The Standard Abdominoplasty
This is also called an abdominoplasty or tummy tuck. In this procedure excess skin and fat can be removed, abdominal contours and scars improved, and the muscles tightened. Different combinations are combined in the various procedures.
The excess skin and fat of the abdominal wall between the pubic area and the umbilicus (navel) is removed leaving the umbilicus in place. The skin of the abdominal wall at the level of the umbilicus is then drawn down to suture it at the pubic level. The patient is left with a long, usually curved scar across the lower part of the abdominal wall at the level of the pubic hair. There is also a scar around the umbilicus. Any looseness of the muscles of the abdominal wall or hernia is repaired at the same time.
Liposuction may be carried out during this procedure to thin the abdominal wall, or as a separate procedure either before or after the abdominoplasty.
In the mini-abdominoplasty surplus skin below the umbilicus is removed leaving a low abdominal scar at the level of the pubic hair. The umbilicus is not disturbed but liposuction is usually carried out at the same time as the procedure to reduce the thickness of fat in the abdominal wall and any laxity or hernia of the abdominal wall is repaired at the same time.
In the extended abdominoplasty surplus skin and fat of the loins and back are also removed so that the scar extends around the flanks on to the lower back.
The endoscopic abdominoplasty is used to tighten the muscles of the abdominal wall to give a better contour and is carried out through a short transverse incision above the pubic hair. Skin is not removed but liposuction can be carried out at the same time.
The apronectomy is a modification of the mini-abdominoplasty for patients who have a large excess of skin and fat hanging down over the pubic area. In this procedure only the surplus skin and fat is removed. The scar is long and transverse extending from one side of the apron to the other.
Modifications to the abdominoplasty skin excision are made when the patient has particular problems associated with scars from previous operations.
An alternative procedure which should always be considered instead of many of the above is liposuction on its own. This reduces fat and causes just a little retraction of the skin.
Who is a candidate?
Anyone who has abdominal skin and fat may be a candidate. With women the problem is usually caused by pregnancy, but is greatly aggravated by weight loss. The muscles of the abdominal wall may be weakened by pregnancy and actually pulled apart in the middle (divarification of recti). Men are similarly affected by weight loss. Stretch marks (striae) are simply the scars which are left after extreme stretching of the skin. They are usually most apparent on the lower part of the abdominal wall. There is no specific treatment for these stretch marks, but many of them are excised in an abdominal reduction and those that are left are tightened making them look less obvious.
Patients that are unable to tighten the abdominal wall skin with exercise or wish to achieve a smoother flatter abdomen will also benefit.
What are the consequences?
The patient is left with noticeable scars. The main scar runs transversely across the lower part of the abdomen (see illustrations above) and in a standard abdominal reduction there will be a scar around the umbilicus. Other or different scars may be left where the patient has particular individual problems. Some patients make better scars than others and in any case all scars are red initially. It is essential that the patient understands where these scars will be and should discuss them with the surgeon. Although we try and hide them beneath underwear and swimwear, fashions can change making previously covered scars visible.
There is numbness in the lower part of the abdominal wall after surgery. This is usually temporary but could be permanent. Swelling above the scar is usually present due to a collection of tissue fluid which normally drains to the groin. This swelling or oedema settles within a few months.
What are the limitations?
The skin is usually tightened downwards and this does not tighten the waist. If this is desired then one can consider removing skin vertically, but one should bear in mind that vertical scars of the abdomen are less good. The tissue of the abdominal wall is generally fatter than the groin and if liposuction is not carried out a fatty bulge may remain above the scar.
The beneficial effects of the operation will last well. However, the effects will be maintained better if the patient keeps exercising the muscles and the weight steady. A further pregnancy will of course stretch the skin again, although probably not to the same degree.