Tummy tuck surgery, also known as abdominoplasty, is a very common procedure to improve the appearance of the abdominal area in both women and men. The goal is to remove the excess skin and fat and to restore weakened or separated abdominal muscles to improve the overall contour of the abdomen. The term describes a variety of techniques that are selectively employed for a range of problems. These may range from minor areas of fat accumulation to excesses of abdominal skin, fat, and laxity of the abdominal wall creating a bulge.
The common causes include:
- Weight gain/loss
- Previous abdominal surgery
Dr. Feiner will recommend the appropriate surgical procedure based on your specific needs and concerns. A tummy tuck is not a substitute for weight loss and should be delayed if you are planning substantial weight loss or future pregnancies.
Candidates for abdominal surgery:
- Physically healthy
- Stable weight following weight loss
- Nonsmokers, no use of nicotine products
- No plan for future pregnancy
- Realistic expectations
- Liposuction: Liposuction involves selectively removing fat with the use of a metal cannula and suction. Liposuction by itself is reserved for individuals with localized fat deposits and minimal skin laxity.
- Mini Abdominoplasty: Involves tightening and removing loose skin below the belly button, treating the lower abdomen. The belly button is not moved during this procedure.
- Standard Abdominoplasty: This is the most common form of tummy tuck. This involves making a curved incision across the lower abdomen. The belly button is released from the surrounding skin. The skin of the entire abdomen is elevated and pulled tight, eliminating the excess skin. This also allows access to the rectus (six-pack) muscles. Pregnancy, weight fluctuations, and aging may cause a separation or gap between the muscles known as a diastasis. These muscles can be repaired during a standard abdominoplasty to create an internal corset, reshaping the waistline and tightening the abdomen. This is often accompanied by liposculpture to enhance the waistline definition and shape. The excess skin is removed, and the belly button is repositioned and made smaller. Stretch marks may be removed as part of this procedure, but not all stretch marks may be eliminated.
- Fleur de Lis Abdominoplasty: This procedure is reserved for massive weight loss patients who also have significant excess laxity of skin from side-to-side. It involves a vertical incision in addition to the standard abdominoplasty incision forming an inverted ‘T’ scar.
- Panniculectomy: his procedure removes only the excess skin and fat hanging below the waistline. It may be covered by insurance if you have documentation of loose, overhanging skin that rubs and chafes, creating skin breakdown and infections.
Abdominoplasty procedures are typically performed on an outpatient basis, meaning you will go home after surgery. It is often useful to have someone around to help as it can be uncomfortably getting around for the first few days after surgery. A compression garment is recommended to help with postoperative discomfort and swelling. Drains may be placed to remove inflammatory fluid that accumulates after surgery. Some procedures may be done “drainless” and Dr. Feiner will discuss this option during your consultation. If liposuction is performed, you can expect to be bruised and swollen in those areas. There occasionally is drainage from the liposuction sites as the fluid that is used to break up the fat dissipates. These are normal occurrences. Light activity is encouraged in the first 10-14 days following surgery. Activity may be gradually increased as tolerated.
Risk of Abdominoplasty:
The risk of pain, bleeding, infection, and reactions to anesthesia may occur as with any surgical procedure. There are risks specific to tummy tuck and liposuction that include:
- Asymmetry- Skin excess and fat are often asymmetric and may affect the placement of the scar and incision
- Hematoma or Seroma- collections of blood or fluid in the areas of surgery
- Numbness- this is a common following tummy tuck. It is typically due to bruising and swelling around the nerves, but some permanent numbness may occur along the area above the scar
- Recurrent skin laxity- The skin is pulled as tight as can be done safely during the surgery, but skin with weakened elasticity may continue to stretch after the surgery when swelling resolves. This is particularly true in patients with significant weight loss as their skin often loses some of its natural elasticity.
- Skin loss (necrosis)- The circulation of the skin is impaired when it is lifted, and this may result in a compromise of incision healing and the potential compromise of the belly button.
- Blood clots- Abdominoplasty procedures are at higher risk for the formation of dangerous blood clots after surgery. High-risk patients may be started on blood thinners and all patients are encouraged to begin walking shortly after to surgery to decrease this risk.