Lexie Otana

Good evening, and a very warm welcome to our webinar on tummy tuck surgery.

My name is Lexie, and I'm the Senior Staff Nurse in Plastics and Cosmetic Surgery here at Benenden.

I'm delighted to be joined by our expert speaker, Mr Simon Mackey, Consultant Plastic Reconstructive anaesthetic Surgeon.

Tonight's session will begin with a presentation from Mr Mackey, followed by a live Q&A.

If you have any questions at any point, please feel free to submit them using the Q&A icon at the bottom of your screen.

You're welcome to ask anonymously or include your name and just a quick note that the session is being recorded, so any names shared may be visible in the recording.

To help us get through as many as possible, please keep questions brief and if you're interested in booking a consultation, we'll share all the relevant contact details at the end of the session.

So, like I said, my name is Lexie, I have a qualification in adult nursing and worked Primarily in intensive care in Bristol and in London.

I joined Benenden in early 2025, and have also, got a Master's in International Marketing and Consumer Psychology.

Now to you, Simon.

Mr Simon Mackey

Thank you.

Can you hear me?

Lexie Otana

Yes.

Mr Simon Mackey

Okay, excellent.

So, hello, I'm Simon Mackey, I'm a Consultant Plastic Reconstructive and Aesthetic surgeon.

I've been in medical practice since 1998, and I've been in plastic surgery for 22 years now and I'm a member of the British Association of Aesthetic Plastic Surgeons in Bapras, and completed the fellowship of the Royal College of Surgeons in plastic surgery, so I've been in plastic surgery for a long time and my primary interest is in reconstructive, surgery of the breast.

Within the NHS, and a lot of the time for that, we use the tummy, so we can use the tummy to make a breast for people.

But a lot of the techniques that we use for reconstruction, we also use cosmetically and one of the major, cosmetic procedures that I undertake for my patients is tummy tuck surgery, or abdominoplasty is the medical word for this.

So, this session is a brief overview of things.

There's a lot more to talk about during a consultation, but we'll talk a little bit about consultation and assessment, the different types of tummy tuck surgery, and some of the other procedures that you can include with tummy tuck surgery, such as Liposuction, or repositioning of the six-pack muscles, or lifting of the mons area.

We'll have a little bit of chat about, what your stay at Benenden would entail, and recovery following this type of surgery, and we'll have a little bit of a chat about, long-term results and then, as Lexie said, there's a question-and-answer session at the end.

So, I'll try and get through as many of those as we can.

So, Benenden Hospital, excellent hospital, in the countryside, doing a lot of cosmetic and plastic surgery now.

So when you first book in, we'll see you for about a 45-minute session, and it's very important for me to get a good idea about you, your current health, your, issues that you're suffering from, because very frequently, with tummy tuck type surgery.

It's not a purely aesthetic, procedure.

People can have issues with loose skin overhanging folds, and problems with infection along folds, discomfort in clothing.

If the six-pack muscles are pulled apart, it can affect your core strength, and it can, give you back pain, or pelvic dysfunction, or pelvic floor issues and it's useful to be able to explore all of those and see what I might be able to help you with.

I'd like to get an idea about medications that you're taking, including supplements, whether or not you're smoking.

Smoking can affect wound healing and can cause things like, tummy button death.

So what I'll do is get a good idea about your general health and factors that we might be able to modify to make your surgery as safe as possible.

I'll then examine you, normally with, Lexie as our chaperone, and I tend to talk out loud and point out asymmetries and, just describe to you what I think is important for you to know and then I'll tend to, take some clinical photographs which form part of your medical record only.

I'll lie you down on the couch and have a feel of your tummy and a feel of the abdominal wall muscles, so I'll normally get you to do a straight leg raise to raise intra-abdominal pressure, and I can just see what the six-pack muscles are doing and then depending on, you and your goals, we'll be able to chat about the different options for tummy tuck surgery and, formulate a treatment plan for you, which is specific to you, which I think will hopefully get you to where you'd like to be and then we can also chat about other procedures, which are commonly performed at the same time.

as tummy tuck surgery.

They can just be procedures on the tummy, but, tummy tuck and breast surgery is very common and lots of people who have lost a lot of weight, say, might be interested in tummy tuck and breast uplift, or arm lift or thigh lift are fairly common, combinations that we can discuss and when you come in for your consultation, the GMC are very clear, that clinicians should see you on two at least two occasions before one of these procedures and what I'd like to do at the second, session is to go through the procedure, limitations, risks, and complications with you in a lot more detail and that will enable us to complete consent paperwork and make sure that you're fully informed before you commit to treatment.

What is tummy tuck surgery? So, again, medically, we call it abdominoplasty surgery, and this is surgery to remove excess skin.

So, as we go through life, our skin tends to lose elasticity, and the skin can be stretched by weight gain, or pregnancies, for example, and the skin's a little bit like a plastic bag a little bit, it can recoil back to its original shape and size.

But if the skin is stretched too much, then rather like a plastic bag, you can develop stretch marks and it just cannot go back to its original shape and size.

So sometimes people who have lost a lot of weight, in particular, feel that their, excess skin, or overhanging excess skin actually worsens, which is an upsetting, side effect of significant weight loss.

So, tummy tuck surgery can remove that excess skin.

Normally, the excess skin lying from the tummy button down to the bikini line is the skin that's removed.

I'll show you some pictures a bit later, or some cartoons a bit later.

But it also enables me to remove excess, scars and stretch marks from that area.

So if people have had laparotomies and, caesarean sections and things and dislike their scars, then the surgery can also tidy those up as well and then the six-pack muscles, again, we've got a cartoon later I'll go through with you, but, the fascia, the gristle that joins the six-pack muscles together.

can also be stretched as you gain weight or with pregnancies and if that stretches, it's not always possible for the six-pack muscles to move back into their correct position.

So as your tummy pressure goes up, as you strain, or just sitting upright, you get a gap in the muscles, and the tummy contents can bulge through that gap and that can lead to an additional convexity to the anterior abdominal wall, which gives you a slightly rounded appearance.

So, tightening those rectus muscles back together with a stitch buried underneath the skin Can enable the function of the muscles to improve, and again, improving core strength and posture can also improve lower back pain symptoms, and we get lots of people coming back reporting, some remarkable, improvement in various symptoms and then sometimes, as people have gained a lot of weight, the mons pubis area, the area of tissue sitting just, sort of below the caesarean scar on the front of the pubis bone, can become stretched as well, and that can descend, and that can be slightly unsightly.

So if you've if you have ptosis or droop or enlargement of the mons area, then it's actually it's a very nice thing to do as part of a tummy tuck, just to reduce that and re-suspend it, and that gives you a much more balanced, proportionate, look.

So, who's suitable for tummy tuck? Well, really, you've got to be fit and healthy enough for a general anaesthetic, because these are overwhelmingly performed under general anaesthetic, so you go off to sleep.

In an ideal world, your weight would be about where you'd like your weight to be in the longer term when you have the surgery performed.

So if you're, you know, very overweight and you have a tummy tuck, it limits the total amount of tissue that I can remove, but also, if you subsequently lose weight, then a lot of that tightening will undo, and you can things can loosen off significantly.

So, in an ideal world, I think, really, you shouldn't regard tummy tuck surgery as being weight loss surgery.

It's more, surgery to remove excess skin.

People who have been, pregnant recently, again, in an ideal world, you should leave things for at least a year following, pregnancy, because it enables the tissues to return to their, you know, their normal position, or as close to their normal position as they can and in an ideal world, as with most of these sorts of procedures, it's often better if you've you're in the situation where you've completed your family before you commit, to this type of surgery.

Again, if you have a tummy tuck, and I tighten things up as much as I can, and then you have a pregnancy and everything gets stretched again, it can undo some of that good work and affect your longer-term result.

So, in addition to the functional, or direct functional, benefits of abdominoplasty surgery, it often makes people feel a bit more comfortable in their clothing, can affect your confidence, and it's one of those procedures that I think plastic surgeons, again, like to perform for our patients because it's got a very high satisfaction rating, and I think it's because it's not a purely cosmetic procedure, it's a functional operation as well.

So a standard abdominoplasty, or tummy tuck, would tend to leave you with these scars.

So you always get a long scar in the lower abdomen from hip to hip, and you have a separate cutout around the tummy button.

So with that, I'll normally cut around the tummy button itself and then I can take out all of the skin from the tummy button down to the bikini line.

which is removed.

I then lift all of the skin up to your rib cage, so I get to the top of the six-pack muscles, and then if you have got a gap in the six-pack muscles, I can use a special stitch to put the six-pack muscles back together and then we sort of flex you in the operating room so that I can close the superior edge of the tummy tuck wound to the inferior edge, and it gives you this long scar.

I also put in some special quilting stitches underneath the skin, just to try and hold the tummy tissue back on the tummy wall, and it helps to prevent you getting, fluid collections or bleeding within that space, and I think gives you a much better-looking result.

The tummy button.

I tend to put in as an inverted V, which is thought to be a very cosmetically appealing look to the tummy button.

But it can depend on the shape of your tummy button.

Sometimes you can convert outies to innies at the same time as this.

But that's t a standard thing.

You can't guarantee that you'll be able to remove stretch marks that lie above the level of the tummy button and, but it's we tend to weigh the amount of tissue that comes off, and I'll often take a photograph of it against a ruler, so that people that would like to see can see exactly what's come off and then I use special dissolving stitches for all of these pictures we show you.

Dissolving stitches, glue, and a special tape dressing.

Which allows you to shower from about two days following the procedure.

You just pat the tapes dry and use a hairdryer in a cool setting and then you put on a compression garment.

The hospital will provide you with some very good post-surgical compression garments, which support the six-pack repair, if you've had a six-pack repair, and support all of the tissue on the anterior abdominal wall, so it should encourage things to heal and control swelling for you, and get you to, get you back to normal a little bit more swiftly.

But I'll talk a bit more about recovery later in this talk.

A mini tummy tuck, quite an appealing thing for lots of people, because it means you don't have to have a cut around the tummy button.

But it's a much less powerful form of tummy tuck.

Really, it's best used for people who have an overhanging flap of skin, or a flap of skin overhanging, commonly a caesarean section scar, or a hysterectomy-type scar in the lower abdomen and where you get skin folding on itself, it can become moist and damp, and people often get some soreness and can be prone to fungal infections.

Which is a condition we call intertrigo.

So if you've got that sort of situation, without too much excess tissue on the rest of the anterior abdominal wall, then a mini tummy tuck just to revise the scar, take away that excess skin in the lower abdomen, is a very nice option to consider.

Sometimes that can be, combined with a repair of the rectus muscles, most usefully if the rectus muscles are just split below the level of the tummy button.

So it can be a little bit awkward to get into the upper abdomen and, it may be one of those procedures where you'd combine it with some liposuction into the flanks, or the, what people tell me, always tell me called the love handle area, just to thin things off and provide a very nice contour to the waist.

Then most commonly for people who have had massive weight loss, so traditionally it were the bariatric surgical procedures, like gastric sleeves or gastric bypasses, but more commonly now, with some of the injectable, medications like Monjaro or Ozempic, people can lose huge amounts of weight and again, as you lose all of that weight, quite disappointingly for a lot of people, you end up with excess skin, and the excess skin causes all of those functional problems that I've outlined earlier on and it can be very, very depressing for people.

So, some of the massive weight loss procedures might require extended scars, which go around the flank somewhat.

We've got a picture of that in a few minutes and very occasionally might need to go all the way around the body.

But a fleur de lys abdominoplasty is probably the most common major variation that's used for massive weight loss patients and the nice thing here is that you're removing tissue from that, sort of, vertical direction, but you can also tighten the tissue in a horizontal plane.

The downside of this, really, is that it does leave you with this long scar on the front of the anterior abdominal wall and fairly frequently, people would prefer to avoid that scar, and we then may just chat about compromising and performing a, something that looks more like a standard abdominoplasty, which is extended to the flanks, just to try to take up some of that excess skin and actually, we can get some very nice results, following that, or taking that approach.

I think where you've lost an awful lot of weight, there's a slightly greater risk of losing the tummy button.

So if you imagine the tummy button is a stalk of scar, when you put on an awful lot of weight, it stretches.

So as you release the tummy button to allow you to do the tummy tuck surgery, sometimes the blood supply to the tummy buttons interfered or interrupted, and the tummy button can die.

So that's one of the things people worry about with the tummy tuck procedure.

But as the tummy button itself is a scar, even if the tummy button dies, it tends to heal up to look like a scar, which looks like a tummy button.

So I think I've lost two tummy buttons in my career, and again, with some careful nursing, the wounds heal, and they still look like tummy buttons.

Then I think Lexie just flicked onto the next slide, which shows an extended abdominoplasty, so very similar scar pattern to a standard tummy tuck, but with this, you're coming further around the flanks to enable you to take up some of that excess skin.

So if you, we've been medicine, we call those dog ears, which is, I think, a terrible word, but all doctors know what that means and to describe it, I tend to suggest, if you had a piece of flat sponge, and you cut a circle out of it, and then tried to close the edges together directly, you can imagine you'd get a large, sort of pocket area either end of that wound, which we call a dog ear.

So, when we remove things as surgeons, we tend to remove things as ellipses, because it enables you just to tuck the edges in together, and get a much more appealing, closure.

But geometrically, even with an ellipse excision or with a tummy tuck type pattern, you can still have a dog ear.

So one of the things that people sometimes need to have adjusted at a later date might be dog ears at either end of the scar.

With any of these procedures at hospitals, there's a package of care that you pay for and it will normally enable us to consider, those sorts of revisions as part of your package of care, if required.

I think it's within a year at Benenden at the moment.

So again, but we'd chat to you about that when you came in to us and then probably the most, significant tummy tuck type procedure is a circumferential abdominoplasty.

Again, I've only ever performed this for people who have lost significant amounts of weight and have significant descent of the buttocks as well.

So, with the circumferential approach, you can Provide a very powerful anterior abdominoplasty and then head around to the back as well and as you close the tissues posteriorly, it tends to lift the buttock position.

But it's, it's quite a large procedure, that and I think with any of these operations, we're generating quite large wounds.

The wounds that you can see on the surface, but also the wounds beneath the skin as well and, the metabolic requirement that you're you to heal all of these wounds.

That your nutrition is good, as you go into one of these procedures and for people who have had things like bariatric procedures, there are some very specific blood tests that are recommended by the British Obesity and Metabolic Surgery Society.

Just to ensure that you're not lacking micronutrients, which could adversely impact wound healing.

But we'd chat to you about those when you came in to us as well and then these are the six-pack muscles, so we've all got six-pack muscles.

I think most of us haven't seen our six-pack muscles, personally, for many years.

But again, when the six-pack muscles get pulled apart, the tension and the sort of musculoaponeurotic, they call it, the muscle there across the anterior abdominal wall, can't function in the way that it ideally would like to and it can affect posture, the muscles can contract in asymmetrical ways, and it can cause all sorts of issues.

Again, typically it's other back pain.

Sometimes ladies after pregnancies can have worsening of, SPD, sort of symphyseal pelvic dysfunction and again, I've had people come back and tell me that a lot of these things seem to improve or can improve significantly with this type of surgery.

It's one of the things I've never promised to be able to improve, but increasingly, I think the evidence is stacking up that, it can be a significant benefit.

I've even got one lady who tells me that she was, had significant urinary incontinence, and the rectus plication actually cured it.

So, again, it's not something I can promise, but we get increasing reports of these, these types of secondary, but very beneficial effects of this surgery.

Then Lexie just teased us with a picture of a very nice lady who's allowed us to use her pictures as an example.

So, She's a lady who had lost a reasonable amount of weight.

Has a significant amount of excess skin in the lower abdomen, a significant amount of skin in the, what everybody seems to call, love handle area.

She'd also, had some, loss of volume in the centre of her breasts, so we performed a mastopexies and uplift procedure at the same time.

But she's had an extended abdominoplasty, so she's got a cut around the tummy button.

She's got the long scar that goes, in her case, from just beyond each hip bone to just beyond each hip bone.

I think in her case, I also lifted her mom's area and she's had a plication of her rectus muscles.

I've put her six-pack muscles back together with a long stitch, long locking stitch that goes all the way from the rib cage down to the pubis area.

So during the procedure, as I said, I flex the bed so I can really try and take out as much tissue as I possibly can and I was trying to get all of her tattoo out, but you have to, prioritize wound healing.

So she's got a little bit of tattoo left, which I don't know if she's going to get a cover-up or similar, but I've got a lot of people, coming in for tummy tuck surgery who have had smaller tattoos done in early life, and really dislike them, so that's another, thing that you can treat with tummy tuck surgery and she's got a nice result.

Scar's still a little bit red, so part of normal scar healing is that the scars will often be a bit red and lumpy initially.

We normally keep some tape dressings on for the first six weeks or so.

But once the tapes have been removed.

The best way to get the scars to soften and to become soft and flat and pale is with massage and moisturisation.

So, I wouldn't necessarily go spending lots of money on very fancy creams and oils.

I think any body lotion or cream that you like is the thing to use, and you're really using the product as a lubricant, and it's the pressure of the massage.

For about a good five minutes twice a day on those scars.

That will encourage them to settle and to become as soft and flat and pale as they ever can do.

The other thing is, you need to try and protect these scars from the sunlight, for the first year or so following the procedure, or you can get something called post-inflammatory hyperpigmentation.

So, although the temptation may be to head on holiday and wear a bikini, in an ideal world, you would keep all of those scars nicely hidden, certainly through the next summer after you've had this surgery done and then one of the other procedures that we commonly, use at the same time as tummy tuck surgery is liposuction.

So, liposuction, again, is not to be regarded as a weight loss procedure.

Really it's a procedure for dealing with stubborn areas of fat that you really just can't shift.

So, in an ideal world, when you have the surgery, you bid about your ideal body weight.

The abdominoplasty itself would hopefully deal with the excess skin, and then liposuction can be used for areas such as the love handles, or causal margin fat, which are otherwise wound shift of their own accord and the liposuction You can either perform it on its own, but with this procedure, I'd normally just go through the tummy tuck scars, and I can use a long cannula to very gently take out the fat cells from that, those trouble areas and the fat cells themselves are removed, they don't come back.

Once they're gone, they're gone and then it relies on the elasticity of the skin and your compression garments to really get everything to flatten off and look as good as possible.

I think with liposuction if you're considering that.

Tends to look very good at the time of the procedure.

At about two or three weeks after the operation, it tends to look more swollen.

People are often quite alarmed.

But actually, as over the coming weeks, as things settle, you can get some very, very pleasing results.

So, risks of tummy suck surgery, there are risks with any operation.

The anaesthetists would go through the anaesthetic risks, but I'm assured that the risks of a modern anaesthesia are such that, statistically, it's actually more dangerous getting to a hospital than it is having a modern anaesthetic, if you're fit and well.

We would aim to try and modify and, modify any risk factors to stack the chance of success as heavily in your favour as possible before one of these procedures, and we give you advice about that and how to look after things post-operatively.

But scar we've spoken about.

Bleeding or hematoma underneath the skin is probably the commonest reason for needing to go back to theatre in an emergency following one of these operations.

So sometimes a vessel that you've cauterized during the procedure can pop open as you cough or twist, in which case we just need to go back in and stop it.

So that's probably about one in 20, 130 cases, maybe? Maybe that's a bit pessimistic.

Scars and bulges, so people who have lost a significant amount of weight, have lots of excess skin.

We've just got to be realistic with what we can achieve with any of these procedures.

So it will improve the tummy area, but it won't necessarily improve You know, excess skin in areas outside the operated field.

Skin numbness is very common, so again, I tend to suggest, and anybody that's got a scar will know it's often quite numb around the scar.

So I tend to suggest to people that the tummy will always be numb after this type of surgery, and I think any sensation that comes back is to be regarded as a bonus.

Although most people do have quite a, you know, a reasonable amount of sensation after this surgery.

Infection is a reasonably common procedure after any operation.

So this is a clean operation.

We'll give you some intravenous antibiotics at the time of the procedure, and take full precautions in our, very nice theatres, which are shown here.

Blood clots so deep vein thrombosis in the leg can be a potentially life-threatening complication of any operation.

 So with this, we try and keep the operating time to a minimum.

We'll try to get you up and out of bed as quickly as possible after surgery.

I tend to give you some low molecular hit heparin in the perioperative period, so a blood thinner and we get you to wear some horrible stockings for a couple of weeks after the procedure as well, just to try and prevent DVT, which can sometimes become something called a pulmonary embolus, where a blood clot can go to the lung and then excessive bleeding, so the blood thinner that we give you to try and stop this from happening can sometimes cause, increase the chance of you having a bleed.

So, it's some of these things, we just have to balance the risks and benefits of them, and just try and steer a, a safe course for you, enabling us to manage you and get the best possible results and, yeah, our theatres are modern and use something called laminar flow air, so they're very, very clean, lots of air changes, and we strive to try and keep our infection rates very low and then with, tummy tuck surgery, mini tummy tucks may go home the same day.

At Benenden Hospital, we tend to keep you in for a one-night stay, and actually 90% of the time, you'll be in for a single night with a standard abdominoplasty or an extended abdominoplasty.

A circumference where you may need to stay in for two nights.

You'll have the dissolving stitches that glue the tape dressing, so you can normally shower from two days after surgery.

Driving is often two or three weeks, so you have to be safely in control of your vehicle, able to perform an emergency stop, and you tend to have to wear your compression garments for the first six weeks and, again, initially, particularly where we've had to repair the six-pack muscles, you may be slightly stooped for the first couple of weeks, but you will naturally straighten out as you feel more comfortable.

Tend to recommend regular paracetamol for the first couple of weeks, and you might like to use some ibuprofen as well, or sometimes recommend some, a weak opiate like codeine, but that tends to make you feel a bit sick, and can make you dizzy, and can give you constipation, which are things that we don't necessarily want you to have, as you're recovering from this type of procedure and in general with these operations, most people are back doing all of the things that they were doing beforehand by about 12 weeks following surgery.

So I've got a lady who's skiing at six weeks, which she doesn't recommend, but she had a lovely skiing holiday.

But I've equally had, people with dressings on just beyond three months, but, so overwhelmingly, it'll be between six and 12 weeks until you feel like you're back to normal and the scars, of course, can take a good year or so to fully mature and look as good as they ever will do.

So, the recovery can take a while and I think return to physical exercise, particularly where we've had to repair the six-pack muscles, lots of people are keen to get back into the gym, but the six-pack repair would be as strong as it's ever going to be at about 12 weeks following the procedure.

So, things like, planking or sit-ups, I tend to recommend 12 weeks before you return to those.

But a lot of people are walking from the day after the procedure, and you can normally walk as far as you can tolerate.

Some people might get onto an exercise bike from two or three weeks after the procedure.

But again, you just need to be sensible, listen to your body.

If it feels like it's probably a bit too much, it is.

You just need to back off whatever activity has upset your tummy, and just Gradually, incrementally increase over the coming weeks and travel, major life events like weddings and things, really, I think in an ideal world, you want to give yourself as much time to recover before those, sorts of things as possible.

I love holidays, so the thought of, you know, messing up a holiday because you're recovering from an operation.

That's something I don't like.

So, so I think, Obviously, if you're trying to get ready in time for a particular event as well, it can just increase the stress levels for you.

So I think, really, you need to look after yourself.

Make, make plans, get the dog looked after, try and send the children away for a couple of days.

So just, just try and make things as easy as possible for you in the, in the post-operative recovery and Lexi's very good, she can often advise on some of these things.

In the pre-assessment checks, and just, chatting.

Lexie Otana

Thank you, Mr Mackey.

So, now we can move on to our Q&A session, and we're really pleased to have so many of you with us today.

While we may not be able to answer every question, we'll do our best to cover as many as we can, and to help us get through as many as we can, please do try to keep your questions brief and on this slide also, you can view our pricing details.

So, some of the questions, we have, One for you, Mr Mackey.

I have an umbilical hernia, is it possible to fix that at the same time as a tummy tuck?

Mr Simon Mackey

So, it can be.

Sometimes I'll probably have to take a look at your umbilical hernia.

So, sometimes if it's a smaller hernia, then yes, it's something I can do in combination.

Sometimes I might ask one of my general surgical colleagues to come in and perform that part of the procedure and other times, if it's a more complicated hernia, it may be better.

to separate the procedures out.

The recovery following hernia repair can sometimes, cause things like gastric stasis and, yeah, so it can make you more prone to vomiting, so it can, sort of interfere with recovery from the abdominoplasty.

But, so, yes, it may be possible to perform it at the same time.

I'll probably have to examine you, and we could just come up with a sensible, way of treating things in your case.

Lexie Otana

Thank you and another question along the same lines, someone's had an umbilical hernia repair approximately 15 years ago.

Would they still be able to have abdominoplasty surgery?

Mr Simon Mackey

Absolutely.

Yes, definitely.

Obviously, I'd have to look at you overall, but yes, that shouldn't stop you from having a tummy type procedure.

I think sometimes, depending on the type of hernia and the type of technique that's been used, it can potentially affect the blood supply to the tummy button, so that could increase the chance that you lose a tummy button.

But as I said, the tummy buttons that I have lost, and the tummy buttons I've seen that have been lost, healer scars, they look like tummy buttons anyway, so, so yes, it shouldn't stop you from having, an abdominoplasty procedure.

Lexie Otana

Thank you.

Someone else asks, that their abdomen is a funny shape below their breasts and protrudes above their waist and lower abdomen.

Could this help to reshape?

Mr Simon Mackey

Protrudes above the waist, and that happened.

So, yes, so I think you might be describing a divarication of the rectus muscles.

So again, when I examine you, I'll look at your rib cage, I'll have a look at your spine as well, because sometimes if people have got a bit of a scoliosis or a skeletal type of anomaly, then that can also affect things, and I can't correct those, I'm afraid.

But from what you're describing, it sounds as if you may have a divarication of the rectus muscles and when I put the six-pack muscles back together.

I look very carefully at the anterior abdominal wall.

If you've still got some, asymmetrical or, unusual shape down to the wall.

I can use some additional stitches just to tighten, different areas of the tummy to try to get you as good results as we possibly can.

Lexie Otana

Thank you and someone else asks, how soon after tummy tuck is it safe to fly?

Mr Simon Mackey

So it's, it's deemed a fairly major procedure, because it takes about two or three hours to perform and the major risk with a long-distance flight, which is a flight of more than four hours is an increased risk of blood clots in the legs.

So, we tend to recommend that you leave things for at least six weeks before a long-distance flight.

I think more practically, if you're a long way from, you know, if you're in the UK and close by, and you have a wound healing issue or a problem, then Lexie and I in the hospital can look after you.

Whereas actually, if you're somewhere slightly further flung and you have, an issue then you might incur some additional costs if you're seeking treatment a long way away.

So, normally about six weeks or so is the minimum.

Again, I'm fairly pessimistic, and I love holidays and things, so I tend to recommend if you can give yourself a good three months to recover, then the overwhelming majority of people will be absolutely fine by three months.

Lexie Otana

Thank you.

How much time would I need off work after a combined tummy tuck and arm lift?

Mr Simon Mackey

Really, it depends on your occupation to a degree.

So, for an office-based job, which is what most people work, I've got I've got patients who, particularly after the pandemic, used to go and visit on the ward, and they're already on their computers working.

So I'd normally recommend a good, week or two off following one of these procedures.

But again, people like personal trainers or, soldiers, it's close to about six to 12 weeks, really, particularly if you've had to repair the six-pack muscles.

So I'd say for most desk-type work, you might want to take a week or two off work entirely, and then ideally phase return, or potentially work from home for a week or so, and then, just get back into things as you feel comfortable.

Lexie Otana

Brilliant and someone else asks, can you remove an apron?

Mr Simon Mackey

So, yep, an apron is a significant overhanging, piece of loose skin, which really sort of hangs down.

So, I've seen and treated aprons that drop down almost to the ankles.

That can be a fairly major undertaking.

So we have it requires some very careful planning.

I think at Benenden, they've got an upper BMI limit for this of 35.

I think it is 35 at Benenden.

So, but, you know, with some careful planning, I think some of the orthopaedic procedures have been up to 40, but I think, really, it's when your BMI is above 35 for this type of surgery, your chance of having a significant or severe complication seems to skyrocket.

So, we're, we're, we're quite cautious.

But yes an apronectomy is a very similar procedure to an abdominoplasty, and in an ideal world, what I'll do with an apronectomy is trying to make it look as much like an abdominoplasty as possible.

So, just to get you as nice a look to the anterior abdominal wall as I can.

But that, again, is another example of where procedures, which lots of people think of as being cosmetic procedures, actually are really it's a functional operation.

If you've got a very heavy abdominal apron, often with oedema, it's very, you know, it's a real, real nuisance. It's difficult to find clothing that fits.

The inflammation in tetraiga that you can get underneath the fold is it can be soul-destroying.

So, so yes, we can do apronectomy.

Lexie Otana

Right, so thank you again for all of your questions, and for being part of this evening's session. That's all the questions we have time for today.

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Take care, and goodbye.

Mr Simon Mackey

Thank you very much.