Sometimes simply dieting and exercising are not enough to take care of waistline problems.  In such cases, a patient may wish to consider a tummy tuck (or abdominoplasty).  A tummy tuck is the surgical removal of excess skin or fatty deposits from the abdomen, along with the repositioning of abdomen muscles into a tighter formation.  This bodily enhancement procedure is designed for those who wish to have a flatter and tighter stomach.  It is also helpful in remedying the vertical separation of abdomen muscles known as diastasis, which can occur following pregnancy.

Reasons for Considering an Abdominoplasty:

• Inability of dieting and exercise to improve the abdomen area.
• Excessive accumulation of skin following weight loss.
• Loss of skin elasticity or diastases (loose abdomen muscles) due to pregnancy.
• The removal of unsightly skin and fat deposits as well as the proper alignment of the abdomen muscles to produce a more flattering look.

Q & A

What is a “Tummy Tuck”? Abdominoplasty, or “Tummy Tucks” are operations designed to improve the contour of the lower abdomen. Bulges in the lower abdomen consist of three components:

1. Fat: Fat deposits in the lower abdomen can be very resistant to weight loss and exercise. Typically, the stubborn fat is located below the umbilicus and the flanks in a “spare tire” pattern.

2. Skin: The skin of the lower abdomen can be stretched considerably by weight loss or pregnancy. Stretch marks are a sure sign that excess skin is present.

3. The abdominal wall: Muscle and tendinous structures composing the abdominal wall can also be stretched out. This can be seen in people with very little fat who still have a bulge in the lower abdominal wall. Abdominoplasty is designed to correct all three components with one operation.

Sounds extreme! Why not just do liposuction? Liposuction is an excellent method of removing fat deposits that are resistant to weight loss. However, if there is excess skin that has been stretched out by childbearing or weight gain, the skin will not “snap back” after liposuction is done. Instead, the extra skin will hang loosely as a “pannus” or “dewlap” from the lower abdomen after the fat is removed. Skin does not shrink to fit new volume like the rubber on a balloon after the air is let out. Any one who has gained significant weight or had children will tell you that stretched-out skin does not go away.

What about the scar? Removing excess skin necessarily leaves a scar. Just as a face-lift removes excess facial skin and leaves a scar on the face, abdominoplasty will leave a scar on the abdomen. Choosing to have an Abdominoplasty is a conscious choice to improve your body shape at the cost of a rather large scar. The good news is that the scar is normally hidden by your underwear, except for a scar around the umbilicus. Scars vary quite a bit from individual to individual, but they are normally well-accepted in view of the improved body shape.

How is the operation done? First, an incision is made across the entire lower abdomen within the “bikini line”. It is then taken deeper down to the abdominal wall. Next and incision is made around the umbilicus to detach it from the surrounding skin. Working through the lower abdominal incision, the fat is lifted off of the underlying abdominal wall from the pubic area to just below the ribs. The skin and fat of the lower abdomen from the umbilicus down is then removed by cutting across it. Excess fat under the upper abdominal skin is then removed. Sutures are placed in the abdominal wall to tighten it - a process called “plication”. The upper abdominal skin is then stretched down to close the open wound. A new hole for the umbilicus is made in the midline of the abdomen and the umbilicus is sewn in place. Drains are placed to prevent fluid accumulation from “weeping” of the tissues.

What about “Mini” Tummy Tucks? “Mini” Abdominoplasties are a limited version of a full Abdominoplasty. In this operation, skin and fat are lifted only off of the abdominal wall below the umbilicus. The bulging abdominal wall is then tightened with sutures, and only a small amount of skin is removed. Liposuction can be safely performed on the abdomen with this procedure at the same time due to the more limited extent of the operation. Since less skin is removed, the scar is smaller. The problem with this operation is that there are very few appropriate candidates. If you have slightly loose skin overhanging the umbilicus, this operation will not correct it. Similarly, very few women have an abdominal bulge that is mostly due to the abdominal wall below the umbilicus. Typically, most patients seeking consultation for an Abdominoplasty have significant excess skin and fat both below, and above the umbilicus.

What other operations can be done at the same time? Other procedures are commonly done in properly selected patients. These can range from breast surgery (breast augmentation or reduction), to face-lifts. Liposuction in areas outside the abdomen such as the thighs can also be safely performed. However, liposuction of areas adjacent to the abdomen requires caution, as they can lead to complications and poor wound healing of the incisions. Adding additional procedures also prolongs the time under anesthesia and may require hospitalization to insure safety. Prolonging anesthesia times can significantly add to the risk of the procedure.

When will I know what the final result will be? Usually the scars take three months to six months to remodel and mature. “What you see is not what you get” until this period of time has elapsed. The shape and minor irregularities “settle out” with time and things continue to improve up to six months after the surgery. The result typically looks good about 30 days after the operation, but continues to “evolve” afterwards.

What if I have scars on my abdomen from previous surgery? If the scars are below the umbilicus, they can be totally removed with the excess skin on the lower abdomen. Scars above the umbilicus in the midline of the abdomen will need to be revised (removed and re-closed) since they will not stretch with the abdominal skin used to close the wound created when the excess skin is removed from the lower abdomen. Revising a midline scar can also enhance the result by allowing removal of additional excess skin adjacent to the midline in conjunction with skin of the lower abdomen. Scars from older gallbladder operations in the right upper abdomen can cause special problems or concerns that your surgeon will discuss with you.

Does it hurt? Yes, Abdominoplasty is a large operation that can be compared to a ceasarian section. It is commonly done as a “same day” surgery with patients being discharged immediately after recovery from the anesthetic, but this can lead to a rough first night at home. Overnight hospitalization is recommended for those patients who can afford it, to assist with pain control. Ideally, patients would stay overnight with an epidural catheter in place. This removes almost all pain during the worst part of the post-operative period. As with most operations, pain is most intense during the first 12 to 24 hours after surgery.

Who is a good candidate for an Abdominoplasty? Good candidates are patients with a low risk for anesthesia who have excess fat and skin in the lower abdomen. Stretch marks are usually a sure sign that Abdominoplasty is the best option to correct the problem.

How much time will I need to take off work? Usually, two weeks are needed to return to work comfortably. Highly motivated patients can return to work sooner with safety provided their work duties are not physically strenuous. Typically, these large operations also leave patients with a lack of energy and easy fatigue. A common complaint is feeling as though “all the energy has been sucked out of me”. This lasts for at least two weeks after the operation.

What activity restrictions will I have? Activity limitations are similar to those for any major abdominal surgery. Lifting greater than 10 to 15 pounds is not advisable due to placation of the abdominal wall. Aerobic exercise such as running is not advisable until three or four weeks after surgery. Weight lifting should be avoided for six weeks, and then resumed slowly with less weight than that lifted pre-operatively.

Will my insurance plan cover the costs of the cosmetic procedure? Unfortunately, the answer is clearly no. In fact, most insurance companies require that you sign a statement of understanding that you are responsible for the costs of the non-covered procedure. Payment for the costs of cosmetic surgery is due in advance for the hospital, the surgeon, and anesthesia.

Is financing available for cosmetic surgery? Yes! Aesthetic Surgery Associates is able to help you apply for financing with finance companies that specialize in funding cosmetic procedures.

Can I have a Tummy Tuck at the same time as a Gynecologic operation such as a hysterectomy, tubal ligation, or laparoscopy? Fortunately, the answer is yes. In the past, there were concerns about the potential increased risk for infectious complications from the combined procedures. A number of scientific studies not validate the safety of doing some cosmetic procedures at the same time as you Gynecological procedures.

Why would I want to combine these types of operations? The answer consists of two parts: 1. Cost savings 2. Combined recovery times. Cost savings are realized by having insurance plans cover the initial start of the operation in the operating room, the initial anesthesia, and your hospital room. Of course, this depends on whether or not the gynecologic operation is covered by your insurance. Adding a cosmetic procedure to one covered by insurance allows lower charges for the total cosmetic procedure “package”. If you are having gynecologic surgery for medically indicated reasons, there is usually a recovery time involved that includes time off of work. By having your cosmetic operation at the same time as you gynecologic procedure, you can recover from both at the same time!

Additional information can be found on the following web sites:
plasticsurgery.org
surgery.org

To arrange a consultation, please call Aesthetic Surgery Associates at (254) 526-5106 or toll-free 1-866-232-0469