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DONALD J. CAPUANO, M.D.
Plastic Surgeon

WELCOME TO

Tummy Tuck USA

Tummy tucks can be an extensive procedure. Other less extensive procedures such as suction contouring, liposuction, liposculpture, tumescent liposuction, ultrasonic liposuction etc, may be more appropriate. If your condition is such that there is a

Significant amounts of hanging skin, or skin that is very crinkled and you can't stand it !!! - then read on

If the amount of excess skin is nil to some (an inch or so) then also check the liposuction pages.

You are interested in information regarding the procedure for removal of excessive skin and fat of the abdominal area. Sometimes there is very little skin and fat but it may be that the quality of the skin is so unacceptable that the individual will trade their situation for a scar. This procedure is known as tummy tuck, abdominoplasty, abdominal lipectomy, abdominal dermatolipectomy, panniculectomy, etc. and is usually combined with liposuction. The names mentioned do reflect some differences in the procedures but it is 'beyond the scope' of this informational session to explain the differences. For the sake of simplicity, the terms 'tummy tuck' or abdominalplasty will be used during the discussion. Suffice it to say that during a 'tummy tuck' both fat and skin are removed from the abdominal area.

Your preoperative evaluation is very important. During this evaluation, Dr Capuano will advise you what, in his experience, would be the most appropriate. Some think that because they can pinch extra skin, that they need a 'tummy tuck'.

While technical details as to how the operation is accomplished may vary, generally the procedure involves making an incision in the crease at the pubic hairline (the groin area). The incision may extend from one hipbone area to the other usully in a gentle curve. Smaller incisions are possible. Tailoring of the incisons to an individuals life style is the GOAL not a guarantee. So if you ware bikinis - incisions may differ -

Through the incision the tissues (both skin and fat ) are lifted off the tummy wall, all the way to the breast bone and the lower ribs. The bellybutton is freed up during the process leaving the base and skin of the belly button standing in the middle of the tummy. The layers of the tummy may be tightened, if indicated, by stitches.

A point about anatomy -
The layers of the abdominal wall include fascia (a coating over the muscle of tough white tissue - you can see this around a beef steak), the muscle, and then more fascia. You may have heard that the muscles are tightened. Well that is in a manner of speaking. As far as I know and have seen, actually the fascia is tightened. The muscles are drawn with the fascia. As you may know, muscle does not hold a stitch very well. Actually even the fascia may not hold a stitch over time. You may have heard of 'recurrent' hernias - well that is what happens when the fascia does not hold the stitch, the hernia pushes through the repair.

After tightening the fascia if indicated, suction removal of fat is usually done.

The extra skin and fat is brought down and removed. The incisions are then sewn together at the area of the pubic hair line, and the remainder of the incisions are closed after the belly button is brought back through the fat and skin.

Drainage tubes are brought out to allow for healing without collections of fluid (although this may still occur). A dressing which wraps around and is held by a Velcro elastic binder is then applied. This keeps the layers of skin and fat tight on the tummy wall so that there is less of a chance that fluid will accumulate.

You should be aware of the possible risks and complications associated with surgery, which include, but are not limited to bleeding, infection, slow wound healing, risks of anesthesia, irregularity of the skin, numbness in the areas treated, collection of fluid in the area, thickened scars, and the possibility of the need for further surgery. Most of these problems have been minor in Dr Capuano's experience. The need for blood transfusions in tummy tucks has been zero in the past fifteen years. The incidence of a sever infection has also been zero. Anesthesia is save in today's day and age. But no matter what we tell you, there is always that chance that an adverse happing could occur. The statistical probability of such happing can be discussed with you is you have specific concerns.

There are many factors to be considered in this surgery, and many judgments to be made by Dr. Capuano. We try to make as many decisions as possible before surgery, but some judgments can only be made at the time of surgery.

During surgery, an incision that was intended to be lower may have to be made higher. This is because the skin might not stretch enough. After surgery, scars can change position, and especially drop. For these reasons final scars may not be exactly where you anticipated.

Rare cases of skin loss, heart and lung problems, hemorrhage, and even death have been recorded. Thankfully, these have not occurred with any of Dr. Capuano's patients. They are listed for your information. These and other remote risks must be accepted by you if you decide to go ahead with surgery. We do not anticipate that these problems will occur, but there is always a chance that one or more of these problems may occur.

If you have questions regarding these risks, please ask the Doctor.

You must be admitted to the hospital for this procedure. You should anticipate a stay of approximately two to four days following your surgery, depending upon your progress.

It is rare but Dr. Capuano might suggest that you donate one unit of your own blood in the event that transfusion is necessary (hasn't happened in 20 years). This is usually done within one month prior to surgery. Information will be given to you regarding auto-donation if indicated in your particular case.

As described above, this procedure is quite extensive. To redescribe, it may last anywhere from three to five hours. It involves making an incision in the skin of the abdomen in the area above the pubic area, which usually extends to both hip areas. The tissues are freed up, and then the skin is pulled downward. Suction lipectomy, (removal of excess fat by means of suction) of the area may be performed at this time. Excess tissue is then removed, the muscles and tissues of the "belly" may be tightened, and the "belly button" repositioned. The skin is then closed, usually with a combination of surgical steel clips and sutures. of sutures and steel clips.

We ask that you refrain from taking any products containing aspirin for at least two weeks prior to your surgery. Do not eat apples, as they contain an aspirin-like substance. Aspirin thins the blood, which may cause more bleeding during surgery. If you are taking aspirin on the advice of a physician, please let us know.

Following your surgery, you will have a large dressing in place. Two drains will be in place, which are usually removed a day or two following surgery. This dressing must remain clean, dry and on.

You will be given medications for swelling, infection and discomfort in the hospital. You will also be given prescriptions for these medications upon your discharge from the hospital. Please take these medications until they are gone, unless advised otherwise. If you have a problem with a medication, please call the office.

If you plan on staying anywhere other than your own home following surgery, notify the office. We need to be able to contact you after surgery.

When you are discharged from the hospital, you will be asked to call the office and make an appointment. At the time of your first post-operative visit, the dressing will be removed, and you will be advised regarding wound care. In most cases, surgical steel clips will be in place. for ten days to two weeks. You will also have stitches, which are removed at the same time as the clips, depending upon wound healing.

You should not engage in any stressful activities at home, and should rest and relax. You may have visible "black and blue" in the areas. This is to be expected. You can also expect numbness in the areas. This may be present for quite some time, but sensation should gradually return. This may take anywhere from three months to one year.

If you notice increasing swelling, redness or a sudden onset of discomfort, please call the office immediately. A problem we have encountered repeatedly with patients undergoing abdominalplasty is that they tend to resume their usual activities too quickly. This is not good for healing. It can cause accumulations of blood and/or fluid, slow wound healing, opening of the incision and infection.

We must urge you to take it easy, especially during the first two - three weeks following surgery. Do not overdo it. Try to rest and relax, and if at all possible it is preferable that you not return to work for at least two weeks. People who have desk (sitting) jobs are especially prone to aggravate a healing wound. In summary, abdominal lipectomy is extensive surgery. While the number of unanticipated problems encountered to this point in Dr. Capuano's experience have been few, and while problems are not anticipated in your particular case, they may occur. We certainly hope that you will do well and be as pleased with the result of your surgery as others have been. A good result and a happy patient are our goals, but these cannot be guaranteed.



PATIENT INFORMATION REGARDING ABDOMINAL LIPECTOMY

You are interested in information regarding the procedure for removal of excessive skin and/or fat of the abdominal area. This procedure is known as abdominal lipectomy.

You should be aware of the possible risks and complications associated with surgery, which include, but are not limited to bleeding, infection, slow wound healing, risks of anesthesia, irregularity of the skin, numbness in the areas treated, collection of fluid in the area, thickened scars, and the possibility of the need for further surgery. There are many factors to be considered in this surgery, and many judgments to be made by Dr. Capuano. We try to make as many decisions as possible before surgery, but some judgments can only be made at the time of surgery.

During surgery, an incision that was intended to be lower may have to be made higher. This is because the skin might not stretch enough. After surgery, scars can change position, and especially drop. For these reasons final scars may not be exactly where you anticipated.

You should be aware that following surgery the measurement of your waist may be larger than previously. This is because usually the area of surgery is below the waistline, and shifting tissues may change the contour and shape of the torso. Although your abdomen will be flatter, the overall look may be wider.

Rare cases of skin loss, heart and lung problems, hemorrhage, and even death have been recorded. These have not occurred with any of Dr. Capuano's patients. They are listed for your information. These and other remote risks must be accepted by you if you decide to go ahead with surgery. We do not anticipate that these problems will occur, but there is always a chance that one or more of these problems may occur.

If you have questions regarding these risks, please ask the Doctor.

You must be admitted to the hospital for this procedure. You should anticipate a stay of approximately two to four days following your surgery, depending upon your progress.

In some cases, the Doctor will suggest that you donate one to two pints of your own blood in the event that transfusion is necessary. This is usually done within one month prior to surgery. Information will be given to you regarding autodonation if indicated in your particular case.

This procedure is quite extensive. It may last anywhere from three to five hours. It involves making an incision in the skin of the abdomen in the area above the pubic area, which usually extends to both hip areas. The tissues are freed up, and then the skin is pulled downward. Suction lipectomy, (removal of excess fat by means of suction) of the area may be performed at this time. Excess tissue is then removed, the muscles and tissues of the "belly" may be tightened, and the "belly button" repositioned. The skin is then closed, usually with a combination of surgical steel clips and sutures. of sutures and steel clips.

We ask that you refrain from taking any products containing aspirin for at least two weeks prior to your surgery. Do not eat apples, as they contain an aspirin-like substance. Aspirin thins the blood, which may cause more bleeding during surgery. If you are taking aspirin on the advice of a physician, please let us know.

Following your surgery, you will have a large dressing in place. Two drains will be in place, which are usually removed a day or two following surgery. This dressing must remain clean, dry and on.

You will be given medications for swelling, infection and discomfort in the hospital. You will also be given prescriptions for these medications upon your discharge from the hospital. Please take these medications until they are gone, unless advised otherwise. If you have a problem with a medication, please call the office.

If you plan on staying anywhere other than your own home following surgery, notify the office. We need to be able to contact you after surgery.

When you are discharged from the hospital, you will be asked to call the office and make an appointment. At the time of your first post-operative visit, the dressing will be removed, and you will be advised regarding wound care. In most cases, surgical steel clips will be in place. for ten days to two weeks. You will also have stitches, which are removed at the same time as the clips, depending upon wound healing.

You should not engage in any stressful activities at home, and should rest and relax. You may have visible "black and blue" in the areas. This is to be expected. You can also expect numbness in the areas. This may be present for quite some time, but sensation should gradually return. This may take anywhere from three months to one year.

If you notice increasing swelling, redness or a sudden onset of discomfort, please call the office immediately. A problem we have encountered repeatedly with patients undergoing abdominalplasty is that they tend to resume their usual activities too quickly. This is not good for healing. It can cause accumulations of blood and/or fluid, slow wound healing, opening of the incision and infection.

We must urge you to take it easy, especially during the first two - three weeks following surgery. Do not overdo it. Try to rest and relax, and if at all possible it is preferable that you not return to work for at least two weeks. People who have desk (sitting) jobs are especially prone to aggravate a healing wound. In summary, abdominal lipectomy is extensive surgery. While the number of unanticipated problems encountered to this point in Dr. Capuano's experience have been few, and while problems are not anticipated in your particular

case, they may occur. We certainly hope that you will do well and be as pleased with the result of your surgery as others have been. A good result and a happy patient are our goals, but these cannot be guaranteed. Photographs and/or video taping will be done before, possibly during and after your surgery. If photos have not been taken, please let us know.

PATIENT INVENTORY FOR ABDOMINALPLASTY

Please complete this inventory for our records

Name___________________________________ Date__________________ Current height______________ Current weight____________ Greatest weight as adult________ Lowest weight as adult________

Please circle problems you may experience - add other problems not listed: Rash Chafing (Skin rubbing) Itching Difficulty walking Difficulty bending Infection or pustules Pain Back strain Muscle strain Drainage Odor Groin pulling Hernia Swelling Back Surgery Difficulty buying clothing Other______________________________________________________________ Have you had abdominal surgery? If yes, please list ______________________________________________________________________ ______________________________________________________________________ What diets have you tried?__________________________________________ _____________________________________________________________________ _____________________________________________________________________ List successful diet(s) : ________________________________________ On what diet did you NOT regain weight _______________________ How often do you exercise __________________________________________ Regular exercise ? Yes No Comments ?? ________________________________ Do you feel that exercise has been helpful? Yes No Because of your condition, do you feel little distress - some distress - significant distress Please measure yourself and record the measurements below At the level of the nipples___________________________ in inches At the level of the bra band below breasts_______________ At the navel (belly button)____________________ Between bra line and navel_______________________ At the level of the pubic bone___________________ Between the navel and pubic bone___________________ For women: Number of children__________________ Did you have a Caesarean section? Yes No Number _____ Thank you.



Patient seen in consultation about ABDOMINAL LIPECTOMY - removal of fat and skin

Points explained and discussed: Admission_____ Method_____ Incisions_____ Autologous transfusion_____ Dressing_____ Drains_____ Placement of navel_____ Tightening of muscles_____

things to be expected: Black and blue_____ Swelling_____ Temporary numbness_____ Scars_____ Stretch marks (better - worse) Muscle tightening _____ Long lasting drainage _____

Possible happenings discussed: Thick scars_____ Small tender areas_____ Localized bleeding_____ Minor infection in the suture line_____ Numbness_____ Change in scar position during or after surgery _____

Rare happenings discussed: Permanent numbness_____ Thickened scars_____ Tender scars_____ Need for blood transfusion_____ Accumulation of fluid_____ Long lasting drainage_____ Treatable lung clots_____ Excessive bleeding necessitating return to surgery____Further loss of time from work and activities_____ Further medical costs if not covered by insurance____

Extremely remote happenings discussed: READ THESE Anesthetic problems including death, paralysis, vegetation Severe mental difficulties_____ Severe bleeding_____ Skin loss_____ Permanent severe nerve injury_____ Major blood vessel injury_____ Heart and lung problems_____ Severe infection_____ Severe medication reactions_____

No guarantees can be given given. Patient seen in consultation about ABDOMINAL LIPECTOMY - removal of fat and skin Points explained and discussed: Admission_____ Method_____ Incisions_____ Autologous transfusion_____ Dressing_____ Drains_____ Placement of navel_____ Tightening of muscles_____ things to be expected: Black and blue_____ Swelling_____ Temporary numbness_____ Scars_____ Stretch marks (better - worse) Muscle tightening _____ Long lasting drainage _____ Possible happenings discussed: Thick scars_____ Small tender areas_____ Localized bleeding_____ Minor infection in the suture line_____ Numbness_____ Change in scar position during or after surgery _____ Rare happenings discussed: Permanent numbness_____ Thickened scars_____ Tender scars_____ Need for blood transfusion_____ Accumulation of fluid_____ Long lasting drainage_____ Treatable lung clots_____ Excessive bleeding necessitating return to surgery____Further loss of time from work and activities_____ Further medical costs if not covered by insurance____ Extremely remote happenings discussed: READ THESE Anesthetic problems including death, paralysis, vegetation Severe mental difficulties_____ Severe bleeding_____ Skin loss_____ Permanent severe nerve injury_____ Major blood vessel injury_____ Heart and lung problems_____ Severe infection_____ Severe medication reactions_____

****** INSTRUCTIONS FOLLOWING ABDOMINAL LIPECTOMY *******

Do not take products containing aspirin following your surgery. Do not eat apples, as they contain an aspirin-like substance. If needed, take a product which does NOT contain aspirin.

Following your surgery you will be in the hospital for two to four days, sometimes longer, depending upon your progress. While in the hospital, you will be given medications for swelling, infection and discomfort. You may be given medications through an I.V.. You may receive injections. At first you should stay in bed unless instructed differently. The first time you get up to walk around, you should have nursing go to the bathroom, assisted at first, until you and the staff caring for you feel you can manage on your own.

You will have a large dressing in place following your surgery. Tubes may be in place for drainage. These are usually removed one or more days following surgery.

The dressing applied directly after surgery should remain on. It may be added to by the nurses from time to time.

If you plan on staying anywhere other than your own home following surgery, notify the office. We need to be able to contact you after surgery.

Upon your discharge from the hospital, you will be given prescriptions for the medicines you were taking in the hospital. Please take these medications as directed, and finish all prescriptions unless advised otherwise. If you have a problem with any medication, please call the office. If you are currently taking other medications, please inform the Doctor. Please do not take aspirin or products containing aspirin until advised otherwise. Please do not eat apples, as they contain an aspirin-like substance.

You may have been given a prescription for iron prior to your surgery or following your surgery. Please take this as directed.

You may be asked to drink Gatorade following your surgery. You may also be asked to take multivitamins following your surgery.

If you notice a sudden increase of redness, swelling or a sudden onset of discomfort, please call the office immediately.

You will be asked to call Dr. Capuano's office to make an appointment to be seen following your surgery. At the time of your first post- operative visit the dressing will be removed, and you will be advised regarding wound care. You will probably have a combination of sutures (stitches) and stainless steel clips in place along the incision. These will be removed anywhere between one and two weeks following surgery.

You should not engage in any stressful activity at home, and should rest and relax. You may have visible areas of bruising, which is to be expected. You can also anticipate numbness in the area. This may be present for quite some time, but sensations should gradually return. This may take anywhere from three months or more to resolve entirely.

Regarding your diet, you may resume your regular diet as tolerated. Do not begin a weight reduction diet immediately after surgery. Ask the Doctor when you may begin this, if planned.

You may feel tired following surgery. This is to be expected, as this is an extensive procedure. This feeling may last a few weeks or more. As you recuperate, this feeling will gradually fade. You can gradually increase your level of activity as tolerated, but ask the Doctor before undertaking any activity of which you are unsure.

Some patients feel "depressed" following surgery. This is not unusual, and this feeling, if it does occur, usually lasts a short time.

You will be seen periodically for follow up in the office. Photographs may be taken periodically to document your progress. You will not be identified in these photos, except for our office records.


****** INSTRUCTIONS FOLLOWING ABDOMINAL LIPECTOMY *******

Do not take products containing aspirin following your surgery. Do not eat apples, as they contain an aspirin-like substance. If needed, take a product which does NOT contain aspirin.

Following your surgery you will be in the hospital for two to four days, sometimes longer, depending upon your progress. While in the hospital, you will be given medications for swelling, infection and discomfort. You may be given medications through an I.V.. You may receive injections. At first you should stay in bed unless instructed differently. The first time you get up to walk around, you should have nursing go to the bathroom, assisted at first, until you and the staff caring for you feel you can manage on your own.

You will have a large dressing in place following your surgery. Tubes may be in place for drainage. These are usually removed one or more days following surgery.

The dressing applied directly after surgery should remain on. It may be added to by the nurses from time to time.

If you plan on staying anywhere other than your own home following surgery, notify the office. We need to be able to contact you after surgery.

Upon your discharge from the hospital, you will be given prescriptions for the medicines you were taking in the hospital. Please take these medications as directed, and finish all prescriptions unless advised otherwise. If you have a problem with any medication, please call the office. If you are currently taking other medications, please inform the Doctor. Please do not take aspirin or products containing aspirin until advised otherwise. Please do not eat apples, as they contain an aspirin-like substance.

You may have been given a prescription for iron prior to your surgery or following your surgery. Please take this as directed.

You may be asked to drink Gatorade following your surgery. You may also be asked to take multivitamins following your surgery.

If you notice a sudden increase of redness, swelling or a sudden onset of discomfort, please call the office immediately.

You will be asked to call Dr. Capuano's office to make an appointment to be seen following your surgery. At the time of your first post- operative visit the dressing will be removed, and you will be advised regarding wound care. You will probably have a combination of sutures (stitches) and stainless steel clips in place along the incision. These will be removed anywhere between one and two weeks following surgery.

You should not engage in any stressful activity at home, and should rest and relax. You may have visible areas of bruising, which is to be expected. You can also anticipate numbness in the area. This may be present for quite some time, but sensations should gradually return. This may take anywhere from three months or more to resolve entirely.

Regarding your diet, you may resume your regular diet as tolerated. Do not begin a weight reduction diet immediately after surgery. Ask the Doctor when you may begin this, if planned.

You may feel tired following surgery. This is to be expected, as this is an extensive procedure. This feeling may last a few weeks or more. As you recuperate, this feeling will gradually fade. You can gradually increase your level of activity as tolerated, but ask the Doctor before undertaking any activity of which you are unsure.

Some patients feel "depressed" following surgery. This is not unusual, and this feeling, if it does occur, usually lasts a short time.

You will be seen periodically for follow up in the office. Photographs may be taken periodically to document your progress. You will not be identified in these photos, except for our office records.


INSTRUCTIONS FOLLOWING YOUR SURGERY FOR EXCESSIVE SKIN AND FAT REMOVAL OF THE ABDOMEN ACTIVITY - AS IN HOSPITAL - DO NOT INCREASE YOUR ACTIVITY VERY MUCH UNTIL YOU SEE THE DOCTOR IN THE OFFICE TEMPERATURE - TAKE YOUR TEMPERATURE FOUR TIMES A DAY - IF YOU SMOKE (AND WE ADVISE YOU NOT TO), MAKE SURE YOU DON'T SMOKE OR DRINK HOT LIQUIDS BEFORE TAKING YOUR TEMPERATURE. REPORT ANY TEMPERATURE ABOVE 100.5 TO THE DOCTOR MOVE YOUR LEGS FREQUENTLY - PUMP YOUR FEET UP AND DOWN TO KEEP THE CIRCULATION MOVING. MEDICINES BENADRYL - AS LISTED ON THE SHEET IBUPROFEN - AS LISTED ON THE SHEET ANTIBIOTIC - (ONLY IF GIVEN A PRESCRIPTION) VITAMINS - 1 MULTIPLE VITAMIN WITH MINERALS 2 TIMES A DAY BATHING - YOU MAY SPONGE BATHE - YOU MAY SHOWER - PAT DRY OR USE A HAIR DRYER FOR WOUNDS DAB WITH ALCOHOL THEN APPLY A DRESSING AS SHOWN IN THE HOSPITAL DRESSINGS - - CHANGE THE DRESSINGS AS SHOWN TO YOU IN THE HOSPITAL - NO DRESSING CHANGES ARE TO BE DONE DRAINS - CHECK AMOUNT OF DRAINAGE THREE TIMES A DAY AND EMPTY THE CHAMBER IF IT IS MORE THAN HALF FULL - NO DRAINS NEED TO BE CHECKED. CALL THE OFFICE =============== ON THE NEXT OFFICE DAY (MONDAY - FRIDAY) AT 585-225-0680 MAKE AN APOINTMENT FOR _________________________________ THE SECRETARY WILL GIVE YOU THE TIME CALL AT ANY TIME FOR QUESTIONS OR PROBLEMS SUCH AS - SUDDEN BLEEDING - ESPECIALLY BRIGHT RED - FEVER, CHILLS, REDNESS AT THE OPERATION SITE - DIZZINESS (USUALLY DUE TO MEDICINES) - NAUSEA, VOMITING ETC - REDNESS OF THE WOUND AND ESPECIALLY IF THERE IS DRAINAGE - CALL SOONER THAN LATER

CONSENT FOR ABDOMINALPLASTY

I have discussed with the Doctor in detail any questions I might have regarding abdominalplasty. While the procedure is thought to be safe and severe complications have not occurred in Dr. Capuano's experience, I understand there is a chance they could occur in my particular case.
I understand: - that there are possible problems and complications involved with surgery, which include but are not limited to bleeding, infection, temporary or permanent numbness, temporary or permanent pain, slow wound healing, painful scars, thickened scars, wound opening, skin loss, loss of the belly button, displacement of the belly button, need for blood transfusion and the need for further surgery. - that there are possible risks and complications involved with anesthesia and surgery which, while extremely remote may occur and include death, paralysis, vegetation, mental difficulties, medication reactions, heart problems, lung problems, and so forth. - that the explanation I have received regarding possible problems and complications is not and cannot be exhaustive and that other, more remote problems or complications could arise. - that a more detailed explanation regarding risks and complications can be given to me at my request. .

- that the costs of further professional and/or hospital fees are not included in current estimates. - that no guarantees as to time away from work and/or social activities can be given, and that estimates regarding return to usual activity are only estimates. - that failure to follow Dr. Capuano's instructions following surgery may change the eventual result of surgery. I acknowledge that I have had the opportunity to speak with the Doctor about this surgery, and that I understand the surgery planned. I am aware of the results that are probably expected, but I also understand that RESULTS CANNOT BE GUARANTEED. I consent to photographing, videotaping, computer imaging and/or drawing of the procedure as indicated. .

If I have any questions, or there is anything I do not understand, I will bring these things to the attention of Dr. Capuano BEFORE MY SURGERY

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