Large Tummy Tuck Staging
Patients who present for tummy tuck procedures weekly to our office are evaluated for single versus double-stage abdominoplasty surgical procedures. In general, larger women who have a significantly large abdominal pannus may require two-stage surgeries.
The first stage is the abdominoplasty with liposuction of the hips. Three to six months later, complete lipo-sculpting of the abdominal flap, flanks and upper iliac crest rolls can be accomplished to greatly debulk the flap in order to truly reduce the size of the woman’s midriff. We instruct all of our patients preoperatively as to whether they will probably be a candidate for a second stage surgery requiring liposuctioning of the abdominal flap in order to reduce the thickness of it. Remember that liposuctioning the flanks and upper epigastric region is dangerous during the initial abdominoplasty procedure due to vascularity and blood supply problems. Once the vessels are cut along the lower C-section areas aka inferior epigastric and the circumflex iliac arteries, the blood supply comes from the upper flank areas. There are three specific blood vessel suppliers and if these are sculpted and liposuctioned, they could end up devascularized in the abdominal flap, which could lead to skin necrosis and death of skin and fatty tissue from the flap. In order to be as safe as possible, lipo-sculpting should be delayed of the upper epigastric and upper flank areas for three to six months to allow revascularization of the lower flap. Large abdominal pannus patients will require a second stage in order to debulk the flap. This will make the patient much happier with her final result and should be instructed to the patient preoperatively.