ABDOMINOPLASTY / TUMMY TUCK
Following pregnancy, weight loss from dieting or bariatric surgery there are often redundant folds of skin and fat on the tummy which remains. In addition the underlying tissues are often weakened and stretched producing an unsightly bulge.
By removing the excess skin and fat as well as repairing the weakened abdominal muscles an abdominoplasty aims to give you a firmer and flatter stomach.
When the excess tissue is only present below the belly button, and hangs like an apron, then a mini abdominoplasty (apronectomy) can be performed. More usually the abdominal wall is also slack and a repair of the muscle needs to be performed in addition to the removal of the excess skin and fat. This is called a full abdominoplasty. Where indicated a limited liposuction can be performed to areas around the loin and hip.
Recent developments of new techniques and special sutures allow the procedure to be performed safely with a simpler recovery process after the operation.
The operation is usually performed under a general anaesthetic.
Are you suitable? – After pregnancy and following significant weight loss through dieting or bariatric surgery, excess abdominal skin and fat can form rolls around the upper and lower tummy. The abdominal rectus or “six packs” muscles may also be weakened and separated allowing the abdominal content to push out producing a ventral hernia. The lower fold of fat can hang like an “apron” which is heavy and uncomfortable. The skin crease under the fold can retain sweat, become excoriated and be difficult to keep clean, especially in the summer months. It is unsightly and makes it difficult for clothes to fit.
Unfortunately when the tissue between the rectus muscles are weakened and widely stretched apart no amount of stomach crunching exercise could bring them together and a surgical repair of the muscle is needed. Similarly if there is an abdominal apron then neither exercise nor dieting will get rid of it and surgical resection is needed to address the problem. These two procedures form the essence of an abdominoplasty.
Commonly refered to as a tummy tuck an abdominoplasty aims to remove the excess skin and fatty tissue through a cut made along the lower part of the abdomen. The excess tissue on the lower abdomen up to the level of the belly button is removed. The skin is then lifted all the way to the rib cage and then stretched down to allow the wound to close. Before this the weakness and separation of the abdominal muscles (rectus muscles) is repaired with a permanent suture from the breast bone to the pubic bone. The skin is then stitched down to the muscle layer using internal quilting sutures. If necessary suction drains will be inserted. The wounds are closed with self-dissolving sutures which do not need to be removed. A pressure garment is applied over dressings. The operation will result in a long scar from hip to hip. There will be a new belly button created whose shape and size may be different from the original.
This is a lesser operation suitable for patients whose upper abdomen is fine and there is only excess tissue below the belly button. This is less common and your surgeon will be able to advise you which procedure is the most appropriate for you. The incision is similar to the fully abdominoplasty on the lower abdomen from hip to hip. The excess skin and fat is removed up to the level of the belly button. There is no dissection above this level and the belly button is left undisturbed. Any weakness in the lower half of the rectus muscle is repaired from the belly button to the pubic bone. The wound is then closed.
Occasionally there are excess fat deposits on the outer hip and loin areas and, if desired, these can be treated with liposuction combined with the abdominoplasty. If there are excess fat deposits on the upper abdomen it would be risky to perform liposuction in this area at the same time as the abdominoplasty as it may jeopardise the blood supply to the skin and cause a wound breakdown. This can be done safely a few months later when the wounds have healed soundly.