Abdominoplasty: restoring function to the abdomen

A matter of silhouette? Not only. Abdominoplasty, too often confined in the collective imagination to the purely aesthetic sphere, is actually a procedure that can significantly change the functionality of the abdomen and, with it, the patient’s quality of life.

Behind the removal of excess skin lies deeper work: the reconstruction and strengthening of the muscular wall, te correction of diastasis and hernias, and the restoration of a body structure capable supporting movement, posture, and breathing.

«Abdominoplasty is a body contouring procedure aimed at reshaping both the upper and lower abdomen when there is an abdominal apron, meaning excess skin and subcutaneous tissue. In addition to treating the superficial part of the abdomen, skin and fat, it is also possible to operate on the muscles and fascia, strengthening them and even restoring the waistline», explains Dr. Aurelio Cardaci, a reconstructive and aesthetic plastic surgeon from Rome with twenty years of international training.

Functionality beyond aesthetics

A weakened abdomen is not just aesthetic issue. «The procedure has a functional value because a patient with a weak abdomen, with significant rectus muscle diastasis, is a patient who experiences abdominal herniation under strain», continues Dr. Cardaci. «They may have gastrointestinal problems, issues with digestion, bloating and difficulty performing daily physical exercise».

To ensure longer-lasting results, surgery is preferably performed when body weight is stable. «Very often, after the procedure, the patient resumes physical activity. Over time, they can return to training and strengthening the abdominal muscles, which, as they become stronger, bring excellent benefits in terms of posture, breathing, and overall physical management».

Abdominolasty: common misconception

One of the most common misconceptions among patients approaching abdominoplasty is the idea that the procedure is meant for weight loss or simply to “remove the belly”: «The patient should come to us after a weight-loss journey, with stable weight for at least six months to a year – emphasises the surgeon – It is a procedure aimed at restoring the body’s silhouette and is often combined with liposuction».

Unlike abdominoplasty, with liposuction «we do not achieve skin tension or the reconfiguration of the skin layer as we would in a procedure that removes even significant portion of skin – clarifies Dr. Cardaci – Liposuction tends to suction out fat and promote skin retraction, although today there are newer techniques that almost ‘skeletonise’ the skin over the muscular fascia and maximise skin retraction in the deeper layers. However, there is still not form of liposuction that can truly replace and abdominoplasty».

Significant weight loss can leave a sagging abdomen caracterised by excess loose skin, especially in the lower (below-the-navel) region. «This requires a complete reshaping of the abdominal area, with incision and removal of lozenge-shaped section of skin (dermolipectomy), tissue lifting, advancement of the flap, and repositioning of the navel with a very fine, easily concealed scar. The result is a more youthful, functional, and harmonious abdomen».

The evolution of techniques

Dr. Cardaci explains that the surgical approach to abdominoplasty has not radically changed from a technical standpoint since the 1970s-80s. However, many aspects have improved, particularly in patient preparation, intraoperative management, and postoperative recovery.

«Today, the procedure is performed under general anesthesia, with at least one night of hospitalisation. The patient must be properly prepared with preoperative tests such as chest X-ray, abdominal wall ultrasound, ECG, and cardiology evaluation. Blood typing is also necessary, especially in larger cases where a transfusion may be required due to postoperative anemia».

As for techniques, «the innovation lies in reduced invasiveness, with tissue detachment limited to what is strictly necessary. We aim to preserve as much vascularization and lymphatic drainage as possible in the lateral portions of the tissue. Blood loss is minimised through effective hemostasis. There are also suturing techniques that reduce dead space, limiting fluid accumulation after surgery and facilitating recovery and early mobilisation».

Faster recovery and improved aftercare

Postoperative management has also evolved significantly. «Today, a patient operated on in the morning, after a procedure lasting about three hours, is already encouraged by late afternoon to move and take a few steps in the room. Early mobilisation improves prognosis and recovery».

There have also been advances in suturing techniques. «Personally, I use modern structures equipped with small anchors that seal the dermis and, thanks to their long absorption time, allow healing without tension, leading to excellent long-term results with minimal visible scarring».

Preparation, safety, and quicker recovery

For those considering abdominoplasty but still feeling apprehensive, one reassuring aspect is the evolution of preoperative preparation and the personalisation of the procedure.

«Today, the patient is studies in great detail before surgery. In more complex cases, therapies are prescribed three to four weeks in advance to ensure the patient is as prepared as possible and can recover as quickly as possible – concludes Dr. Cardaci – Techniques have improved greatly, with reduced blood loss and shorter surgery times. In the postoperative phase, after just 3-4 days, patients usually experience no discomfort or pain, can move around, and perform small daily activities, keeping in mind that full recovery from abdominoplasty generally takes at least 2-3 weeks».