it.
What is really needed with the compression garments?
You will go home with an abdomen binder that wraps around your back and Velcro fastens in the front. The nurses will put it on you right after surgery. They may put it on too tight or too loose. Please adjust the tension of the binder when you get home and make it snug but not tight. It is supposed to make you feel supported and comfortable, not tight and constrictive. When used with the heavy pillow, I do think there is some benefit to the compression binder. It will likely limit the amount of swelling and almost all patients say that it makes the abdomen feel more supported and less painful. But I don’t feel that compression garments are as important as some surgeons. Nor, do I think that one type of garment is significant more effective than another. I think that they should be worn as long as they seem to be making you feel better than when you are not wearing them. That may be a week, or it may be a month. I think that the garment we give you is great, but you can change it to any garment that you may have found that you like better at any time. It seems that most patients change to a Spanx type garment after the first week or two.
How am I to deal with the scars?
There really is not much that you can do to significantly influence the scars in my opinion. Most of the healing will be based on your genetics. But in general, there are some properties about scars that you may be able to influence to some degree. Significant tension across a scar line will make the scar more prone to widen or heal heavy. Avoiding significant stretching across a scar will limit this effect. For abdominoplasty surgery, the scar is already in a location that is protected from this severe strain. Most people bend forward at the waist which will reduce the tension and very few people hyperextend at the waist. But severe hyperextension like that seen with some yoga poses might make things worse, so avoid those activities. I am not sure that I am 100% sold on the outright efficacy of scar creams and gels. They may have some effect on some scars but cannot be expected to make scars completely fade away. If you want to use them, doing so at about 1 month after surgery makes sense. Until then, using paper tape on the scars and changing them once a week makes sense to me. If there are any blisters on the skin or open wounds, they should not be taped, but should be covered with a dry gauze, saline moistened gauze, or bacitracin ointment based on the condition of the wound.
What activities should I be expected to do?
There is no time of strict bedrest with this surgery. Be up moving around the day of surgery to some extent based on your ability to do so. My common rule of thumb is that if it hurts to do it, don’t do it. If it doesn’t hurt to do it and you want to do it, you are probably safe to do it. I would suggest maintaining a normal baseline heart rate below 80 and a blood pressure that is normal for the first week. After that, simple exercises that do not strain the abdomen muscles are OK to do. You can pick up you baby. You can get the gallon of milk out of the refrigerator. You can go get your mail at the end of the driveway. Just stay off the treadmill for a week and then when you start back up, take it slow and advance as your body allows. Sit ups and pulls ups probably won’t feel comfortable for 6-8 weeks.
When do I follow up after surgery?
I typically see my patients one week after surgery. The tapes are removed from the incisions and new tapes applied. Occasionally, some fluid needs to be removed using a syringe at the 1-week appointment. You may have questions about the garment or activity or the scar that I can answer at this appointment. Then I see my patients at 3 weeks after surgery. The only sutures that I typically remove are those in the belly button and these are removed at this time. Then I usually see my patients at the 3-month mark. Photos are taken at this visit because most of the swelling will be gone, and the scars will be starting to mature at this time. If there are ever any hiccups along the way, patients should be able to return to clinic at any time for them to be addressed.
These are just a few of the things you may be considering on your journey to a flat stomach. The surgery is a big deal, but lots of people do it and they all recover. You will too and it won’t be as bad as you think.
If you are interested in this procedure or whatever else our office has to offer, please call our office at (919) 805-3441 or place an inquiry, here.