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After losing a lot of weight or after frequent weight gains and loses, the skin of the belly may slacken. The same problem occurs after childbirth, when the skin looses its elasticity. In the case of exaggerated obesity, the skin hangs down with a thick fat layer.

These deformations can reach such a high degree that the belly hangs down like an apron. This causes hygienic and aesthetic problems or even loco-motor disorder. We can see bellies swelling out without a significant gain in weight, but with loose skin. In this case the two abdominal muscles have moved away from each other, and the muscle-sinew coat has stretched. Most commonly it is the result of childbirth.

In planning surgery, we must take into consideration which problem dominates, and how extensive the deformation is. The amount of the excess skin-fat complex and the extent of scarring depend on these factors; also whether or not the muscle-sinew coat should be repaired.

The surgery is made through an incision in the pubic hair connecting the two hipbones. The skin-fat layer is removed up to the costal arcs and almost to the breast-bone. The navel is cut around, leaving it on the base. A part under the navel is removed and the edges of the wound are joined after making a new opening for the navel, through which it is pulled out and fixed with knotty sutures. Silicone tubes are inserted to drain away mucus. In some cases liposuction is performed before the surgery to decrease the thickness of the fat layer, this may give a better result.

After the operation a pressure bandage is applied with a bag of sand. This is to decrease the possibility of bleeding and to help the wounds to adhere. We have special compression suits in which the patient may shower and dry. These may be worn for 4 weeks without interruption. The drains are removed on the 2nd – 3rd day, after which the patient may go home. Stitches are taken out after the 2nd – 3rd week. The compression bandage or suit is to be worn constantly for 4 weeks, and for a further 2 weeks during the daytime; it is recommended to wear for longer periods if playing sports.

Possible complications: bleeding, typical for the first 24-48 hours, skin necrosis (the stretching may hinder the circulation). Increased production of mucus and serum may cause problems in the first weeks; this must be removed. The most dangerous complication is the thrombus-embolism; this is life threatening. The causes may be the large wound, being overweight, smoking, lack of movement and varicose veins. The danger can be from a blood clot in the smaller veins which travels through the circulation possibly causing a serious closure in the lungs. Skin necrosis is also a serious complication caused by damage to the circulation. Most commonly it occurs under the navel on a small area, but in serious cases it can be more than palm-sized. Usually it recovers spontaneously, but the healing may take months. The area involved will differ in its colour and condition from the surrounding healthy skin.

In the first weeks the possibility of inflammation also endangers the health of the patient. This may lead to intense suppuration and the development of abdominal abscesses. The quality of wound healing is significantly affected by the long line of incision. The wound often widens and sometimes abnormal scar formation (keloid) occurs.

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