It is important to understand what is the best way to recover after a tummy tuck or abdominoplasty. This educational writing reviews how and why we position ourselves after the operation to allow for proper blood drainage from the legs. This is done to minimize blood clots and risks. General recovery instructions are covered in a different section under patient instructions and can be linked here. This writing reviews specifically drainage of blood from the legs and how we position ourselves to allow for the best healing and the lowest risks. This was written in response from a patient’s question from Glen Mills, PA.
Let’s start with the essential information. Blood drains downhill – just like water drains downhill. This is an important physical property of fluids. Blood and water both drain downwards. We can physically see this by studying our own hand. Hold your hand down at your side and the veins will get distended and full of blood. This is because it’s below your heart, and the blood runs down. Now raise your hand above your head. Wait 30 seconds, and the veins will empty as the venous blood drains out of the veins and hand. This allows us to visualize the drainage principle discussed that is so important to recovery after an abdominoplasty.
In the body, the heart pumps the blood around inside us. The heart should be thought of as “the bottom of the hill.” Everything above the level of the heart will have good drainage. Body parts below it will not drain well. After a tummy tuck, we need to get the legs above the heart. If they are above the heart, the blood will drain from the veins and decrease the chance of clotting. After this cosmetic surgery, use multiple pillows to achieve this. Sometimes ten pillows are necessary. It also makes it much easier if you lie down. This lowers the heart. Now, the legs can be more easily elevated above the heart. I call this the “tilted back lounge chair” position.
Sitting or standing up for long periods of time is considered a blood clot prone position. Why? Because the legs are dependent and below the heart. The blood can’t flow out of the legs easily. These positions are not recommended after surgery.
After surgery, the blood becomes “thick” or more prone to blood clots. The body is healing and trying to stop the normal bleeding that happens with surgical operations. Blood clots in the legs are also called deep venous clots or thrombosis. The initials are DVT. The clots can then move inside the veins and travel to the lungs. This is called a pulmonary embolus or PE. This problem is not common after surgery and is rare after cosmetic operations. But we want to maximize safety and to minimize any chance of this.
As discussed above, after surgery the blood tends to be “thick” or more prone to clot for about two weeks. After this period, assuming all is going well, the risk returns to essentially normal. After surgery, if the legs are not elevated properly, the blood won’t drain well. It can be thought of as being like water that is not flowing well. Think of a pond that has bad drainage. It can get stagnant. Give the water good drainage and it is clean and healthy. This is what we want for our legs. Get them elevated so the blood drain properly, and your leg veins will be clean and healthy.
Operations have different risks of blood clots or DVT. For example, short operations on the face have very low risks of this problem. Operations that are not done by plastic surgeons, such as hip operations and pelvic operations, can have a much higher risk of clots. Most plastic surgery operations have low risk. The abdominoplasty operation is one that we worry about the most, because it has a higher risk of this problem more than other cosmetic procedures.
Why is this the case? It gets back to drainage of blood. The tummy tuck recovery typically includes use of an abdominal binder. Also, the muscles are tightened. Both these factors cause increased abdominal pressure. The blood from the legs drains through the abdomen, so this pressure slows down the drainage.
Besides the “tilted black lounge chair” position, other things are recommended to minimize risks. Blood drains better with movement of the legs and the associated muscle contractions to move them. The muscles, when moving and contracting, physically pushes out the blood from the legs and gives better drainage. After operations, getting up and moving around is very important. It is called “Early Ambulation.” The leg movement and muscle contractions are important for the best blood drainage. Early Ambulation is always strongly recommended. But because of pain after surgery and the need to rest, we are still going to have lots of time in bed. So I recommend what I call the “Invisible Bicycle” in addition.
The “Invisible Bicycle” is a term I have coined to convey the leg movements that are recommended after the operation. Pump and move the legs, like riding a bicycle. You do this when you are in the “tilted back lounge chair” position. Imagine you are slowly riding a bike. Surprisingly, it doesn’t really hurt to do this after surgery. It doesn’t have to be fast. It can be done slowly. Also, one leg can be moved at a time and then the other. This alternating leg movement is best and recommended. This movement contracts the muscles and promotes blood drainage. It works especially well when the legs are elevated, giving the best preventative position.
Other methods are important to decrease DVT risks. Every operation I perform includes the use of sequential leg compression machines. These “leg boots” squeeze your legs when asleep to keep the blood flowing during surgery and promoting circulation. They are actually placed before the operation begins, as studies have shown they need to be on before the induction or start of anesthesia.
Also, leg compression stockings are to be worn during and after the operation. These stockings have different names. A common brand is Jobst stockings. Most drug stores sell brands that are similar. These are to be purchased and worn during and for two weeks after surgery. They compress the veins and again get better drainage.
After a tummy tuck, we want a flat, thin, and attractive stomach. But we want safety first and the lowest risks. I focus on safety with all my operations. By understanding the drainage of blood from the legs, we can more easily remember what is important during the recovery from the abdominoplasty operation.
Please come in for a consultation to review the specifics of your procedure.
