Instructions After Abdominoplasty

Most patients have minimal discomfort upon waking because of the local anesthetic and IV pain medication. “Tightness” in the abdominal area is more often described rather than pain. The local anesthetic will wear off in 6 – 8 hours.

Post-surgical nausea and vomiting is uncommon with IV sedation as opposed to general anesthesia.

It is not uncommon to feel drowsy for several hours after the procedure. You must be driven home and made comfortable to rest. A recliner chair works best for sitting and sleeping the first 10 days or so after surgery. Keeping the head elevated above the heart and keeping your torso in a semi-flexed position will help with swelling and comfort. Putting ice packs on the abdomen will help also, but they must be applied over the binder.

It is very important for you to closely follow postoperative instructions to maximize the benefits of surgery and minimize unwanted complications. Ask for clarification by your surgeon or the staff if you do not understand any of the following instructions:

• Activities: Quiet rest is required in the first week after surgery. However, it is very important that you routinely squeeze the muscles in your legs and get up to slowly walk around the house for a few minutes out of every waking hour. This helps to prevent deep vein thrombosis (blood clots) in the legs which can be life threatening.
• Elastic Abdominal Compression Binder: After abdominoplasty surgery, an elastic support binder will be worn to prevent accumulation of fluid under the skin of the abdomen. Patients are required to wear this elastic binder (or later a girdle) continuously for approximately six weeks after surgery. Your surgeon will tell you when you may discontinue wearing it. The binder/girdle should be “comfortably snug.” If you are having tingling or swelling in your extremities, the garment is too snug. If you can easily slide your hand underneath, it is too loose. Wearing the garment helps to decrease swelling sooner and helps to prevent the accumulation of fluid pockets (seromas.) If you develop a fluid pocket, please notify the office. Seromas develop frequently and may require treatment. If a treated area becomes red, tender, and inflamed, notify our office immediately, including weekends.
• Jobst Stockings: Compression (Jobst) stockings must be worn on your legs 24 hours a day after surgery. The compression increases blood circulation in your legs to help prevent blood clots. However, squeezing the muscles of your legs frequently and getting up to walk for a few minutes every hour, is very important, too. If you don’t do those things (wear the stockings, do the squeezing exercises, and walk) you will be at a much greater risk for deep vein thrombosis (blood clots.) If you develop a clot and it goes to your lungs, you could die.
• Drains: You will have one or two drainage tubes sutured to each corner of the abdominal incision. A fluid collection bulb will be attached to the tubes. The drains extend up under the skin and serve to pull excess fluid away to help prevent a seroma. When the bulbs are full of fluid or are no longer compressed (squeezed down) to provide suction, you must empty the fluid and recompress the bulbs. The fluid will be red (blood) early after the procedure and will gradually lighten to a pinkish color over several days of time.
• Personal Hygiene and Wound Care: You may sponge bathe with a wash cloth as needed beginning the day after surgery. Keep the water temperature comfortably warm, not hot. Do NOT submerge in water (take a bath) or shower until Dr. McMenamin says it is OK. Keep your wound dressings and binder/stockings dry. Remove the binder and inspect the skin daily. If you observe excessive redness or darkness of the skin or any other alarming changes, contact the doctor immediately. Cover the abdomen with a soft, clean, folded towel and replace the binder comfortably snug as discussed above.
• Reapplying the binder: Position the binder out flat on your bed. Lie down on it on your back with the seam of the binder aligned with your spine. Position the towel over your abdomen from the pubic line to the breast line and allow it to curve around your sides. Have someone help you pull the non-sticky side of the binder over while you hold the towel and then pull the sticky side over top to adhere snugly. The drainage tubes should extend from underneath and the bulbs should be safety pinned to the binder. Underwear should be worn on the outside of the binder so the elastic band won’t dig into the skin.
• Discomfort and Bruising: The numbness from the local anesthetic will begin to wear off about 8 to 12 hours after surgery. Because you have just undergone extensive surgery, expect to have significant discomfort. For most people, the most uncomfortable days are the second or third days after surgery. It may be difficult for you to straighten your back to stand up or to lie down flat. Bending slightly at the waist and bending your knees and keeping your head elevated will help. Bruising and swelling in the areas of treatment as well as in the pubic areas and upper hips/legs is to be expected. The extent varies from person to person. Males should not be alarmed about swelling or bruising extending into the penis.
• Pain medication: You will be given Vicodin (or some similar narcotic) for pain. Because you will have some level of numbness in the first 12 hours, only take Extra Strength Tylenol for pain as directed on the bottle. After that, if you need it, you can take up to two Vicodin in a 4 hour period. ALWAYS take it with a meal so as not to upset your stomach. DO NOT take Aspirin, Ibuprofen, or similar medications for at least 14 days following surgery as they tend to promote bleeding. Also, do not take Tylenol and Vicodin at the same time. Vicodin (and some other pain medications) contains Tylenol and you will over dose on it.
• Do not take Ginko Biloba, Vitamin E, Vitamin C, fish oils, or any other supplement of any kind for two weeks after surgery.
• Do not smoke/chew tobacco products or drink alcoholic beverages for two weeks.
• Do not immerse in water (swim, bathe, hot tub, etc.), take a shower, or wash your hair until you’ve been cleared to by Dr. McMenamin.
• Diet: After surgery, drinking generous amounts of water, fruit juices, or soft drinks will prevent dehydration and help your body to rid itself of the medications used in surgery. Light, bland, low salt meals are recommended the day of surgery with resumption of your normal diet as tolerated. It is very important that you keep your intake of calories up and that you get protein in your diet. Your body needs calories, especially protein, to heal. Eggs, dairy products, fish, and poultry are all good sources of protein. Fiber is very important to maintain regular bowel habits. Whole grains, bran, and fresh fruits and vegetables are good fiber sources.
• Lidocaine Flush: Approximately 12-24 hours after abdominoplasty, some patients develop a mild, inconsequential response to lidocaine. Symptoms include feeling flushed, developing redness in the face, neck, and upper trunk, and feeling a little feverish. For those of you who have ever taken Niacin to help with cholesterol, it is similar to a Niacin flush. This is not something to be concerned about, and it will pass in a matter of hours.
• Follow-up Appointment: You will be given an appointment for follow-up for one to three days after surgery. This will give you an opportunity to ask additional questions you may have. Your appointment time will be on the Preoperative handout and the purple surgery scheduling sheet. Please make every effort to attend all postoperative visits. Follow-up visits are at no charge to you for usual post operative care.