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Tummy Tuck

The Procedure

A tummy tuck is a surgical procedure to remove excess skin & fat from the lower abdomen, and tighten abdominal muscles.

The procedure is particularly helpful to women who, through multiple pregnancies have stretched their abdomen so far that it does not return to it’s normal shape. Tummy tucks are often performed in conjunction with liposuction.


Ideal Candidate

  • Women who are finished with their pregnancy or deliveries
  • Women who have excessive skin laxity of the lower abdominal wall, skin overhanging from the umbilicus at least to the suprapubic region
  • Women who are realistic in accepting of scarring which can include keloid, hypertrophic, widespread and hyperpigment or hypopigmented scars
  • Women who have had significant weight fluctuations in which liposuction is not a reasonable alternative due to the laxity of loose skin of the lower abdomen and hips
  • Women who are finished having children and pregnancy

HOLLYWOOD’S FLAT STOMACHS

Celebrity Plastic Surgeon Dr. Stuart Linder speaks about celebrity tummy tuck revision.

Length: 3:08


Types of Tummy Tuck

Mini

For patients who have lower abdominal skin laxity that is significant.

Modified

For patients who have had significant weight loss as well as large pregnancies causing stretching of the skin.

Extensive

For patients who have had gastric bypass procedures, lap banding procedures or loss a lot of weight.

Belt

For patients who have had massive weight loss circumferentially around the body.


Techniques

MINI MODIFIED EXTENSIVE BELT
Ideal for significant weight loss No Yes Yes Yes
Ideal for gastric bypass weight loss No No Yes Yes
Requires time off work No Yes Yes Yes
Visible scarring Yes Yes Yes Yes

Tummmy Tuck vs. Liposuction

Benefits of Tummy Tucks

Tummy tucks are intended for women with skin laxity and/or skin laxity with lipodystrophy or adiposity and excessive fat.

Pros

  • Removal of excessive fat
  • Flatter stomach
  • Tightens lower abdominal muscles
  • Better posture

Cons

  • Visible scarring
  • Best results may take over a year
  • Secondary surgery sometimes required

Benefits of Liposuction

Liposuctions are intended for people with fat deposits that are “trouble areas”, where exercise and diet seem not to have any effect

Pros

  • Target specific locations of fat
  • Smoothing out of the hips
  • Reducing the muffin top
  • More contoured lower abdominal area

Cons

  • Risk for deep venous thrombosis and pulmonary embolus

Anesthesia

Abdominoplasties should be performed under general anesthesia with a Board Certified Anesthesiologist.

All anesthesia is performed by Board Certified anesthesiologist, Dr. Hoffman.

Laryngeal mask airways can be used in the majority of the patients.  However, those who have a history of reflux or gastroesophageal disease are usually better candidates for endotracheal tube intubation.  This should be discussed with your Board Certified Anesthesiologist.


The Surgery

Tummy tucks are performed through an incision made in the lower abdominal wall using the suprapubic region, often similar to a cesarian section of Pfannenstiel-like incision. These however are extended to the bilateral hip region or the anterior superior iliac spines. Patients who have had previous C-sections can have the C-section scar revised and extended for their abdominoplasty or tummy tuck procedures. After making the full thickness incision, dissection is carried down through the fatty layers, referred to as Camper’s and Scarpa’s fascia and down to the muscles of the abdominal wall. The muscle dissection stays above the fascia layer overlying the muscles, including the rectus abdominis muscle in the midline or the middle and the external oblique muscles which are found in the sides of the abdominal wall. Dissection is carried out above the fascia all the way up and above and around the belly buttock stock with the umbilicus up towards the ribcage called the subcostal margin, depending upon the amount of skin needed to be removed in order to allow flattening. This dissection can vary. After the dissection is carried out, tightening of the midline rectus sheath is accomplished. We use O-Ethibond figure-of-eight interrupted sutures in case one suture breaks. Other sutures will remain intact. Running a single suture up and down can be dangerous because if it breaks the entire suturing of the midline can come apart.

It normally takes six to eight weeks for the Ethibond sutures to scar down. Therefore, patients are instructed not to do heavy lower abdominal exercising for six to eight weeks. The umbilicus is then repositioned into its new position with a cuff of fat removed and an oval or round shape donor site with insetting of the umbilical stock. The umbilical stock is maintained to the abdominal muscle fascia. It is not transected in my practice.

Liposculpturing of the hips or the muffin top usually is performed concurrently with an abdominoplasty in our practice in order to slim down the hips and the thighs. Patients who only have skin laxity may not require liposuctioning of the hips or lower flank region. I do not perform liposuctioning of the upper flanks or epigastrium above the belly button at the same time as abdominoplasty. This can lead to avascular necrosis or poor blood supply which can lead to dead tissue in the lower abdomen. Liposuctioning of the upper abdomen and flanks can be performed three to six months after healing has occurred with neovascularization and revascularization of the lower abdominal flap.


Cost

Tummy tuck cost will vary per patient.

This includes surgeon’s fee, operating room fees, implant cost and anesthesia fees.


Surgery Time Table

Preoperative Patient is started on an intravenous antibiotic (Ancef, Cipro and Vancomycin)
Surgery Mini: 30-60 minutes · Modified: 1-2 hours · Extensive: 2-3 hours · Belt: 4-6 hours
Recovery Room At least one hour. This is a requirement of federal law in Medicare.
Next Day Dressings are removed, fluids are evaluated each six hours
Week 1 Drainage tubes are removed
Week 2 Initial sutures are now removed along the lower abdominal area and the umbilicus.
Week 3 Sutures are removed along the umbilicus
Week 4 Photographs are taken and patients can now perform light exercising including aerobic and anaerobic, but no rectus muscle isolation
Week 6 Abdominal compression garment is worn for six weeks
Week 8 At this time, patients can go back to normal lifting, training, and continue with the Bio Corneum silicone scar treatment.

Frequently Asked Questions

  • How Are Tummy Tucks Different From Liposuction?

    Liposuctioning is specifically targeting localized fat deposit areas with good skin tone. Tummy tucks are intended for women with skin laxity and/or skin laxity with lipodystrophy or adiposity and excessive fat. The results from abdominoplasties, paniculectomies and tummy tucks are excellent, especially if the patients are realistic as to the scarring that is the significant tradeoff. Scarring is unpredictable from tummy tucks and due to the tension of the lower flap, can be thick, keloid, hypertrophic widespread hyperpigmentation or hypopigmentation. Patients must be realistic as to the scars and expectations must be realistic. Nobody can guarantee a thin line scar, not even a scar as perfect as the previous C-section because a significant amount of tension is found with lower abdominoplasties and paniculectomies which can lead to keloid, hypertrophic and widespread scarring. Tummy tuck procedures are excellent for patients who desire to have flat, smooth stomachs, tightening of the lower abdominal musculature walls will help to flatten the stomach as well. Final results may take over a year for the swelling and scarring to settle. This is a highly invasive procedure. Abdominoplasties require drainage tube placement as well as abdominal girdles and contour compressive dressings for up to two to three months. Patients will have to refrain from heavy exercising due to the possibility of tearing sutures and bleeding internally.