The abdominoplasty procedure (tummy tuck) was initially described in 1880 and significant refinements in technique have occurred since then, making this a popular procedure and an integral component of a “mommy-makeover” procedure.
What are the primary indications for abdominoplasty?
Both male and female patients may present with one or more of three primary problems, which can be addressed by this procedure.
- Excessive / loose skin. This results from stretching the skin beyond the point of elastic recoil and over time excess skin develops. Significant weight loss, large abdominal tumours, long-standing hernias, pregnancy and bariatric surgery are the most common causes of this. The loose skin is usually of poor quality and tone and often has numerous stretch marks (termed straie distensae). If the skin fold hangs below the lower abdominal crease, then only an abdominoplasty will be able to address this.
- Excessive fat thickness. There are many reasons for excessive fat thickness both medical as well as lifestyle problems. Often excessive fat and excessive skin co-exist. If there is only excessive fat, then the possibility of a liposuction can be entertained. Generally, liposuction will be able to reduce the skin pinch thickness by 50%. If more reduction is required, especially in the lower abdomen, then an abdominoplasty may be a better choice.
- Muscle laxity. The supporting layer of abdominal muscles and fascia may become weakened by the same factors that cause the overlying skin to stretch. While core strengthening exercises may be very beneficial, there are certain problems, to which surgery is the only reasonable solution. Rectus diastasis, where the two “six-pack” muscles are separated by a gap can only be addressed by surgery. This is a common problem after multiple pregnancies.
How is an abdominoplasty performed ?
An incision is marked in the lowest abdominal crease. These days, a very low incision is the aim, as clothing and swim-wear fashion dictate that low-cut garments are preferable. The length of the incision is dependent on the patient’s frame, as well as the amount of excess tissue to be removed. A range from 36 cm to 66 cm can be anticipated. I generally place the scar 6cm above the lower end of the pubic bone, and leave at least 9cm from the scar to the belly button.
The skin and fat are elevated from the underlying muscles and belly button is cut out (like a button). The upper abdominal skin and fat are also elevated. The lax muscles are then sutured together with permanent sutures. If significant hernias are present, I prefer mesh reconstruction with Permacol Mesh, which I do in conjunction with a general surgeon. A new hole is made in the upper abdominal skin (much like a button-hole on a shirt and the lower abdominal skin and fat excess are removed. The weight of the removed tissue can vary from 700g to several kilograms. The belly button is then popped through the hole (similar to fastening a shirt button) and sutured in place. The lower incision is then sutured. I always perform liposuction, especially to contour the flanks, but excessive liposuction and upper abdominal liposuction can be dangerous and I tend to avoid doing this. Drains are always placed, which remain in place for 5-7 days.
What is the recovery like?
Generally, abdominoplasty takes somewhat longer to recovery than most other plastic surgery procedures. I always advise a general anaesthetic and an overnight stay, with strict fluid monitoring and a urinary catheter. Mobilization takes place the following day, but most patients are bent over due to the tightness of the abdominal skin, which takes 2-3 weeks to settle. Pain is moderate, but excessive movement may be quite sore. Most patients feel they have “turned a corner” after about 1 week, but generally take 2 weeks to get back to activities of daily living, including driving. Full recovery may take 2 months.
What is the difference between a “full” and a “mini” abdominoplasty ?
The above description is of a “full” abdominoplasty. The lower abdominal scar is longer and there is a circumferential scar around the belly button as it position in relation to the abdominal skin is moved. There is no belly button scar on a “mini” as the lower abdominal scar is often shorter. The downside of this is that significantly less skin excess can be removed – generally about 3 cm of vertical shortening can be achieved. The bulk of the result from a “mini” comes from a comprehensive abdominal liposuction which is always done in conjunction with the modest skin resection. Recovery is generally more rapid with a “mini”.
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