Tummy Tuck: Getting the Most From Abdominal Cosmetic Surgery

Cosmetic surgery of the abdomen comes under a number of names; however, all procedures are not the same. "Tummy Tuck" is a name which implies a minimal operation, yet it refers to one of the more extensive operations that plastic surgeons perform, hence the title "tummy tuck" is misleading.

Abdominal cosmetic surgery, better known as Abdominoplasty, is a safe operation when properly done. Wide margins of error, however, do not exist. Done safely, it can be immensely gratifying to the patient. Done poorly, it can endanger a patient's health. Also, deformities from a less than well-done abdominoplasty can rarely be improved by corrective surgery.

Who Needs Abdominoplasty?

The usual patient seeking abdominoplasty is a woman in her 30's to 40's who has finished childbearing and wants to improve the appearance of her stretched out abdomen. Her abdomen may be protruding (pouching out) especially in the lower portion. There is usually excess skin that didn't bounce back, and extra fat as well. There may be stretch marks (striae) from pregnancy. There may be separation of the abdominal muscles (diastasis), which does not respond to exercise. In fact, many women have tried tirelessly to improve their abdomen with diet and exercise, but to no avail. For these people, abdominoplasty is a logical answer.

What Scars Does it Leave?

The scars should be low down in the abdominal crease and hardly noticeable. You cannot expect to have skin removed without leaving a scar; however, using careful techniques, the scar can be very fine. The scar does not have to have cross-hatching suture or staple marks, and it can be low enough to be covered by a bikini. The loss of the stretch marks in the lower abdomen is a good trade-off for the narrow scar resulting from abdominoplasty. Within 6 to 12 months, the scar will turn your normal skin color and be difficult to see.

The Procedure

The plan of cosmetic abdominal surgery is to remove excess skin and fat, and tighten the remaining skin so that it will resemble how you looked before having children. Any prior surgical scars in the lower abdomen will be removed in the process. A skillful plastic surgeon can alleviate the abdominal skin and subcutaneous tissue off the abdominal muscular wall and bring it down -- like you were pulling down a blind -- then cut off the excess and re-attach the cut edges. Sound simple? it's a little more complex than that, but you get the idea.

Before suturing everything together, however, the surgeon must repair the muscle separation in order to tighten the abdominal wall and bring it in, correcting the out-pouching.

What Happens to the Naval?

The naval, (belly-button, or umbilicus) needs to stay in it's normal position. A circular incision is made around it, and it is left in place. When the abdominal skin is pulled down in the form of a flap, a fenestration, or window, is made at the exact level in the midline, and the naval is brought through and re-secured in it's new location to look normal. Taking the extra time to make it look attractive, the surgeon can suture it down to the fascia in order to give it the proper degree of indentation. This is easier said than done. You may have heard of people who ended up with their belly-button in the wrong place. You're right, this shouldn't happen. With a few accurate measurements, according to human anatomic design, it can be done right!

What Can Go Wrong?

Good question; and an important one. Remember, this is a big operation from the standpoint of body surface involved. All sorts of things can go wrong, unless the surgeon and patient make plans to avoid them. Careful planning is essential. Knowing the possible complications of abdominoplasty is key to preventing them; however, taking the extra time necessary may be more than some surgeons want to spend. It can either be done fast, or it can be done right. You cannot have it both ways. Placement of the incision in the proper location is all important.

What if it is done too fast. One way a surgeon can do it fast is to make the incision high in the mid abdomen just below the naval instead of down in the bikini line. The surgeon will not have to dissect as far; therfore it becomes a shorter operation. The problem is, that the patient has to live with an objectionable high and visible scar for the rest of her life. Such a scar cannot be corrected regardless of how much money the patient is willing to pay.

The second most common way to perform an abdominoplasty quickly is for the surgeon to do the dissection with the electro-cautery machine, burning the tissue as he goes. Sure, there's a little less bleeding at the time, but what happens to burned tissue? It weeps fluid (serum). In such cases, the patient has to put up with the presence of suction drains for 2 to 3 weeks to avert a seroma, and the risk of infection is higher due to the long indwelling drains.

A seroma is a collection of fluid beneath the abdominal flap, and it prevents the flap from sealing and healing down to the abdominal wall like it is supposed to. This is the most common complication of "tummy tuck" surgery, and it is easily preventable. If the surgeon performs the dissection with a sharp scalpel and scissors, the risk of seroma formation is almost nil. After sharp dissection, the drains can safely be removed at 3 days and seromas rarely occur.

What is the Worst Thing That Can Happen?

Well, death, of course. As with flying, the worst thing that can happen is the plane can crash. Remember, this is a big operation. If you don't add another operation to it, you'll be as safe as it gets. The last thing you want to say to your plastic surgeon is, "while you're at it, doctor, would you add...?" If you add liposuction to the surgery, for example, you'll be playing with life and death . . . yours! For a cosmetic surgical procedure, it is simply not worth it!

When you read in the newspapers about someone dying from plastic surgery, it is almost always a combination of abdominoplasty and something else, such as liposuction. Combinations with abdominaplasty do more than add to the risk, they multiply the risks. The physiology is well known, so avoid the "while you're at it syndrome." If you want to avoid serious complications, say "no" to combinations!

Are There Other Operations to Improve the Abdomen?

Of course there are, and each one has its place. Liposuction alone, for example, can in many instances improve the abdominal shape if the fat is located external to the abdominal wall. One can count on skin retraction afterward; especially in the younger years. After age 40, however, we begin to lose our elastic fibers, and the skin doesn't snap back as well.

Despite the amount of hype you may be subjected to, avoid unproven procedures that go by catch-phrase names. A "Mini Tuck" for example r "Mini Abdominoplasty" means removing just a little bit of lower abdominal skin and fat. It rarely provides the result that you are looking for. It does not tighten skin above the naval, but it leaves a shorter scar. The mini operation provides a mini result. With a Mini Abdominoplasty, the expectations a patient has are all too frequently much greater than the actual results.

Panniculectomy is another option reserved for the obese patient with a huge overhanging apron flap hanging over their thighs, creating functional problems of every kind for them. This big chunk of useless skin and fat is another structure making demands on the patient's circulatory system and heart muscle. It needs to be amputated, both for cleanliness, and to take a load off the heart. The operation leaves an enormously long scar; however, it improves the patient's hygiene and health, and is well worth it. Although a panniculectomy does improve a patient's appearance, it is not considered to be a cosmetic procedure.

Plastic surgery of the abdomen cannot be successfully performed in the patient who has a great deal of internal abdominal fat (omentum and bowel mesentery). Weight loss is essential before cosmetic abdominal surgery can be carried out successfully in these patients.

What Can I Expect From Abdominoplasty?

For the right patient, choosing the right operation and taking the appropriate safety precautions, you can expect to have a flatter abdomen with a low scar and a normal looking naval. Your lower abdominal stretch marks will be gone, and you'll feel better about yourself in a swim suit. You will need to spend your first two weeks walking in a semi-flexed posture so as not to apply tension on the scar while initial healing occurs; however, when you stand up two weeks later and see your tight flat abdomen, you'll think that it was all worth it.

For more information regarding cosmetic abdominal surgery (abdominoplasty), be sure to visit our web site at http://www.fairbanksplasticsurgery.com/saltlakecity/utah/procedure/abdominoplasty-or-tummy-tuck-cost-and-procedure/.