INFORMED-CONSENT – ABDOMINOPLASTY SURGERY

INSTRUCTIONS
This is an informed-consent document that has been prepared to help your plastic surgeon inform you of
abdominoplasty surgery, its risks, as well as alternative treatments.

It is important that you read this information carefully and completely. Please initial each page, indicating that
you have read the page and sign the consent for surgery as proposed by your plastic surgeon.

INTRODUCTION
Abdominoplasty is a surgical procedure to remove excess skin and fatty tissue from the middle and lower
abdomen and to tighten muscles of the abdominal wall. Abdominoplasty is not a surgical treatment for being
overweight. Obese individual who intend to lose weight should postpone all forms of body contouring surgery
until they have been able to maintain their weight loss.

There are a variety of different techniques used by plastic surgeons for abdominoplasty. Abdominoplasty can
be combined with other forms of body-contouring surgery including suction-assisted lipectomy or performed
at the same time with other elective surgeries.

ALTERNATIVE TREATMENTS
Alternative forms of management consist of not treating the areas of loose skin and fatty deposits. Suction
assisted lipectomy surgery may be a surgical alternative to abdominoplasty if there is good skin tone and
localized abdominal fatty deposits in an individual of normal weight. Diet and exercise programs may be of
benefit in the overall reduction of excess body fat.

Risks and potential complications are associated with alternative forms of treatment that involve surgery.

RISKS of ABDOMINOPLASTY SURGERY

Every surgical procedure involves a certain amount of risk and it is important that you understand the risks
involved with abdominoplasty. An individual’s choice to undergo a surgical procedure is based on the
comparison of the risk to potential benefit. Although the majority of patients do not experience the following
complications, you should discuss each of them with your plastic surgeon to make sure you understand all
possible consequences of abdominoplasty.

Bleeding- It is possible, though unusual, to experience a bleeding episode during or after surgery. Should
post-operative bleeding occur, it may require emergency treatment to drain accumulated blood or blood
transfusion. Do not take any aspirin or anti-inflammatory medications for ten days before surgery, as this may
increase the risk of bleeding.

Infection- Infection is unusual after this type of surgery. Should an infection occur, treatment including
antibiotics or additional surgery may be necessary.

Change in skin sensation- Diminished (or loss of) skin sensation in the lower abdominal area may not
totally resolve after abdominoplasty.

Skin contour irregularities- Contour irregularities and depressions may occur after abdominoplasty.
Visible and palpable wrinkling of skin can occur.

Skin scarring- Excessive scarring is uncommon. In rare cases, abnormal scars may result. Scars may be
unattractive and of different color than surrounding skin. Additional treatments including surgery may be
necessary to treat abnormal scarring.

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Risks of Abdominoplasty surgery, continued

Surgical anesthesia- Both local and general anesthesia involve risk. There is the possibility of
complications, injury, and even death from all forms of surgical anesthesia or sedation.

Asymmetry- Symmetrical body appearance may not result from abdominoplasty. Factors such as skin tone,
fatty deposits, bony prominence, and muscle tone may contribute to normal asymmetry in body features.

Delayed healing- Wound disruption or delayed wound healing is possible. Some areas of the abdomen may
not heal normally and may take a long time to heal. Some areas of skin may die. This may require frequent
dressing changes or further surgery to remove the non-healed tissue.

Smokers have a greater risk of skin loss and wound healing complications.

Allergic reactions- In rare cases, local allergies to tape, suture material, or topical preparations have
been reported. Systemic reactions which are more serious may occur to drugs used during surgery and
prescription medicines. Allergic reactions may require additional treatment.

Pulmonary complications- Pulmonary complications may occur secondarily to both blood clots
(pulmonary emboli) or partial collapse of the lungs after general anesthesia. Should either of these
complications occur, you may require hospitalization and additional treatment. Pulmonary emboli can
be life-threatening or fatal in some circumstances.

Seroma- Fluid accumulations infrequently occur in between the skin and the abdominal wall. Should this
problem occur, it may require additional procedures for drainage of fluid.

Umbilicus- Malposition, scarring, unacceptable appearance or loss of the umbilicus (navel) may occur.

Long term effects- Subsequent alterations in body contour may occur as the result of aging, weight loss
or gain, pregnancy, or other circumstances not related to abdominoplasty.

Pain- Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue after
abdominoplasty.

Other- You may be disappointed with the results of surgery. Infrequently, it is necessary to perform additional
surgery to improve your results.

ADDITIONAL SURGERY NECESSARY

Should complications occur, additional surgery or other treatments may be necessary. Even though risks
and complications occur infrequently, the risks cited are particularly associated with abdominoplasty. Other
complications and risks can occur but are even more uncommon. The practice of medicine and surgery is
not an exact science. Although good results are expected, there is no guarantee or warranty expressed or
implied, on the results that may be obtained.

HEALTH INSURANCE
Most health insurance companies exclude coverage for cosmetic surgical operations such as abdominoplasty
or any complications that might occur from surgery. Please carefully review your health insurance subscriber
information pamphlet.

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FINANCIAL RESPONSIBILITIES
The cost of surgery involves several charges for the services provided. The total includes fees charged by
your doctor, the cost of surgical supplies, anesthesia, laboratory tests, and possible outpatient hospital
charges, depending on where the surgery is performed. Depending on whether the cost of surgery is covered
by an insurance plan, you will be responsible for necessary co-payments, deductibles, and charges not
covered. Additional costs may occur should complications develop from the surgery. Secondary surgery or
hospital day-surgery charges involved with revisionary surgery would also be your responsibility.

DISCLAIMER
lnformed-consent documents are used to communicate information about the proposed surgical treatment
of a disease or condition along with disclosure of risks and alternative forms of treatment(s). The informed-
consent process attempts to define principles of risk disclosure that should generally meet the needs of most
patients in most circumstances.

However, informed-consent documents should not be considered all inclusive in defining other methods of
care and risks encountered. Your plastic surgeon may provide you with additional or different in formation
which is based on all the facts in your particular case and the state of medical knowledge.

Informed-consent documents are not intended to define or serve as the standard of medical care. Standards
of medical care are determined on the basis of all of the facts involved in an individual case and are subject to
change as scientific knowledge and technology advance and as practice patterns evolve.

It is important that you read the above information carefully and have all of your questions
answered before signing the consent on the next page.

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 CONSENT FOR SURGERY / PROCEDURE or TREATMENT

1. I hereby authorize Dr. ______________________ and such assistants as may be selected to perform
the following procedure or treatment:

______________________________________________________________________________________________
I have received the following information sheet:

INFORMED-CONSENT for ABDOMINOPLASTY SURGERY

2. I recognize that during the course of the operation and medical treatment or anesthesia, unforeseen
conditions may necessitate different procedures than those above. I therefore authorize the above
physician and assistants or designees to perform such other procedures that are in the exercise of his
or her professional judgement necessary and desirable. The authority granted under this paragraph
shall include all conditions that require treatment and are not known to my physician at the time the
procedure is begun.

3. I consent to the administration of such anesthetics considered necessary or advisable. I understand that
all forms of anesthesia involves risk and the possibility of complications, injury, and sometimes death.

4. I acknowledge that no guarantee has been given by anyone as to the results that may be obtained.

5. I consent to the photographing or televising of the operation(s) or procedure(s) to be performed,

including appropriate portions of my body, for medical, scientific or educational purposes, provided
my identity is not revealed by the pictures.

6. For purposes of advancing medical education, I consent to the admittance of observers to the
operating room.

7. I consent to the disposal of any tissue, medical devices or body parts which may be removed.

8. I authorize the release of my Social Security number to appropriate agencies for legal reporting and
medical-device registration, if applicable.

9. IT HAS BEEN EXPLAINED TO ME IN A WAY THAT I UNDERSTAND:

a. THE ABOVE TREATMENT OR PROCEDURE TO BE UNDERTAKEN
b. THERE MAY BE ALTERNATIVE PROCEDURES OR METHODS OF TREATMENT
c. THERE ARE RISKS TO THE PROCEDURE OR TREATMENT PROPOSED

I CONSENT TO THE TREATMENT OR PROCEDURE AND THE ABOVE LISTED ITEMS (1-9). I AM
SATISFIED WITH THE EXPLANATION.

___________________________________________________________________________________________
Patient or Person Authorized to Sign for Patient

Date _____________________ Witness___________________________________________________________

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