Abdominoplasty (Tummy Tuck) in São Paulo, Brazil

I recommend abdominoplasty for:

• excess abdominal skin and fat resistant to diet and exercise;

• wall laxity after pregnancy, with or without diastasis;

• excess skin after significant weight loss;

• a stable weight for at least 6 months;

• a completed family, for women of reproductive age;

• good general health, with a complete cardiology evaluation.

I do not recommend — or I postpone — when:

• future pregnancy is planned;

• in my practice, BMI is above approximately 32 to 35: risk tends to increase and the result can become less predictable — I generally recommend weight loss and reassessment; this cutoff is not universal and depends on the clinical profile and the extent of the procedure;

• the patient smokes and does not plan to stop 4 weeks before and 4 weeks after;

• the expectation is to resolve obesity with surgery — abdominoplasty is not a bariatric procedure;

• there are extensive abdominal scars that compromise flap circulation; in that case the surgical design changes, or the indication is dropped.

I examine you standing and lying down. Standing: how much skin is redundant above and below the navel — which decides between mini and classic —, skin quality, fat distribution in the flanks, and the position of the navel. Lying down, with the abdomen contracted: the width of the diastasis, palpated along the entire linea alba, and the presence of an umbilical or epigastric hernia, which I treat in the same procedure. I examine previous scars — cesarean, laparoscopy, cholecystectomy — because each one changes flap circulation and the incision design.

What makes me change the plan: redundant skin above the navel excludes the mini; wide diastasis with a hernia changes the wall strategy; a high BMI postpones surgery; and a patient who wants "just the skin removed" but has diastasis needs to know that, without plication, the belly stays projected.

In my practice, when a patient presents signs or symptoms consistent with rectus abdominis diastasis, I request an abdominal wall ultrasound to document the inter-rectus distance at different levels and to check for associated hernias. Physical examination remains fundamental; ultrasound complements the assessment and provides an objective measurement for planning.

Under general anesthesia, at Hospital Albert Einstein, in 2 to 4 hours. The incision is low, planned with you at the consultation to stay within the underwear line. I dissect the flap up to the costal margin, free the navel, bring the rectus muscles together with plication — correcting the diastasis along its full length — and treat the hernia, when present. I then pull the flap down, remove the excess skin and fat, and reposition the navel through a new opening, taking care that it looks natural, without a "buttonhole" appearance. When I include flank liposuction, I perform it in the same procedure, respecting the volume limit that protects flap circulation.

Closure is done in layers, with sutures that relieve tension on the scar.

During abdominoplasty closure, I place Baroudi quilting sutures and, routinely in my practice, place Blake drains. Drainless abdominoplasty techniques exist, especially when progressive tension sutures are used; the choice varies among surgeons. I prefer to combine quilting sutures and drainage to monitor fluid output and reduce dead space after surgery. The drain does not prevent hematoma or eliminate the need for reoperation when there is significant bleeding, but its output can help flag a change early that requires evaluation. After surgery, I recommend a semi-flexed position for the first two weeks, with individual progression, to reduce tension on the scar and avoid strain on the lower back.

• Seroma — one of the most frequent complications: fluid buildup under the flap. In my protocol, I use Baroudi quilting sutures, Blake drains, and post-operative compression as the case progresses. Drainless protocols with progressive tension sutures exist and also show good results. When a seroma occurs, management depends on volume and progression; it can often be treated with an office aspiration, but persistent or complex cases require an individualized approach.

• Venous thrombosis and pulmonary embolism — the most serious risk. Compression stockings, pneumatic compression during surgery, walking the next day, and medication prophylaxis based on individual risk.

• Hematoma — rare; drained when significant.

• Flap compromise and dehiscence — a risk that rises with smoking, excessive tension, and overly aggressive liposuction on the flap. That is the reason for the three rules: stop smoking, close without tension, and limit associated liposuction.

• Altered sensation in the lower abdomen — common and, in most cases, temporary.

• Widened or hypertrophic scar — care with topical silicone and sun protection starting in the third week; revision, when needed, no earlier than 12 to 18 months.

• Infection — rare, with prophylactic antibiotics and a hospital environment.