Abdominoplasty or a “tummy tuck” is an operation that removes the extra skin in the tummy that can hang over the belt line. The best candidate for an abdominoplasty is a patient who has undergone substantial weight loss and is left with loose, hanging skin. Ideally a patient should be within 10% of the statistically recommended weight for his or her height, age and sex. If the weight is greater than that, a weight loss program involving both diet restriction and regular exercise is recommended. On occasion I will consider assisting the weight loss by liposuction, however, liposuction is NOT a substitute for weight loss. My typical patient is a woman who has had her children, gained more than forty pounds during one or more pregnancies, lost most or all of the weight, may have had a C section, and now has skin hanging from her lower abdomen over her pubic area.
There are three types of abdominoplasties that I offer:
In a belt lipectomy, only the redundant, folded skin is removed. The incision is only as long as it needs to be to remove the skin and not leave behind raised areas (“dog ears”) at either end. No skin needs to be lifted up off of the underlying fascia. However, there is little or no tightening of the rest of the abdominal skin. A belt lipectomy could possibly be done under local anesthesia. This procedure is best for someone who only is concerned with skin folded over the lower part of the abdomen and feels that the rest of the tummy looks fine.
In a mini-abdominoplasty, an incision is made from hipbone to hipbone and the skin is raised to the level of the belly button. Liposuction is used to reduce fullness throughout the abdomen. Excess skin is then measured and removed. The best candidate for this procedure is someone who has little or no excess skin above the belly button with overhanging skin below. The skin above the belly button is not affected so if redundancy is present there, a mini-abdominoplasty may not be the best choice.
A full abdominoplasty usually requires an incision that is slightly longer than the mini-abdominoplasty incision. The belly button is incised circumferentially and left attached to the abdomen while the skin is lifted all the way up to the rib cage. Above the belly button the skin is only lifted off the rectus muscle to help preserve blood supply to the edge of the flap. If the rectus muscles have been pushed apart (usually from pregnancy), then they are sewn back together. Two drains are always used. A pain pump is always used. This device slowly injects numbing medicine into catheters left in the abdomen along the rib cage. This effectively numbs the sensory nerves to the abdomen and makes the first three days of recovery more comfortable.
I prefer to not do any liposuction on full abdominoplasties because of concerns I have for preservation of the blood supply. Although other plastic surgeons routinely combine the two, I feel the potential risks are too great. Doing the liposuction first and the abdominoplasty at a later date is safer.
Recovery varies with the type of abdominoplasty done. If only a belt lipectomy is done, then an abdominal binder is placed moderate activity may be resumed after the drain or drains are removed in about three days. If a mini-abdominoplasty is done, an abdominal binder is placed and activity is limited for one week. Activity is slowly begun after two weeks, slowly progressing to normal by six weeks. If a full abdominoplasty is done, activity is restricted for two weeks. A pain pump is used and the catheters are removed after three days. Drains are removed after one week and sutures after two weeks. Activity resumes guardedly after three weeks and progresses to normal by six weeks. It is usually not possible to return to work before two weeks and may take as long as six weeks for jobs requiring high levels of activity.
The scars left from a tummy tuck usually extend from hip bone to hip bone, around the belly button and sometime a small vertical scar in the lower midline where the belly button used to be. Although they are not as fine line as facial scars, they are thin enough to be easily hidden under most undergarments and my patients have been satisfied with the results.