Tummy Tuck, Abdominoplasty
written by board-certified New York Plastic Surgeon Dr. Howard Bellin
Abdominoplasty: This procedure is sometimes called the
"Tummy Tuck", and while it's mostly done
to neutralize the ravages left from pregnancy, it also helps
both men and women to regain their youthful figures.
The surgeon begins by making a long, shallow, horizontal
incision across the patient's lower abdomen. Starting
at one of the hips, he continues it to just above the groin
crease. Then crossing over the upper level of the pubic
hair, he brings it over to the opposite hip, where it ends.
At the same time he makes a small, circular incision around
the navel without detaching it from its underlying blood
supply. Then, with the patient's navel still in place,
he lifts the loosened abdominal skin over the entire front
of the trunk and all the way up to the lower border of the
ribs. Now any of the possible problems are ready to be corrected.
Lax muscles are fixed by putting permanent sutures in
the tough material that covers them, and then folding the
muscles back upon themselves. This process also narrows
the waist and flattens out that lower bulge.
Then all of the excess skin and fat between the umbilicus
and the line above the pubic hair is pulled down and cut
away. This also removes offending stretch marks and even
some old scars, such as those that develop from an appendectomy
or cesarean section.
Afterward, the remaining skin is drawn downward until
it reaches the line of the long incision from the pubis
to t he hips. When this incision is closed, the skin is
fastened with sutures.
As the navel was never moved, it is now covered with skin;
by cutting a new hole directly above it, it can be pulled
through the surface and sutured in place. So the umbilicus
ends up in exactly the same position as before.
There will be a small and acceptable scar that encircles
the navel, and a lower major scar that runs across the long
incision. This one may thicken into high visibility, but
it is easily hidden by underwear or a bathing suit.
Occasionally the abdominoplasty is done with an extensive
up-and-down incision that runs from between the ribs to
above the pubis. But the vertical cut is not in a favorable
position for healing, so the scar will probably be very
this, and there's no way to hide it.
Of course, if the abdominal region already has a vertical
scar, then this is not likely to be a consideration. But
in some cases the patient will not have a choice. If the
deterioration is unusually bad, the surgeon may have to
make the vertical incision as well as the horizontal incision
in order to repair it.
Besides the scarring, the results of the abdominoplasty
are generally excellent, although they may not be entirely
permanent. For example, another pregnancy or further aging
might bring back some of the original problems, as will
overeating. But excised fat cells never return, so the patient
will still be better off having had the operation.
The cost of the abdominoplasty should be $7,500 to $10,000.
The recovery period can extend for up to six weeks.
A day or two of bed rest is normally required after the
surgery, and there is bound to be some post-operative pain.
This is usually nothing more than a dull ache that disappears
with bed rest, but once in a while it will be more severe.
Also, some patients feel a pulling in the abdominal region
that may persist for several weeks.
You can start to engage in light activity almost immediately
following the period of bed rest; after four to six weeks
you should be completely back in your regular routine, including
hard work and even strenuous exercise.
However, during the first one or two weeks of convalescence
walking will probably have to be done in a slightly bent-over
position due to the unnatural tightness across your stomach.
Complications like infection and postoperative bleeding
are not too common. There may be some skin loss above the
pubic hair, resulting in a wider and more visible scar,
but this is never serious, and it can normally be revised
later on.
FOR HANGING SKIN (VARIATION 1)
When people gain and then lose a great deal of weight,
they can develop the same problems that often result from
pregnancy or aging. If so, the basic abdominoplasty will
be enough to help them. But if the weight gain was really
massive, they may be left with an additional condition that
requires a special procedure.
The skin can stretch out to such an extent that it never
shrinks back. Instead, it hangs from the stomach like a
flabby apron, interfering with cleanliness and making it
difficult to wear clothes. This is humiliating and unhealthy,
and it should be corrected as soon as possible.
The surgeon starts out by making the same lengthy incision
as before. Then he gathers all of the hanging skin, pulls
it tight, cuts if off, and sutures the wound. This leaves
a visible scar over the incision.
If the patient also has torn skin, damaged muscles, stretch
marks, or a lower bulge, the entire abdominoplasty can be
performed at the same time.
FOR OBESITY (VARIATION 2)
As a general rule, obese people should not be made thinner
through cosmetic surgery. Surely a combined program of exercise
and diet will lead to a more sensible and satisfactory solution.
Nevertheless, it is possible to thin out the stomach area,
and it may even be necessary for the patient's health.
The surgery begins just like the abdominoplasty, with
the lengthy incision from hip to hip and circular cut around
the navel. But this time when the skin is lifted off the
muscle, the large layer of exposed fat is carefully removed.
This is done from the pubis up to the lower border of the
ribs, and around to each side as far as possible.
Unfortunately, the results of this correction are not
always acceptable, because it's extremely difficult
to taper the fat removal to blend in naturally wit the rest
of the torso. Also, the risk of skin loss is greatly increased,
so the long scar is apt to be thick and upsetting. Thus
the operation is usually discouraged.
FOR LOCALIZED FAT DEPOSITS (VARIATION 3)
This correction is for truly huge people who have uncomfortable
rolls of fat that fill up their middles. Once again, the
preferred treatment is diet and exercise, but this time
the surgery is more feasible because a major operation can
be avoided. A local incision is made in the most prominent
area, and the unsightly rolls are simply removed. The patient
will still have to check into a hospital, and there will
be a long and visible scar over the site of the wound.
FOR THE EXAGGERATED POTBELLY (VARIATION 4)
Prolonged obesity causes fat to accumulate not only under
the skin, but in an internal structure called the omentum.
This structure is attached to the stomach and covers the
intestines like an internal apron. It has the capacity to
store tremendous amounts of fat; as it spreads out, it swells
the abdomen totally out of proportion with the rest of the
body. The most vivid examples are men with beer bellies,
but woman can be affected too.
The problem is corrected by removing the omentum during
the conventional abdominoplasty. But this means that the
abdomen itself must be opened up, and this is rarely advisable.
Also, the omentum acts as a guardian against intra-abdominal
infection if the appendix or intestines should ever happen
to rupture. So the procedure is almost never recommended,
even though the result can be a startling change in appearance.
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