TUMMY TUCK REVISION
Patients often present for large panniculectomy surgery, requiring multi-stage operations in order to obtain the perfect result. Large paniculectomies are performed on patients with a large abdominal pannus. These patients are instructed well prior to their original surgery that they will probably need a second surgery in order to perform secondary excision of dermoglandular tissue along the hips with possible tumescent liposuction of the flanks upper epigastric region. They may also require secondary surgery to remove some of the thick fat from the lower abdominal wall which can be done by a direct dermoglandular resection with liposuction of the abdominal flap three months after the original surgery.
The patient above underwent a panniculectomy, tumescent liposuction of the lateral saddlebags and a breast enhancement procedure. The patient is now status post a panniculectomy of approximately six months. She has undergone stage procedure with liposuction of the upper abdominal area and the upper flanks and iliac crest rolls three months after the original tummy tuck and now has a smooth abdomen without the thickened bones that can often been seen in the hypogastrium lower abdominal flap in the lateral dog-ear like regions. Patients in my opinion should not undergo tumescent liposuction of the upper epigastrium or flanks concurrently with the panniculectomy due to the possibility of devascularization of the abdominal flap. The blood supply to the upper lateral flap includes subcostal iliolumbar and intercostal arteries. I believe these should be maintained and should not have possible trauma from liposuctioning which could lead to avascular necrosis of the lower abdominal flap and dead tissue. My patients are instructed that from the large tummy tucks that are stage surgeries with direct excision of the lower abdominal flap, lipo of the epigastrium flanks and possible recurrent skin excision on the hips with liposuction of the muffin top will be useful in order to obtain an even slimmer and debulking result.