mother of 3 in her late 30’s who is bothered by the appearance of her abdomen after pregnancy. She gained 65 lbs with her last pregnancy and wished to be able to feel comfortable wearing a 2- piece bathing suit again. Many patients mistake the bulging of the abdomen after pregnancy with somehow being overweight. They come in to see me and feel guilty, as if they could correct their problem with further weight loss or exercise. That is certainly not the case here, as she is 5 4 ½ inches and 122 lbs, giving her a BMII of 20.62, and is extremely physically fit. The problem is skin and muscle that was stretched with her pregnancies. Her umbilicus is high, and we need to decide between placing the entire abdominal scar higher, or placing it in the best “thong line” position and accepting a small vertical scar in the lower abdomen that represents the skin that was previously around the umbilicus. In other words, we cut around the outside of the umbilicus (belly button) and leave the belly button attached where it is- after repairing the stretched muscles, the skin is pulled down like a window shade and the excess skin is removed, ant the belly button is popped back up through a new incision. She is shown before and again, 3 years after surgery. The abdominal scar is in the optimal “thong” position, placed 6 ½ cm above where the vaginal lips come together. The small vertical scar is seen just above this and is from the skin that was previously around her umbilicus before the skin was detached and pulled down. She has an excellent contour to her abdomen, and now feels comfortable again in a 2-piece bathing suit.
A mother of 3 in her early 40’s who is bothered by a ”bump” of her stomach after pregnancy, despite diet and exercise. She is also bothered by unfavorable scarring after gallbladder surgery at the age of 21. She had had this revised by a plastic surgeon 12 months before seeing me but was still unhappy with the scar. A subcostal incision is sometimes called a “Kocher” incision and can make an abdominoplasty more challenging. Limited undermining can allow us to maintain the blood supply to the lower abdominal skin. Liposuction of the abdomen can also increase the risk of healing problems with an abdominoplasty. Sometimes a scar can be improved further by releasing and breaking up the scar tissue and fat grafting around the scar.
Lipoabdominoplasty utilizing Power assisted liposuction was used to break up the fat around the old scar using a “Becker” type cannula and judicious liposuction was performed to remove 400 cc of fat from the upper abdomen. Then an abdominplasty was performed with limited undermining to preserve the blood supply to the lower abdominal skin. Fat equalization was performed to break up and smooth the fat under the scar.
She is shown before and again, 4 years after surgery.