# The Truth About Tummy Tucks

An episode of [Vain-ish](https://invisiblenetwork.ai/podcast/1824105551), 24 Mar 2026, 57 min.

Audio: https://enrichment.soundstack.com/4vjqq8/episode.flightcast.com/sd9hz4l5l65lpbmq752ngb35.mp3

Specialist Plastic Surgeon Professor Mark Ashton breaks down the realities of abdominoplasty, while Bec shares her experience with hernia and muscle repair after twins. Together, they unpack recovery, expectations and common misconceptions. Find us on Instagram: @vainishpodcast and thanks to our guest Professor Mark Ashton Hosts: @becjudd and @jessierobertsx Producer: Liza Altarejos Audio Imager: Chris Marsh Video Producer: Justin Hill Find more great podcasts at www.listnr.com See omnystudio.com/listener for privacy information.

## Transcript

[0:02] a listener production.
[0:05] I'm Bec Judd.
[0:06] And I'm Jess Roberts.
[0:07] And we're done with the smoke and mirrors.
[0:09] Fainish shares honest stories about what it takes to look amazing because we did not wake up like this.
[0:15] And you should know the stuff that we chat about on this podcast is based on our personal experiences.
[0:21] We're sharing it for your entertainment.
[0:23] It's definitely not medical advice.
[0:26] And we'll always be clear with you when something is a paid endorsement.
[0:29] Please always chat with your qualified healthcare team before making any decisions about your health.
[0:50] Hi, everybody.
[0:50] I'm Bec John.
[0:51] And I'm Jess Roberts.
[0:52] And welcome to Veineers.
[0:54] All right, Rebecca.
[0:55] So from our audience, we've had a lot of people asking about tummy tucks and just the changes in our body and what we can do about it.
[1:04] Especially after pregnancy.
[1:06] Yeah.
[1:06] Weight gain and just, let's be honest, getting older.
[1:10] Yeah.
[1:10] Yeah.
[1:11] Multiple kids.
[1:12] So on Vanish, as you know, we love having open, judgment-free chats about the way our bodies change over time.
[1:20] And we want to give you clear, balanced information because we know you're curious because you keep asking us whether we've had them done ourselves and if we can bring someone on to explain it.
[1:30] There's always so many questions.
[1:32] So today we're diving into the world of abdominoplasty, which is called what we call it tummy tuck.
[1:38] Tummy tuck, that's right.
[1:39] So it's a topic that pops up a lot in beauty and wellness circles.
[1:42] It's not always explained with proper medical insight.
[1:46] What we do here on Vanish is we bring in the best experts in the country, and we've done that for you today, a qualified surgeon who is super, super experienced in this.
[1:56] Welcome to Vanish, Professor Mark Ashton.
[1:59] Thank you very much for having me.
[2:00] Pleasure.
[2:01] So excited to have you here.
[2:02] So Mark, tell us, what are your qualifications?
[2:05] So I'm a professor of surgery and professor of anatomy at the University of Melbourne.
[2:10] I was head of the Royal Melbourne Plastic Surgery Unit and Royal Women's Plastic Surgery Unit for just under 20 years.
[2:16] And I now head up the plastic surgery unit at Epworth Hospital in Freemasons.
[2:21] Gosh, it's very qualified.
[2:22] Very qualified.
[2:24] I don't think we've had a professor in the Vanish House yet.
[2:27] No, I can't even say the word.
[2:28] We are everywhere.
[2:29] They're not that special.
[2:30] There's lots of us around.
[2:31] Are there?
[2:32] I don't know if there are.
[2:33] No, it's the first time we've met one.
[2:35] We know a lot of plastic surgeons and we haven't met a professor before.
[2:37] Yeah, exactly, exactly.
[2:40] So can you explain to us what abdominoplasty, a.k.a.
[2:43] a tummy tuck, is?
[2:46] So maybe we should go right back to the start if we could and explain a hormone called relaxin.
[2:52] So this hormone relaxin is a bit like insulin.
[2:55] It was discovered just under 100 years ago and it's produced by the ovaries, by the uterus and by the placenta and it's integral to understanding what happens in pregnancy and why you have that splitting of the muscles, that separation of the muscles and why you end up with loose skin and around your abdomen but also why your breasts drop as well.
[3:14] So relaxin is an evolutionary hormone and it's designed to make the ligaments in and around the pelvis nice and soft so the baby's head can get through the pelvic floor at the time of delivery.
[3:24] Great idea.
[3:24] Makes sense.
[3:26] The problem is that hormone relaxin works on every other ligament in your body.
[3:29] In particular, the ligaments which join your two rectus muscles.
[3:33] They're the muscles at the front of your abdomen that give you your six pack.
[3:37] And they're held together by a ligament which is normally about one or two millimeters thick.
[3:41] What happens in pregnancy under the influence of relaxin, because the baby is pushing continuously, is those muscles separate.
[3:48] That's called a divarication or separation of those muscles.
[3:52] And in severe cases, that can be 15 to 20 centimetres up to the left.
[3:56] Well, 20.
[3:57] I thought mine was bad.
[3:59] Mine was about 10 after.
[4:02] After kids.
[4:03] Yeah, so I don't know what it was when I was having the twins.
[4:05] Yeah.
[4:06] It wasn't just my muscles.
[4:07] It was the ribs as well.
[4:08] My ribs, they were a shelf up here.
[4:10] Yeah, that's exactly right, Bec.
[4:11] And so what's happening is that hormone relaxant makes everything nice and soft and spongy.
[4:15] Yeah.
[4:15] And it's designed to do that so that you don't end up in obstructive labor.
[4:19] You end up with organs in positions they're never supposed to be in.
[4:22] Correct.
[4:22] Correct.
[4:23] But do you know what annoys me is that once the relaxant goes, your body doesn't really go back to where it started.
[4:29] No.
[4:30] And some people, and I'm thinking just about my tummy afterwards,
[4:35] It doesn't even get close.
[4:37] So what's going on with that?
[4:38] So the relaxant, not only does it make that collagen in the ligaments soft and spongy, but it remodels it.
[4:45] So it's a bit like you reset the ligament to a new position.
[4:48] So it's never going back.
[4:50] The other thing which is interesting and I suppose explains a little bit in that...
[4:54] people's sensitivity to relaxin varies.
[4:56] So some people both produce more relaxin and are more sensitive to it.
[5:00] So that's why some people can have two or three kids and end up with the washboard stomach and you look at them walking down the beach in the bikini going, how did you possibly do that?
[5:08] And others can have one or two
[5:10] children and their tummy is completely trashed.
[5:13] It would be fair to say that the more you're exposed to a relaxin, the more likely you are for that separation to occur.
[5:19] And the second thing is the bigger your babies, the more likely that's to occur.
[5:23] So Bec, we were talking before about twins.
[5:25] So if you've had twins, you've got twice the volume.
[5:28] So the chances of those muscles separating are close to 100%.
[5:31] Yeah.
[5:32] I measured 52 centimetres a day I delivered them.
[5:35] What?
[5:35] How are you looking normal?
[5:38] Speaking like the relaxing and stuff, is that why people say like put waist trainers on and all the belly bands to kind of put everything back together again?
[5:47] Do you recommend that or?
[5:49] Well, you're sort of fighting an uphill battle.
[5:51] So it will help.
[5:52] All that stuff will help.
[5:53] But you're not going to be able to combat nature in the longer term, particularly if you then go and have second or third or fourth pregnancy.
[6:01] The chances of you being able to return your muscle back to where it was before you had any kids is pretty remote.
[6:08] Wow.
[6:08] Yeah.
[6:09] I love Pilates, clinical Pilates, especially in the postnatal phase with a physiotherapist who specialises in this specialty.
[6:16] It was so good for me, but even so with three...
[6:21] treatments a week, it's really good for approximating the muscles, but they can only go so far, right?
[6:28] With your waist trainers and your Pilates and everything else you're doing, some people will never get it closed.
[6:34] Yeah, correct.
[6:35] So postnatal physiotherapy and the training and things like that will make a difference.
[6:40] It definitely makes a difference, but it's not going to get you back to where you were before kids.
[6:45] So there's obviously so many different types of tummy tucks.
[6:50] How many is there that you can do?
[6:51] Lots.
[6:51] Lots.
[6:52] And like everything in plastic surgery, there's variation on variation on variation.
[6:55] So maybe let's just talk about that and make it as simple as we possibly can.
[6:59] Yeah, yeah, please.
[7:00] So the relaxant works on two tissues.
[7:03] So it works on that ligament joining the muscles together and it also works on the skin of your abdomen as well.
[7:09] So abdominoplasty is addressing those two things and people have those to varying degrees.
[7:14] So if your muscles are widely apart, then we would need to bring those muscles back together and we normally would suture those back together using a variety of techniques.
[7:24] So that's the first component.
[7:26] Do they dissolve or do they stay there forever?
[7:27] Yeah.
[7:28] What I do is I use a suture that dissolves over about 12 to 18 months.
[7:31] Some people use permanent sutures and some people use mesh.
[7:35] We know about the mesh.
[7:37] We've got girlfriends with the mesh.
[7:38] So I would prefer personally not to use mesh because I've seen so many people who've had mesh and then run into problems because it induces scar tissue, which then becomes uncomfortable in the longer term.
[7:49] That's exactly what our friend has.
[7:50] Yeah.
[7:51] It's like sitting up sometimes.
[7:53] Yeah, she's like, oh, pain.
[7:55] Yeah.
[7:55] Yeah.
[7:55] Correct.
[7:56] So me personally, but that's, you know, it's the individual specialist would do different things, but I would use a suture that does its job and then after 18 months or so, it's gone and you don't see it again.
[8:06] Is that because you've done the stitcher and then it goes away, the muscles have kind of remembered to stay there now?
[8:12] Correct.
[8:13] The ligament which you've sutured together, again, remodels and it sticks together again.
[8:17] So your muscles end up being back to one or two millimetres apart where they were before pregnancy.
[8:22] Wow.
[8:23] That is so amazing.
[8:24] So abdominalplasty, some description will always involve bringing those muscles together.
[8:28] Yeah.
[8:28] And the second component is we need to address the skin.
[8:30] Now, the amount of excess skin is dependent upon the types of pregnancy you had, how much weight you put on, how much weight you've lost.
[8:37] If you're someone who didn't put on any weight during their pregnancy and has a pretty much flat stomach, but the muscles are apart, you could do what we call a limited or a
[8:47] a mini abdominoplasty.
[8:49] And what we're talking about there is using an incision.
[8:50] If you've had a cesarean section scar, we'd use that cesarean section scar.
[8:54] If you haven't, you'd use an incision and then we'd use some laparoscopic or endoscopic instrumentation.
[8:59] And we can make that incision for five centimetres long below the bikini line to access that muscles where they've separated and bring them back together.
[9:07] So you can get the muscles fixed...
[9:08] With a minimal scar down the room.
[9:09] With minimal scarring if you don't have the loose skin.
[9:11] If you don't have loose skin.
[9:12] If you have loose skin, then we would remove this skin to where the apron finishes.
[9:19] What's the apron?
[9:20] So the apron is that overhang of skin, which normally sits just above the pubic hairline and extends for a varying distance out towards your hips.
[9:28] The shelf.
[9:30] The shelf.
[9:30] Call it the shelf.
[9:31] Don't say the swear word.
[9:32] I'm not saying that one.
[9:33] So in the shelf, that's why I jumped in and said it before you were the guest.
[9:36] What do you call it?
[9:37] Is that technically not a swear word, but it sounds a bit vulgar?
[9:39] Yeah, yeah.
[9:40] Yeah.
[9:40] I'm not going there.
[9:41] No, don't.
[9:41] We won't.
[9:42] We won't.
[9:42] So the shelf.
[9:43] So that apron can sometimes be, what, 15 centimetres and other times can be like hip to hip, right?
[9:49] Correct.
[9:49] And some people it can be almost around the whole, you know, pass the hips into their back.
[9:55] So the other group of people who would come in looking for possibly having an abdominoplasty are those people who haven't had kids
[10:02] but have lost a large amount of weight, in which case their muscles are together, but they still have the apron.
[10:08] So the surgery is modified, so we don't do the rectus divarication repair or the muscle repair.
[10:14] We're just doing the skin component.
[10:16] And that extends around to where
[10:19] that apron or that excess skin finishes.
[10:21] And in massive weight loss patients, so patients have lost 50, 60, 70 kilos, the excess skin may be so extensive that you may need to do a circumferential or 360 or completely around the body excision of skin.
[10:35] Gosh, that would be quite a crazy recovery.
[10:37] That is a crazy, crazy recovery.
[10:39] And that's a specialised individual separate aspect of abdominoplasty surgery.
[10:45] And if you were considering having that, I would strongly recommend that you consult a specialist who only does that.
[10:54] This is not your straightforward, easy abdominoplasty.
[10:56] There's lots of extra risks.
[10:58] which are perhaps a little bit outside of what we're talking about today, but how wide or long that scar is determined by how much extra skin you have.
[11:06] Okay.
[11:07] Is it still a plastic surgeon or is it a different type of specialty who would do that specific skin tightening?
[11:13] It would ordinarily be a plastic surgeon, but there are some bariatric or weight loss surgeons who are embarking upon this surgery.
[11:22] The problem we have is that the longer that scar and the wider the surgery, the more at risk the blood supply to that skin becomes.
[11:31] And so my...
[11:32] My suggestion would be certainly one of the consultants, one of the specialists that you would want to do as part of your preoperative consultation process would be to consult with a plastic surgeon to get their viewpoint on things.
[11:44] Yeah.
[11:44] So what are some of the biggest mistakes you see in recovery?
[11:49] Is it the patient not having adequate time or support to recover?
[11:53] Yeah, that's a key one.
[11:54] Mm-hmm.
[11:55] So maybe if we break it down to before, during and after.
[11:57] So before, get your weight to where you want it to be.
[12:00] So there's lots of studies that have shown that if you're BMI, and that's not the best measure, and there'd be a lot of people out there who'd say BMI is a waste of time.
[12:08] It's probably good because it's an indicator and it's pretty much all we have at the moment.
[12:12] It's a guide without being definitive.
[12:15] Yeah, correct.
[12:16] But we do know that if your BMI is over 30, you've got roughly a four times increased risk of something going wrong.
[12:21] So this is elective surgery.
[12:23] So get your BMI under 30.
[12:24] Yeah, you're not in a rush.
[12:25] You don't have to do it tonight.
[12:27] It's not life-saving emergency surgery.
[12:29] So get your BMI down.
[12:30] The studies in Denmark have suggested getting BMI down to 25 to 27 is associated with even a better result.
[12:38] So in Denmark, one of my fellow colleagues is head of plastic surgery in Aarhus.
[12:42] They don't operate on anyone unless their BMI is under 27 and they want it to be 25.
[12:48] So...
[12:50] If you're having difficulty in getting your BMI to that safer weight range, it is definitely worthwhile speaking to your GP and having a conversation about medications and whether they might be right for you to assist you in getting your weight down to that healthy range.
[13:08] So that would be the first thing that I'd say.
[13:10] Before, yeah.
[13:11] Second thing I'd say is...
[13:13] Allocate time.
[13:14] So what we would say is rather than you go to see me and say, when can you fit me in, I would flip that.
[13:21] I would say, in my busy, chaotic, crazy life, I've got six weeks that I can make vacant.
[13:29] Hmm.
[13:30] for me to have surgery, is it possible for me to have surgery with you in that time?
[13:35] So we are working around your schedule, not you're working around my schedule.
[13:40] Like if you want to sell this operation, which is what people sell all the time, and they say, oh, look, this is just like a big cesarean section operation.
[13:46] Oh, no, this is...
[13:48] Nothing like a cesarean section.
[13:49] It's the amount of tissue that you lift to get those muscles up together is from your pubic hairline up to your rib cage on the top and the bottom.
[13:57] So it's like two dinner plate sizes of tissue, which you then have to lift up.
[14:04] and then get to stick back together again.
[14:06] And that's going to take three, four, five weeks.
[14:08] So you've got to have allocated three, four, five weeks where you're not doing any twisting, you're not doing any exercise, you're not getting in and out of a car, you're not putting on a seatbelt, you're not driving, you're not packing the dishwasher, you're not putting the laundry out, you're not making the bed, you're not vacuuming, you're not cooking, you're not cleaning, you're not unloading the car, you're not looking after kids.
[14:24] You're not doing anything.
[14:25] You ain't doing anything.
[14:26] You're sitting there and watching TV.
[14:28] You're Netflixing and chilling.
[14:30] Totally.
[14:31] So I had a muscle repair after I had my twins through my caesarean scar.
[14:39] I didn't lose any skin, didn't have a belly button or anything.
[14:42] It was pretty much like a hernia repair, I guess.
[14:45] I could put my whole fist...
[14:46] through my stomach.
[14:47] Do you remember?
[14:47] I remember.
[14:48] Yeah, it was gross.
[14:49] I'd eat dinner and my dinner would pop out.
[14:51] So I was at where my belly button was at that point, did lots of Pilates.
[14:56] That made me really strong.
[14:58] I had a really great recovery after four kids, but I could not close the area around my belly button.
[15:05] So I did have the muscles repaired from pretty much my sternum all the way down to my caesarean scar.
[15:11] And just on what Mark was talking about then, afterwards, I could not stand up straight for weeks.
[15:18] And I didn't have the full shebang.
[15:19] I just had the muscle repair.
[15:21] I was walking around like the hunchback of Notre Dame for probably about a month.
[15:26] Yeah.
[15:26] It felt physically impossible to stand up straight.
[15:29] And it felt like if I tried to, I would have torn my abs open.
[15:34] Wow.
[15:34] It was, and this was a very, I would say, minimal compared to people who do a full proper tummy tuck.
[15:41] It was the most painful experience of my life.
[15:45] Yeah.
[15:45] So if you are considering an abdominoplasty,
[15:50] please take six weeks off because you're not doing anything.
[15:54] You're not lifting your kids.
[15:55] You're not putting them in prams.
[15:56] You're not putting prams in boots.
[15:58] You're not getting food out of the oven.
[15:59] You're not even taking a lid off a Vegemite jar.
[16:04] You can't even really poo properly.
[16:05] You need to have poo softness because you can't push...
[16:08] Is it because of all the medication you're taking as well and just everyone touching your insides?
[16:13] The other thing too is that it related to how your body heals.
[16:17] So if your body's healing well and you're letting everything settle down and there's no inflammation, then what tends to happen is the pain drops down from, as you said, seven or eight out of 10 back down to maybe one or a half out of 10.
[16:28] And people think, oh, great.
[16:30] Okay, my pain's settling down.
[16:31] I'm getting better.
[16:33] I can start reintroducing those things.
[16:35] I've had people who are two weeks.
[16:37] Pain's gone back to zero, one and a half out of 10.
[16:39] Like they're doing pretty well.
[16:41] They've sent the nanny home.
[16:42] They've said they can go back to work.
[16:44] They've canceled all these things they had in place.
[16:46] And then all of a sudden,
[16:48] The pain comes back again because you haven't allowed your body to heal.
[16:51] Your body can take around three and a half, four weeks before it really starts healing.
[16:55] You've got to give it time to rest.
[16:56] And so if we were to say, what's the most common mistake that people make?
[17:01] It's that, as you said, Bec, they don't allocate time for the recovery.
[17:06] what injuries they came back in with?
[17:07] The most difficult thing, which I don't have to tell anyone who's listening to this program knows, is you can't turn kids off.
[17:12] Kids are there 24-7.
[17:14] So you need someone who can come in and intervene in between you and your children.
[17:18] That's usually mum, mother-in-law, plus and minus mother-in-law, and husbands and partners.
[17:24] We try our very best, but we don't get it and we don't intuitively understand when they need help.
[17:29] So mums and mother-in-laws are the go-to people.
[17:32] If that doesn't happen, what tends to happen is that people come back with fluid because you're moving that lower abdomen, which means the two layers of tissues we talk about are gliding over the top of each other.
[17:43] And what that means is that you get inflammation, which means your pain increases.
[17:48] And it's usually 24, 48 hours after you've done that increased activity.
[17:52] And then you get that increased fluid, which we call a seroma.
[17:55] It's just a clear straw colored fluid, which collects in between those two layers.
[18:00] And that will continue and persist until you rest and let the tissues and the inflammation settle back down again.
[18:06] Okay.
[18:08] So the most common reason for people having ongoing seromas is they're not resting.
[18:14] And the problem about that seroma fluid is it's irritant.
[18:17] It's reflective that you've got ongoing inflammation, which means your body responds by making scar tissue.
[18:23] Mm-hmm.
[18:23] which means that when it eventually does settle down, you have lost your postoperative result and you've got scar tissue in your abdomen, which means you've got all sorts of irregularities in your abdomen.
[18:35] So you actually then are setting yourself up for revisional surgery to go and remove the scar tissue, which means going and having the, not quite the whole operation again, because you don't have to do the muscle repair.
[18:45] But you've got to go back through the skull.
[18:47] You've just been through this, like it's a big, big surgery and recovery and then it's not how you wanted it to be.
[18:55] Yeah, I'm the queen.
[18:56] I'm the queen of not listening.
[18:59] Resting.
[18:59] Is there a thing such as like you can pop your muscles back open, you can pop a stitch and you can get like a dint in your body
[19:06] abdominal repair?
[19:07] Yes, you can.
[19:08] How does that happen?
[19:09] Going back to doing weight training.
[19:10] Yeah, I was going to say, it'd be... Too early.
[19:12] At what point are most patients cleared for weight training?
[19:15] Three months.
[19:15] Three months, okay.
[19:17] So, and that's related to the way in which your body heals.
[19:19] So, your body heals initially by laying down a type of collagen called collagen type 3.
[19:24] It's a really bulky, spongy, thick type of collagen.
[19:28] It's like if everyone cut themselves, I know that initial scar is quite thick.
[19:31] It's red and then it goes to pink.
[19:33] Mm-hmm.
[19:34] And at about three months, it starts to change from collagen type 3 to collagen type 1.
[19:39] That collagen type 1 is much finer, much stronger, and is white in color, and there's less blood supply.
[19:45] So that's why your scars all start at red, pinky color, and then they fade over time to becoming white.
[19:51] So once that scar is starting to be white, it means the scar has matured or gone from collagen type 3 to collagen type 1, which means it's much stronger, which means you can start doing weight training.
[20:01] And that's about three months.
[20:01] Good to know.
[20:02] I like that.
[20:02] Like, check your scar and... Yeah, that's a good indicator.
[20:05] Indicate, you've got a white scar, you can go do weight training now.
[20:08] So I'm assuming that many of the women who come in for a full tummy tuck with you, with the repair and the skin and the revised, the new belly button, because the belly button is a hallmark of a tummy tuck surgery.
[20:22] Yeah, you are absolutely on the money.
[20:24] A belly button done badly is right smack bang in the middle of your abdomen.
[20:28] It's on your cat's butt.
[20:29] Mm-hmm.
[20:29] And it looks terrible.
[20:30] It's a giveaway.
[20:32] It's a giveaway.
[20:33] So, again, you need to be speaking to someone who does this all the time.
[20:38] Like I'm old.
[20:39] So what happens is we start doing lots of different plastic surgery.
[20:43] And then as we get older, we tend to refine what we do and we do less...
[20:48] operations but to a greater depth and a greater level of specialisation.
[20:53] And in abdominoplasty, as you said, Bec, the hallmark of the bad abdominoplasty is the round circle umbilicus, which is too long and it sort of sticks out on the surface.
[21:04] Most belly buttons are innies is what most people want.
[21:08] And so there's a variety of different surgical techniques that you can utilise to recreate an innie belly button and that's what you want.
[21:15] Can you just do belly buttons?
[21:17] Yeah.
[21:18] Like, is that a thing?
[21:19] Well, you should say our belly buttons are so bad.
[21:21] You've got to cue.
[21:21] Yours is better than mine.
[21:22] Mine is so stretched.
[21:25] I've had four kids' belly buttons.
[21:29] I'm vain, but I live with my really weird belly button and my stretchy stomach.
[21:34] Yeah, yeah.
[21:35] I like it.
[21:35] Actually, speaking of tummy tucks, can you do...
[21:40] An upper tummy tuck.
[21:41] So, you know, when you're tight down here, but you've got the loose skin up there, can you go through your boobs?
[21:46] Can you do a reverse tummy tuck?
[21:48] Super, super great question.
[21:50] I get asked that all the time.
[21:52] And I've seen a couple of people who have been mad enough to do that.
[21:55] Try it.
[21:56] And it looks horrible.
[21:58] Wow, why?
[21:59] How would they do it?
[22:00] It's almost like an incision under the boob, like as if you're getting your breasts done and you lift up?
[22:04] So the bit under your breasts, what they call the inframammary fold, that's the crease underneath your breasts, that works well because that's part of a standard breast reduction technique that some people use.
[22:13] And so that bit, we know how to get that to work.
[22:16] It's the bit in between your breasts and your cleavage.
[22:19] So it's like an upside down, it's like a big W.
[22:22] Yeah.
[22:23] And the bit in the middle is the bit, it's under tension.
[22:26] So scars under tension end up being thick and red and stretch.
[22:30] So you end up in your cleavage having this thick, red, wide scar that looks horrible.
[22:37] There's a reason nobody does it.
[22:38] There's a reason this isn't a thing.
[22:41] Yeah.
[22:41] What you said is absolutely true.
[22:42] There's a lot of people, particularly if they carry their babies high, is that the skin underneath their umbilicus is relatively tight and the skin above their umbilicus underneath their ribs is really loose, particularly when they sit down and they lean over.
[22:55] Yeah.
[22:56] That's why we're high-waisted everything.
[22:58] Because you tuck your belly button in, you tuck all your pregnancy's leftover skin in, you wear your high-waisted pants,
[23:04] And then you pull them right up and you tuck it in.
[23:06] I still see my skin like when I like even the high waist.
[23:08] Oh, and nothing low.
[23:10] Everything's up, tuck it in.
[23:11] Yeah, because of that.
[23:12] Because of that.
[23:13] And unfortunately, what you've got to do then is you've got to do that full abdominoplasty.
[23:16] So you've got to take the skin, which is at the level of your umbilicus and take it down to your pubic hairline to get it all nice and tight.
[23:24] So it's a bit like the analogy would be getting your doona.
[23:27] And pulling it super tight.
[23:29] So you're going to pull it hip-to-hip scar and then lift the belly button.
[23:33] Back into a new spot.
[23:33] But what if you have loose skin but not enough to clear the old belly button and you pull it down and you've still got the old belly button on?
[23:42] is visible, because I know someone who this happened to, what do you do with that?
[23:46] Would you say, no, you're not a candidate for this surgery?
[23:48] Or you say, I'll create you a new belly button, your old one's still going to be visible and we'll laser it?
[23:52] Or what are the options?
[23:54] Yeah, great question.
[23:55] So that's really, really common.
[23:56] So...
[23:58] In an ideal world, you will be taking the skin, which is at the level of the belly button, and taking it all the way down to the top of your pubic hairline because then you can keep that scar in your bikini line.
[24:08] If you don't have enough skin, the options are that you take the belly button skin halfway there
[24:15] cut out the belly button and read that circle.
[24:18] You put that back together again as a vertical line and then you just do the normal operation and that keeps the scar low.
[24:26] Or the second option is you say, well, I'm going to bring that tissue down as far as I can and have a higher scar.
[24:33] Which means the scar is no longer visible.
[24:36] In your bikini line.
[24:38] And so the right answer to that depends upon the individual patient and also what they scarring are like, because everyone makes different scars, right?
[24:47] Yeah.
[24:47] For example, if you come from Yugoslavia, as an example, we know that you've got a significantly higher chance of making hypertrophic or super red scars.
[24:57] Yeah.
[24:58] And if you come from Asia, so you've got Asian background, high risk of doing keto, which is one step worse.
[25:02] Because that's lumpier scars, aren't they?
[25:04] So in that, if you've got those people, you'd be saying either don't have the surgery at all or definitely not do the thing where we leave the scar in the middle of your belly button or maybe accept a higher scar.
[25:14] But you need to have a conversation with that and know what's going on.
[25:17] Yeah.
[25:18] What I would tend to do is make that scar as low as you possibly can and explain to the patient that we're going to let everything settle down because most people after having an abdominoplasty, even though it's super tight at that surgery, when you come back at 12, 18 months down the track, the skin miraculously has got loose again.
[25:35] So you can take that as a second operation and take it down lower.
[25:40] So you can do that.
[25:41] But you've got to have that conversation with the patient ahead of time so they know what the plan is.
[25:47] Six weeks, recovery is now 12.
[25:48] If you're going to do it twice.
[25:49] And also just have realistic expectations.
[25:52] Mm-hmm.
[25:53] About your scars.
[25:55] Yeah.
[25:55] Yeah, and where they're going to be and you're going through all of this and you're still going to be very visible to see them in this instance because you don't have enough.
[26:02] So you've got saggy skin but not enough to completely pull it down.
[26:06] Yeah.
[26:07] And if you're okay to have two belly buttons.
[26:09] Yeah.
[26:09] You could have two belly buttons.
[26:11] Yeah.
[26:11] I mean, you know, the second one you said you'd change into a vertical line.
[26:14] Yeah.
[26:14] But it's, you've got to see, again, you've got to see that scar before you're happy with it.
[26:19] I'd be doing that like less than 1% of people.
[26:22] Yeah.
[26:22] Because everyone says, yeah, I'm fine with the scar.
[26:23] I'm fine with the scar.
[26:24] And then you look and go, oh.
[26:26] No.
[26:26] No.
[26:27] Well, that's why I never did any loose skin removal after my twins and I kept my belly button is because I didn't want to have any scars.
[26:35] I just wanted kind of the muscles fixed.
[26:36] If I could have got rid of everything easily with no scars, I probably would have done it, but it just wasn't going to work for me.
[26:44] So I live with it and it's fine.
[26:45] Because we're high-waisted everything.
[26:47] People always say, oh, how do you have that tummy after twins?
[26:51] Because every photo that I post, I'm standing up.
[26:54] Maybe for this one I'll post one sitting down so then everyone can see what my skin actually looks like because it ain't pretty.
[27:03] No, I'm the same.
[27:04] I'm the same.
[27:04] And Bec, just picking that up, if you've got excess skin above the belly button and it's relatively tight underneath the button, then as you highlight, a very real option for you is to do nothing.
[27:15] Say, look, I'm going to accept my extra skin above my belly button because the alternatives are scarring, which in many cases is going to be worse than what I currently have.
[27:26] Exactly.
[27:26] And it comes back to
[27:28] an open and honest discussion about a transparent discussion with your surgeon about what the likely outcome is and individualizing treatment that's right for you.
[27:37] What you don't want to have is a situation where you go and see a surgeon who says, oh, this is how I do everyone.
[27:42] And then you end up with this scar and you're going, oh my God, I didn't expect that to happen.
[27:46] Yes, exactly.
[27:47] The treatment and the outcome, you need to be involved in that discussion.
[27:50] You need to be part of that conversation so that you can decide what's right for you.
[27:55] And the treatment needs to be individualized to you, not to the surgeon.
[28:00] Yes, 100%.
[28:01] And he hit the nail on the head there because that was kind of where I ended up.
[28:05] It's like, I would prefer to have this funky, I've had four kids, including twins, belly button and this really loose skin.
[28:13] I would prefer that look than scars all over my stomach.
[28:16] So, yeah.
[28:25] So what should someone ask their surgeon to ensure they're making the right decision?
[28:29] I would come back to where we started before and I would approach that in a way where you're picking up, if you can, all of those four elements we talked about.
[28:39] So one, I'm going to turn up to that consultation at the right weight with adequate time allowing for my recovery and I've got my support team around me to get the best possible outcome.
[28:49] Yeah.
[28:50] Yeah.
[28:50] Then I would speak to the surgeon.
[28:52] I'd do my research on them.
[28:54] And remember I said that as we get older, we tend to specialise or subspecialise in particular areas.
[29:01] So plastic surgeons start off doing microsurgery, hand surgery, reconstructive surgery, burn surgery, and then they subspecialise into different areas.
[29:10] If you're considering having an abdominoplasty surgery, you don't want a hand surgeon doing it who does it part-time on the weekends.
[29:15] You want a guy who does this...
[29:18] All the time, that's all he does.
[29:20] And similarly, if you've got a really complicated hand injury, you don't want an abdominoplasty doing your hand surgery.
[29:25] You want to choose the specialist that's right to you.
[29:28] So how do you do that?
[29:28] Well, you should be able to find that on the internet, but also when you're speaking to the staff in the rooms, ask them how much work in this particular area does this particular surgeon do?
[29:39] Does he do it once a week, once a month?
[29:41] In our situation, for example, we would be doing breast and abdominal surgery four times a week, somewhere between eight and 10 cases a week.
[29:50] Yeah, okay.
[29:50] Which means that it's about 500 cases a year.
[29:54] Yeah.
[29:54] That's where you want to be.
[29:55] That's why we got you on here.
[29:56] Yeah, exactly.
[29:57] We knew you were the abdominoplasty guy.
[30:00] You've got a very good reputation in Australia for being the guy.
[30:03] The guy.
[30:03] So, yeah.
[30:04] Don't forget also that you've got to get on with the staff around that particular surgeon because the recovery, you're going to be back there two, three times a month minimum for a period of three or four months.
[30:15] So you need to be getting on with the receptionist, need to be getting on with the nursing staff.
[30:19] And the other thing too is looking at them and understanding them gives you an insight into the dynamic of those rooms.
[30:26] Is it a happy place?
[30:27] Is the environment of that surgery...
[30:30] conducive of having a good experience because things do go wrong.
[30:35] Now, if you're having trouble with the surgeon or the environment and things are going okay before surgery, what's it going to be like when problems happen?
[30:46] Yeah.
[30:47] Okay.
[30:47] Yeah.
[30:48] So you've got to make sure that the staff you're dealing with are professional and that you feel empowered to be able to raise concerns should you have them
[30:58] before surgery because then that's the best indication that after surgery you're going to be looked after.
[31:03] Okay.
[31:03] Very good.
[31:04] So when it comes to in the operative room and you go in and you see like they probably just need their skin done, but then you go in and you see like the tiniest little bit of separation, would you just go in and stitch it up for them?
[31:18] Yeah.
[31:18] Yeah.
[31:19] So the analogy, I'm hoping I gross people out, but what we're trying to do, it's a bit like getting a house and lifting the roof off.
[31:26] Yeah.
[31:27] So we lift the roof off and we look down from a top into each of the bedrooms.
[31:32] And so it's not uncommon for us that when we're doing repairing that muscle wall, that we find people have got an umbilical hernia or they've got an incisional hernia or they've had a lap band and the lap band is in the wrong spot or the lap band is visible, though it's too high.
[31:47] Well, you've taken the roof off, so just go and fix it.
[31:49] Like, it's like so easy.
[31:50] You get the floor plan.
[31:51] It's like you've got to fix it.
[31:53] That's what I did when I had my tubes tied.
[31:55] I'm like, well, you're already in there.
[31:56] Yeah, yeah.
[31:56] Just tie them.
[31:58] They're going to deliver two children.
[31:59] Plastic surgery.
[32:00] Oh, you're in there.
[32:01] But it's one of those things, like you're there.
[32:03] And so what we always do is we always take photos because it's amazing how many people say, oh, I'm really grossed out.
[32:09] But no, I definitely want to have a look.
[32:11] What does it look like on the inside?
[32:12] And you say, well, here's your hernia and there's your lap band and there's your scar and there's the scar from your seizure.
[32:17] And you're going, oh, really?
[32:18] So cool.
[32:19] And then you say, this is what we did.
[32:20] So we fixed that and we fixed that and we fixed that.
[32:21] You put it all back together again.
[32:23] Job's done.
[32:24] Fixed.
[32:25] Move on.
[32:25] Next stage of your life.
[32:26] There you go.
[32:26] Okay.
[32:27] The impact that this surgery can have can be beneficial in many ways.
[32:34] I, myself, but also friends, back pain with big hernias was a real thing.
[32:41] And...
[32:42] Just how you said then you're putting it back together.
[32:45] When you put muscles back in the places where they're supposed to belong, I bet you've seen some pretty incredible transformations in terms of back pain and life, being able to function better in life post this surgery.
[32:58] Great, great question.
[33:00] So you may or may not be aware that there was a period in time where the...
[33:05] Abdominoplasty surgery was not covered by the medical benefits schedule.
[33:09] And the plastic surgeons in particular, Alistair Campbell is a plastic surgeon in Canberra, did a prospective study where he looked at people before and after abdominoplasty surgery.
[33:19] And he was able to show that...
[33:22] absolutely without any shadow of a doubt that the abdominoplasty surgery, because it puts the muscles back where they're meant to be, resulted in a significant improvement in back pain.
[33:31] And that makes sense.
[33:32] If you think about it, if your muscles are apart and you're standing up, then your bowel and your spleen and your liver and everything is falling forward, which means you've got to balance everything.
[33:40] So you've got to lean back, which means that you're going to get back pain.
[33:44] The other thing he found was that urinary symptoms, such as stress and urge incontinence, was also improved.
[33:51] by abdominoplasty surgery.
[33:52] Now, I work with a urogynecologist.
[33:54] It's one of the things that we did at the women's hospital.
[33:57] And I'm not going to say for a second that an abdominoplasty will fix all forms of stress and urge incontinence.
[34:03] But we do know that there are physical, demonstrable sequelae of having your muscles apart,
[34:09] Back pain and urinary symptoms being the two most common that are fixed by abdominoplasty surgery.
[34:15] So it is what we call a functional operation.
[34:18] It's not just aesthetic.
[34:19] It's not just cosmetic.
[34:20] It is a physical operation.
[34:23] change which you are impacting upon the abdomen to bring it back to how it was before pregnancy.
[34:28] Yeah.
[34:29] Once I had my muscles repaired, I could now sit up from lying down before I could not sit up.
[34:34] I can't do that now.
[34:35] I can't do a sit up.
[34:36] I would have to roll onto my side to stand up.
[34:38] It was quite amazing how weak I was.
[34:41] just I'm a very active, sporty person.
[34:43] There were things I could not do that now I can do, like sitting up from a lying position.
[34:49] Isn't that insane?
[34:50] I could not do that after twins and now I can because there was no support.
[34:54] And the more I would try and sit up and use those muscles, the more they would pull apart.
[34:59] And then I'd get this doming where the inside would just pop out
[35:02] where my belly button is, and you just feel weak.
[35:05] That's why I don't exercise.
[35:07] I give up on it because I'm like, I can't do a sit-up.
[35:10] You actually can't.
[35:11] I do Pilates with you.
[35:12] You can't sit up.
[35:12] And I can see all my food still going down.
[35:15] And when I lift myself up, my full belly button comes out.
[35:18] I still have that.
[35:18] Yeah.
[35:19] I just commando roll everywhere.
[35:22] So at what point...
[35:24] the Medicare support, where does that sit now and what are the rules for someone who might be in pain who might like to access this?
[35:33] Okay, so there's the way in which that's decided is through a book called the Medicare Benefit Schedule and it has a list of what they call descriptors, which are little paragraphs which absolutely describe what you need to comply with
[35:46] to be eligible for what they call an item number.
[35:48] And the item number then generates your private health fund and the Medicare schedule.
[35:52] So the two we're talking about are the item numbers 30175 and 30177.
[35:56] There's a couple of others, but they're the two main ones.
[36:01] 30175 relates to how far apart your muscles are.
[36:04] Okay.
[36:05] And your muscles need to be more than three centimetres apart on an ultrasound performed by an independent objective person.
[36:12] So it can't be the doctor in his rooms because he's gaming the system.
[36:16] So it's got to be an independent objective assessment.
[36:18] And if it's more than three centimetres and you've had pregnancy,
[36:23] then you can comply or you are suitable for that item number, which accesses the Medicare benefit schedule.
[36:30] The other one relates to the skin in association with the muscle.
[36:34] So that can be either as a result of pregnancy or as a result of massive weight loss.
[36:40] And there's a number of strict criteria there, but you need to have one, had significant weight loss.
[36:45] You need to have problems associated with your apron.
[36:48] So people who have large aprons often have
[36:51] rashes and the skin breaking down, infections and things like that.
[36:55] You need to have done something to address your weight loss and you need to be stable for a period of time.
[37:01] And the government says that all the conservative other things we talked about, like physio and so forth,
[37:06] have not been adequately able to address your concerns.
[37:10] And if that happens, you qualify for a number 30177.
[37:12] Okay.
[37:15] The thing you need to be aware of is that, that item number 30177 is classified as a higher band procedure with health funds.
[37:23] So you would need to check with your health fund
[37:26] beforehand because you don't want to be in that situation where you do all these things, get it all organised, you go to your health fund and then they suddenly say... Don't comply.
[37:34] You don't comply because you haven't got the right banding.
[37:36] Yeah, yeah.
[37:37] Okay, interesting.
[37:38] Let's talk about post-operative care.
[37:41] What can people expect from a full tummy tuck?
[37:44] My advice is what you're looking for in your postoperative recovery is you want it to be boringly uneventful.
[37:49] So you want to know what's happening ahead of time.
[37:51] You want to be told ahead of time what you're meant to be expecting so you know what to do and how to comply.
[37:56] Most surgeons would keep their patients in hospital for a minimum of one night.
[37:59] I would say normally two or three nights in hospital.
[38:02] That's quite a lot for elective plastic surgery.
[38:05] And the reason why I would do that is, again, it's not so much the patient, it's the family.
[38:10] You're saying to the family, no, this is really big surgery.
[38:14] When you get home, your wife cannot do the things she's ordinarily doing.
[38:17] So you're pre-training the family and the support network to look after you.
[38:22] The other thing we talked about is blood supply.
[38:24] And so by keeping you in hospital for one or two nights is it allows me to make sure that the blood supply of that tissue is exactly what we want it to be, that it's alive, that it's healing well.
[38:34] And we want to make sure that you don't have any of the biggest complication in that first 24 hours is bleeding.
[38:41] And that usually results from people doing too much in that first 24 hours, particularly getting up and going to the toilet.
[38:46] So what we would do is you had an odontoplasty is we would put a urinary catheter in for 48 hours.
[38:51] Oh, really?
[38:52] So you're just in bed and you're just chilling.
[38:54] I guess that's the whole thing because when you're having your, when you have surgery, you're on so much medication that you don't understand or realize the pain that you are in because you just kind of...
[39:03] I know with me having a cesarean, I was up.
[39:05] Like my block was very quickly in and out of my system and I was up within like eight hours after having a cesarean.
[39:12] They couldn't believe it but I had no pain.
[39:14] But I was on all the medications.
[39:16] Yeah.
[39:17] And I got staph infection and I split open.
[39:20] Like it was...
[39:21] Yeah, not great.
[39:22] But you're absolutely right because that's the thing is that the drugs we use in the hospital are also the advantages that we've got really strong stuff.
[39:28] Yeah.
[39:29] So we can give you drugs so you're not in any pain.
[39:31] But the problem then is that you're not in any pain.
[39:34] So you tend to think – I'll get out of bed.
[39:35] Get out of bed and do stuff.
[39:36] Yeah, of course you did.
[39:37] Of course you did.
[39:38] Of course I did.
[39:39] You're so naughty.
[39:39] And they were like, what are you doing up?
[39:41] Like you shouldn't be able to walk yet.
[39:42] Yeah.
[39:42] Yeah.
[39:43] Yeah, so I would keep in for two or three days and then gently go home with those very strict instructions.
[39:48] And then as you're going into that next week to two weeks to three weeks, the only thing we get stressed about is deep venous thrombosis or clots in your leg.
[39:56] So remember we said that I'm getting you to rest and I don't want you to do very much.
[40:00] So it's a bit like on a long-haul aeroplane flight, there's a risk getting clots in your legs.
[40:05] which can be managed.
[40:06] We just don't want them moving to your lungs because that can be lethal.
[40:10] So we're absolutely super vigilant to make sure that you don't get any clots in your legs or DVT in that first two to three weeks.
[40:18] How do we do that?
[40:19] Well, it starts on the operating table.
[40:21] So we're going to give you compression stockings and pneumatic things.
[40:24] We're going to pre-warm you, which we know is associated with lower incidence of DVT.
[40:29] postoperatively in the ward, you're going to have the compression stockings, which pump your legs.
[40:32] And then we're going to do a whole heap of exercises and things in the postoperative period.
[40:37] But then when you come back to see us at a week and 10 days, we're looking for that.
[40:40] And if we're worried or concerned, we're going to get an ultrasound.
[40:42] So we just, again, boringly uneventful.
[40:45] We want to know exactly what we're looking for.
[40:47] The patient knows what we're looking for.
[40:48] We know we're doing this.
[40:50] So nothing is a surprise.
[40:51] You know exactly what's going on.
[40:53] And literally, it needs to be two or three weeks of doing nothing, just chilling.
[40:57] Drains and bags, do you send patients home with those and how long do they usually stay attached for?
[41:02] Controversial.
[41:03] So some people would not use a drain at all and you would use what we call the sequential tensioning technique.
[41:09] Now, I'll just explain that briefly because then it helps everyone understand why we have different techniques.
[41:15] One isn't necessarily better than the other.
[41:17] It just depends on the individual surgeon.
[41:19] What we're trying to do is we've got to lift that skin and soft tissue up off the muscles so we can put them back together again.
[41:24] We then have effectively two dinner plates, as we talked about, between the skin on the top and the muscle on the bottom that we want to stick back down.
[41:31] So if we stick that back down by itself and don't do anything else, it will slide around, which means it doesn't stick, which means we end up with inflammation, which means we end up with seroma, which means we end up with scar tissue, which means we end up with concreation.
[41:42] So we don't want that.
[41:43] So one way is we actually sew the two layers together with a series of sutures, maybe 20, maybe 30, and physically sew the top layer, the roof,
[41:51] back to the floor to hold it back together.
[41:53] So that's called a sequential suturing technique.
[41:56] That's one option.
[41:57] The other option is that you put some drains in and they work effectively like a cryovac at the butchers.
[42:02] So you're under pressure, sucking everything in and physically splinting from the inside, the two layers together, holding it all together.
[42:10] And if any fluid collects, then that...
[42:12] It comes out.
[42:12] It comes out and keeps everything stuck together.
[42:15] So the drain would need to stay in until there's no fluid coming out and everything and then probably next to 24, 48 hours.
[42:21] So minimum of five.
[42:23] You don't do those.
[42:24] I do drains is what I do and I do some suturing as well too to try and hold everything together.
[42:29] And then the third thing is that people use is they use a compression garment around the outside to try and force everything together.
[42:37] The thing you need to be careful of is with that compression garment is that, remember I said to you, is that in that first two weeks or so, we're worried about blood supply.
[42:47] So if you're using a garment to compress the tissue, you've got to make sure the blood supply to the tissue is protected.
[42:55] So again...
[42:57] doing an abdominoplasty with liposuction, so you've upped the ante, and then you put an external compression garment on, you've upped the ante again.
[43:05] You've suddenly gone from boringly uneventful to we're flying over Ukraine on the way through to London to have a quick look.
[43:12] So you just, you can do it.
[43:13] Boring is best.
[43:13] Boring is best.
[43:14] How long after your operation can you have a shower?
[43:18] Most plastic surgeons now would use some form of a sterile super glue on the wound.
[43:22] So what that means is we effectively seal the wound so it's waterproof.
[43:26] Okay.
[43:27] So in theory, you could get that incision area wet, but the problem is we've got some drains coming out.
[43:33] So the drains coming out, if they get wet, you get wet dressing sitting up against the skin and your skin's going to turn like you've been in the bath for too long.
[43:39] Yeah.
[43:39] So we don't want that.
[43:40] So you would need to keep the drain site clean and dry until the drain comes out, ballpark 10 days, two weeks.
[43:48] Oh, that's a long time.
[43:49] You're just top and tailing, babe.
[43:50] No, you're just going to call it a pommy wash. No, you just get the...
[43:54] Handheld shower.
[43:55] Yeah, and you just do that and just... Yeah.
[43:57] Or like a basin of warm water and like a face washer.
[44:00] There is no way you're not going to get me not showering twice a day.
[44:02] Yeah, I just have to...
[44:06] So it's a big surgery.
[44:08] You're a professor.
[44:09] You've done a lot of plastic surgeries.
[44:11] Is this...
[44:12] the biggest operation?
[44:14] So the biggest operation that most plastic surgeons would be would be to take an abdominoplasty and then combine it with breast reconstruction, which is called a DEP or a free flat breast reconstruction where we take the tissue from your tummy and use it to reconstruct your breast either after a mastectomy or something like that.
[44:31] So this is like an abdominoplasty with steroids.
[44:34] And how long does that take?
[44:36] Somewhere between 6 and 12 hours.
[44:37] Oh, my God.
[44:39] Wow.
[44:39] Okay, so that's a big bopper.
[44:41] How many of those do you do a year?
[44:42] So I don't do as many of those.
[44:43] I don't do maybe two of those a year.
[44:45] So when we were at the Royal Melbourne and when we set up the system at the Women's Hospital, our unit there was doing two to three a week.
[44:53] Wow.
[44:54] It's a great operation because it allows you to get your own tissue to make your breast, which has been removed.
[45:01] So you don't have to have implants and all sorts of other things like that.
[45:04] And in the longer term,
[45:06] job's over.
[45:06] You've got your own tissue sitting in the right spot.
[45:08] If you put on weight, your breasts put on weight.
[45:09] If you lose weight, your breasts lose weight.
[45:11] But it's a big operation.
[45:13] That would be a big team, right?
[45:15] Big team.
[45:16] So two surgeons, four or five nursing staff, anaesthetist in hospital for a week to 10 days.
[45:22] Yeah, it's a full mummy makeover.
[45:24] Yeah.
[45:25] We always love to educate our listeners.
[45:28] You know, we show both sides of different surgeries when we talk to people and we talk about mindset and body dysmorphia.
[45:36] Are there situations where there's red flags with patients?
[45:41] And how do you deal with these patients?
[45:43] So the first thing is that there may be a physical reason why we would be worried about doing an abdominoplasty surgery.
[45:51] The first, obviously, is if the BMI is over 30.
[45:53] You're saying it's elective surgery, let's get your BMI down.
[45:56] But we've done all that and then we've looked at their tummy and we're going, what are the things that are going to make me say I'm worried or concerned about doing surgery on this patient?
[46:03] And the first thing is previous surgery or previous scars on the abdomen because a blood vessel is not going to go through a scar.
[46:08] It has to go around a scar.
[46:10] So if someone has come in and they've had, say, an open gallbladder removal,
[46:14] they're going to have a transverse scar or horizontal scar across their upper abdomen, which means the skin and soft tissue underneath that is at risk because you're making another cut when you do your abdominoplasty surgery.
[46:25] So you need to do what we call a delay procedure or a minor procedure beforehand to protect that.
[46:30] Otherwise, if you do that surgery a standard way, that skin's going to die.
[46:34] Similarly, if you had people who've had a lot of other abdominal surgery, you'd be looking at that abdomen going, okay, is there a way I can do the surgery and safely protect the blood supply to the tissue?
[46:45] And if I can't, then I would suggest we don't embark upon surgery at all.
[46:49] then there are that group of people who come in and you think, this is an ideal candidate for an abdominoplasty surgery.
[46:57] It's going to do all the things I want.
[47:00] But there's something about that patient which is making me nervous or making me worried that it's not the right operation for that particular patient.
[47:08] And then it becomes that conversation.
[47:10] It's not, can I do this surgery?
[47:12] It's, should I do this surgery?
[47:14] And that's a different question.
[47:16] Usually that person comes in and before they even walk in, the nursing staff or the receptionist staff...
[47:22] I'll look at you like this.
[47:24] Yeah, they sort of pick up this vibe.
[47:26] And it comes back to what we talked about before.
[47:27] It's not just the environment.
[47:28] It's about the staff around them.
[47:30] So the staff around your surgeon is also integral.
[47:33] They're part of your care.
[47:35] So if they're picking up that your expectation of outcome is not going to be likely met by the surgeon that they work with and know what his work's like...
[47:44] They're going to be going, okay, so in our rooms, for example, you would come in, you'd meet the receptionist, you'd meet our nursing staff.
[47:51] The nursing staff would ask you to get this robe and they would take a series of photographs and then they're going to put you into a gown and then you would come in and have a conversation.
[48:01] So there's an opportunity at that initial meeting where the nursing staff are super experienced there, 25, 30 years in this industry,
[48:10] And they can see what your expectation of outcome is, what you're presenting with, and they can give you objective, unbiased advice different to the surgeons.
[48:21] Because they're an impartial person who's on your side.
[48:24] Do you know what I mean?
[48:26] But yes, we do see people come in who've got washboard stomach and they've got the smallest amount of excess skin.
[48:31] That'd be nice.
[48:34] Yes, you are not a candidate.
[48:35] Go home.
[48:37] I suppose then the other time is where you see that environment around that patient that we're talking about is also not quite right.
[48:46] So they're asking for surgery but they're saying, I can't take time off work.
[48:49] I'm climbing Mount Everest.
[48:50] I'm going to do a hike in two weeks and you're like.
[48:53] No, in which case you're just going to say, great operation.
[48:56] Yes, it will get the results for you.
[48:57] Just not now.
[48:58] Just not now.
[48:58] Yeah.
[48:59] So what are the most common misconceptions you encounter about tummy tucks?
[49:04] The first and the most common is that people don't recognise that it's big surgery.
[49:10] So all surgery has risks and there are operations which I would say are good operations in that they're safe, reliable, predictable and work.
[49:17] And there are operations which are not so good operations in which there's a degree of risk, there's a degree of unpredictability, there's a degree of things going wrong.
[49:26] So let's think of a couple, Brazilian butt lift would be one, which we know in the wrong hands are unpredictable, don't work and do kill people on a regular basis.
[49:36] How is that even kind of legal?
[49:37] Like that's a whole nother question.
[49:39] Whole nother question.
[49:40] So the most common misconception is it's not big surgery.
[49:43] It is big surgery.
[49:44] All surgery has risks.
[49:46] You can minimise that risk, but you can't eliminate it.
[49:48] So that's the first thing.
[49:49] It's elective surgery.
[49:51] So make sure you get yourself and your team and your support family organised around that to make that recovery boringly uneventful.
[49:59] That's what you want.
[50:00] And then an abdominoplasty surgery is not...
[50:05] a substitute for weight loss or for hard exercise and gym and things like that.
[50:14] It's supportive.
[50:14] If your muscles are apart, then we know your muscles are not as strong.
[50:17] Your core is not as strong and it can help.
[50:19] It can bring the muscles back together again, but it's no substitute for an aggressive physical exercise regime.
[50:26] And I suppose the biggest thing we would see is that people come in and they're thinking that the abdominoplasty can get rid of their abdomen
[50:34] or that they can use an abdominoplasty surgery to get rid of a barrel abdomen in particular.
[50:39] Oh, yeah, yeah.
[50:40] So those people who don't put weight onto their arms or their legs or their face, but put it onto their abdomen, they have almost like a barrel abdomen.
[50:48] And when you look at their abdomen, it's super, super tight.
[50:51] And the problem with those patients is that to bring those muscles back together again, because the muscles are always apart, maybe 10, 15 centimetres apart, that's why the abdomen is barrel-shaped,
[51:02] You can't get them together because it's under too much tension.
[51:04] And the only way you can fix that is to get them to lose weight.
[51:08] So the analogy I would use is you're away overseas, you've been away for six weeks, you're about to pack your bags to come home and the suitcase won't close.
[51:15] Well, the only way you're going to be able to close the suitcase is to take clothes out.
[51:19] And that's what we've got to try and do here.
[51:20] You've got to try and get the person's weight down because they're holding fat in and around the internal organs.
[51:26] You want to get that fat down to give you some laxity to get the muscles back together again.
[51:31] You can do the operation, but down the track when their weight is more allowable to get those muscles back together again.
[51:39] Because it would be confusing for someone that has got small legs, smaller arms to go, well, the only thing is my stomach.
[51:45] It must be my muscles and my structure or whatever.
[51:48] It would be confusing for them.
[51:50] And then going into seeing you and you're like, no, no, this is, you actually do need to lose weight here.
[51:55] It's fat around your organs.
[51:56] Correct.
[52:00] It's not that you can't do the surgery.
[52:02] It's just that you need to do it when it's safe to do that surgery.
[52:06] And it's going to be successful.
[52:08] Yeah, correct.
[52:08] Because if you force that, which I've seen people do, you say, oh, that's not a problem.
[52:11] I've got really big sutures.
[52:12] I'm just super going to tighten up.
[52:14] Well, it's a bit like check the bag in and you've got the zip together and then you arrive, it explodes midair, and you arrive back at Tullamarine or, you know, mascot airport, and suddenly you find your suitcases all over the place.
[52:26] Yeah, yeah.
[52:27] I think another thing is, and I'm sure you do this, you see that in like friends, family, you know, people who we know, there's often unrealistic expectations with surgery and people chase perfection.
[52:41] And they'll be like, oh, I had this done.
[52:42] Oh, but I've got this and you can see my scar.
[52:44] I've got this dent.
[52:46] I think people need to be aware that perfection is kind of impossible, right?
[52:51] Like every surgery leaves a scar, leaves a mark.
[52:54] You can go to the best surgeon, the most experienced surgeon, and you might not heal as well as someone else you know who used that same surgeon and did that treatment.
[53:03] I feel like people who go in thinking that this plastic surgery is going to make them perfect need to know that it's not.
[53:09] Yeah, and that's my job and my team's job to try and pick that up ahead of time and then educate people where we can.
[53:16] Where's a good place for people to go and find good plastic surgeons?
[53:21] What's the resource?
[53:23] I would go to, first up, the Australian Society of Plastic Surgeons.
[53:26] So that's ASPS.
[53:29] They have a huge variety of information on there that can help you.
[53:35] Also, they're objective.
[53:36] So they're not trying to sell anyone.
[53:37] They're just trying to educate and help you.
[53:39] So that's where I would start.
[53:40] Mm-hmm.
[53:41] The other thing which I think is really important, and as you know, with the Cosmetic Cowboys and all those things that I was pretty heavily involved in.
[53:46] This is why I asked.
[53:47] Yeah.
[53:48] Because there's a lot of people out there and they don't know where to begin and they Google and they go, oh, that website looks good.
[53:54] Yeah.
[53:55] You'd want that if you're undergoing surgery for the person you're seeing to actually be a surgeon.
[53:59] Like that would, to me, make sense.
[54:01] So how do you make sure they're a surgeon?
[54:03] Well, in Australia, they're a fellow of the Royal Australasian College of Surgeons or FRACS.
[54:09] So that would be at the back, FRACS.
[54:11] Yeah, they have to have FRACS.
[54:12] And what happens if someone says, puts FRACS after their name and they're not?
[54:15] That's highly illegal, right?
[54:16] Yeah, yeah.
[54:16] So I'm on the College of Surgeons Council, and I'm Chair of Professional Development, so we would come after those people and say, take that down.
[54:24] Do you see that happen?
[54:25] Like if people see fracks written after someone's name, can they be very confident that they are who they say they are?
[54:31] Yes.
[54:32] Okay, good.
[54:32] Because we police that pretty heavily.
[54:34] Good.
[54:34] And APRA.
[54:35] And now, so yeah, APRA's a good one.
[54:38] And then the other thing, if you go on APRA, you want to look and see if what their registration classification is.
[54:45] You want some specialist registration and they will tell you what that is.
[54:51] So you don't want to be a general registration, you want to be specialist registration.
[54:55] And they'll tell you if they're a plastic and reconstructive surgeon or if they're an anaesthetist or theirs and so forth.
[55:01] The other thing which is a dead giveaway is that
[55:05] the environment in which that particular person is working.
[55:08] So if you go and see that particular surgeon or practitioner and you walk in and then ask questions like, where do you operate?
[55:16] In a hospital?
[55:17] Is the hospital accredited?
[55:18] Because you want to be on an accredited hospital, right?
[55:20] Mm-hmm.
[55:21] Do you use an anesthetist?
[55:22] Is the anesthetist accredited?
[55:23] Who is it?
[55:25] So you can do your research where you can look around that person and see, are they operating in a hospital with an anesthetist in an accredited facility?
[55:33] And are they actually a surgeon?
[55:35] Then all of a sudden, hang on, I'm getting a bit together, you know, when I do.
[55:38] And then as we talked about before, make sure that that's what that person both enjoys doing and does a lot of.
[55:44] You don't want the occasional surgeon doing your big operation as we've talked about.
[55:48] Just for the money.
[55:49] Like you want to know they're passionate about it and love doing it.
[55:52] And all of those things should be relatively apparent before you get there.
[55:56] Now, if that's being withheld, if that information is not freely being disclosed to you, smell a rat.
[56:03] Yeah, smell a rat.
[56:04] Red flag.
[56:04] Listen to your gut going, if your gut's going, I don't know about that.
[56:09] And you're exactly right, Bec.
[56:10] Like if someone comes in this botched surgery, almost every single person at some stage before the surgery has said,
[56:19] this isn't right, but he must know what he's doing so I continued on.
[56:26] No, just stop.
[56:27] It's elective surgery.
[56:29] Come back and get a second or a third opinion.
[56:33] Good advice.
[56:33] Good advice.
[56:34] All right.
[56:35] Wow, so informative.
[56:36] Yeah.
[56:37] So good.
[56:37] So good.
[56:38] It's been a pleasure having you on.
[56:39] Thank you so much for coming in.
[56:41] We appreciate you giving us your time.
[56:43] My absolute pleasure.
[56:44] Thanks, Jess.
[56:44] Thanks, Bec.
[56:45] Cheers.
[56:45] Thanks.
[56:46] All right.
[56:46] We'll see you next week for another episode of Vanish.
[56:49] Bye.
[56:50] Bye for now.

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