Addominoplastica

L’addominoplastica è l’intervento che si effettua per rimodellare la parete addominale e consiste nell’asportazione del tessuto adiposo e della cute presente in eccesso a livello dell’addome. Molto spesso è necessario anche agire sulla parete muscolo fasciale a causa del suo rilassamento. L’intervento consiste in un vero e proprio lifting della parete addominale con una sutura finale nella regione pubica, che può essere normalmente contenuta in un costume da bagno.
L’intervento si esegue in anestesia generale o spinale in sala operatoria e dura circa 3 ore.
Alla fine dell’intervento viene fatta indossare una guaina elastica e la paziente potrà riprendere gradualmente una normale vita di relazione dopo circa 5 giorni.Dopo circa 4 settimane è possibile riprendere l’attività sportiva.L’addominoplastica è la procedura chirurgica con la quale si asporta il grasso e la cute in eccesso dalla porzione media ed inferiore dell’addome e con la quale eventualmente si ricostruisce l’integrità dei muscoli della parete addominale. Quest’intervento modifica in maniera eclatante la protrusione dell’addome, ma il tutto a scapito di cicatrici permanenti che a seconda dei casi possono anche prolungarsi da una spina iliaca all’altra. 
I migliori candidati per quest’intervento sono pazienti in relativa buona salute, con eccesso di grasso e mantello cutaneo esuberante. Ad esempio donne che in seguito ad una gravidanza hanno disteso i loro tessuti in maniera eccessiva e non riescono più a riacquistare la forma fisica o ancora pazienti che abbiano una ridotta elasticità cutanea come coloro che hanno avuto un notevole calo ponderale (ex obesi). L’addominoplastica non va però in nessun caso considerata una scorciatoia di una dieta e quindi pazienti francamente in sovrappeso devono posporre l’intervento al dimagrimento. Così anche le pazienti che hanno in animo di avere un altro figlio è opportuno che attendino, per non rischiare di invalidare totalmente l’esito dell’intervento.

Rischi

Migliaia di addominoplastica vengono eseguite ogni anno senza che si verifichino complicanze di alcun genere. Ciò nonostante, come tutta la chirurgia anche questo intervento comporta dei rischi. Le complicanze sono costituite da infezioni (da trattare con terapia antibiotica), ematomi, sieromi (che vanno eventualmente drenati), tromboflebiti degli arti inferiori (il cui rischio viene minimizzato con la mobilizzazione precoce del/la paziente). Talvolta può manifestarsi una cattiva guarigione che può portare ad importanti cicatrici che richiedono un secondo intervento correttivo. Come sempe, se l’intervento è eseguito da un chirurgo plastico esperto, le complicanze sono molto rare e normalmente di ridotta entità. I fumatori hanno un rischio notevolmente aumentato di ritardo di guarigione e di insorgenza di complicanze.

Preparazione all’intervento

E’ buona norma, a cominciare dalla settimana precedente all’intervento, non assumere Ac. Acetilsalicico (aspirina) per evitare problemi di coagulazione, e per i fumatori astenersi per almeno 4 settimane (due prima e due dopo l’operazione).
Se si è reduci da un’infezione o una malattia sarebbe prudente posporre l’intervento chirurgico.
Se si viene operati in regime di Day-Surgery (dimissione nello stesso giorno) è indispensabile che il/la paziente venga accompagnato da una persona che possa prendersene cura nel riaccompagnarla a casa e nelle necessità delle prime 24-48 ore

L’intervento chirurgico

La procedura chirurgica richiede da 2 a 4 ore a secondo dell’estensione del difetto da correggere. Comunemente l’incisione chirurgica si estende da una spina iliaca all’altra passando subito al di sopra della regione pubica. Poi si separano i tessuti cutaneo e sottocutaneo dalla parete addominale estendendo lo scollamento fino alle costole. I muscoli vengono riaccollati fra loro e la cute viene quindi stirata verso il basso ed asportata nella sua porzione in eccesso. Una seconda incisione viene fatta intorno all’ombelico per liberarlo ed effettuare il suo spostamento. Nelle addominoplastiche parziali (mini-addominoplastiche) questa incisione può essere evitata. Generalmente dei tubi di drenaggio vengono lasciati in situ.
Una mini-addominoplastica invece può richiedere 1, 1 ½ ora. L’incisione è più corta di quella descritta in precedenza; si scolla una porzione di tessuto compresa tra la linea di incisione e l’ombelico, si stira verso il basso e si rimuove la porzione in eccesso prima di riaccostare i margini.

L’Anestesia

L’addominoplastica classica viene effettuata in Anestesia Generale, mentre la mini-addominoplastica può anche essere eseguita in Anestesia Locale con l’aggiunta o meno di sedazione.

Il post-operatorio

Nei primi giorni l’addome potrà essere particolarmente gonfio, in relazione all’estensione dell’intervento subito. La prima medicazione viene fatta dopo due giorni ed i tessuti dovranno essere tenuti asciutti sino alla rimozione dei drenaggi.
Nei primissimi giorni il dolore, presente soprattutto nei casi in cui vengono riaccostati i muscoli, viene controllato con terapia farmacologica. A secondo dell’estensione dell’intervento si chiede al paziente di riprendere con calma l’attività fisica, proibendo comunque per 4 settimane lo sport. I primi punti si rimuovono dopo una settimana, gli ultimi dopo tre. l/la paziente indosserà, alla rimozione della prima medicazione, una guaina compressiva che porterà per 4 settimane. Le prime due giorno e notte, le seconde 2 soltanto di giorno.
Il/la paziente avvertirà una ridotta sensibilità della cute addominale che riprenderà gradualmente nel corso delle settimane

Ripresa dell’attività

Il ritorno alle normali attività è in relazione all’entità dell’intervento subito, alle condizioni fisiche in cui si è affrontato l’intervento chirurgico ed alle singole capacità reattive. Una ripresa graduale non comincerà comunque prima di due settimane. La cicatrice sembrerà addirittura peggiorare nei primi 5-6 mesi per poi gradualmente andare a migliorare nello spazio di almeno 9-12 mesi dall’intervento.

Il nuovo aspetto

L’addominoplastica, sia essa parziale o completa, da ottimi risultati a quei/quelle pazienti che hanno problemi di eccesso cutaneo o di muscoli rilassati. Le aspettative devono quindi essere realistiche e bisogna essere preparati ad una lunga ed importante cicatrice. L’addominoplastica può cambiare l’aspetto e restituire quella self-confidence perduta, ma non necessariamente cambia il proprio look secondo i propri desideri o modifica il modo di fare delle persone che ci circondano.

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