What is Abdominoplasty?
Abdominoplasty, also known as a tummy tuck, removes excess skin and fat, as well as restore weakened or separated abdominal muscles. Factors that often contribute to these issues include aging, pregnancy, genetics, prior surgeries, and significant weight fluctuations. A tummy tuck results in a flatter abdomen that is proportionate with your body type.
Am I a good candidate for abdominoplasty?
Candidates for abdominoplasty surgery in Boston and Worcester, Massachusetts are healthy men or women who are unhappy with the appearance of their abdomen. It is important that patients are at a stable weight, are non-smokers, and have realistic expectations for the outcome of their surgery. Furthermore, patients should be aware that a tummy tuck should not be used as a primary weight loss solution. A consultation with Dr. Hall can help you decide if a tummy tuck is right for you or if you might benefit from a different procedure.
Abdominoplasty – Patient 166
A mother of 2 in her early 40’s who is bothered by the appearance of her stomach. She was especially concerned about the scar placement and wanted to make sure that it would be placed in a thong position where it would be hidden by most clothing styles. She is shown before and again, 1 year after an extended abdominoplasty. EXPAREL was used during surgery to decrease her need for narcotics after surgery. Progressive Tension Sutures were placed at the time of surgery to decrease the risk of seroma. Her scar placement is 6.5 cm from the vaginal fornix to keep the scar low, in a “ thong” position. Tattoos have been blurred for her privacy. Nearly 5 lbs of skin were removed with the extended abdominoplasty.
Abdominoplasty – Patient 165
A mother of 2 in her late 50’s who is bothered by bulging of her abdomen in clothing. She felt that her left side bulged more and on exam was noted to had an inguinal hernia on that side. She has had 2 C-sections. Her umbilicus is relatively high and in her case we “floated” the umbilicus by pulling it down lower, avoiding a scar around the umbilicus and a midline scar from the umbilical slit in the lower abdomen. She is shown before and again, more than 3 years after her extended abdominoplasty with floating of the umbilicus. Her inguinal hernia was repaired by General Surgery at the same time. Her scar is placed low in a “thong” position where it is hidden by most clothing styles.
Discussion: Floating of the umbilicus is a technique that I find useful in patients with a relatively high umbilicus that do not have much looseness in the upper stomach and wish to avoid a scar around the umbilicus and a vertical slit scar in the lower abdomen. The umbilicus is detached at its base and brought down lower, instead of cutting around the top of the umbilicus and popping it back up through in the new position. It does not “pull the sheet tight” in the upper abdomen as much as with a traditional technique but can work well in some cases as shown here. Liposuction was used to form a midline groove above the umbilicus. The abdominal muscles are still tightened and bring in the waist and correct the muscle bulge. Her incision is “extended” to allow better tightening of the sides and has higher tension placed on the sides to better shape the stomach.
Abdominoplasty – Patient 164
A mother of 3, including twins, in her mid 40’s. She had gained 70 lbs with her pregnancy and “carried large”. She also had a hernia of the muscle wall above the umbilicus. (a ventral hernia).
Exparel was used during her surgery as part of our Enhanced Recovery after Surgery (ERAS) protocol. Exparel is a Liposomal Marcaine, an injection placed at the time of surgery that slowly breaks down and releases long-acting local anesthetic for the first 72 hours after surgery. Pain varies between patients but she was amazed that she did not require any narcotics after surgery, and stopped taking ibuprofen after two weeks. She reports that she is already down in size from a 10/8 to a 6.
She is 5’5” and 149 lbs and is shown just 6 weeks after her surgery. Her ventral hernia was repaired at the same time by general surgery. It is early to show her result, because swelling will continue to go away over the next 5 months and the scars will continue to fade for the next two years. Nonetheless, the early results are dramatic. She is thrilled to be able to wear fitted clothes now. The oblique view shows the “champagne groove” and the hollow around the umbilicus that were sculpted at the time of surgery.
Abdominoplasty – Patient 163
A mother of 3 in her later 50’s who is bothered by excess skin and bulging of her abdomen after pregnancies that makes it difficult to wear fitted clothing. She is 5’4” and 148 lbs and is shown before and again, 8 ½ months after abdominoplasty .
Exparel was used during her surgery as part of our Enhanced Recovery after Surgery (ERAS) protocol. Exparel is a Liposomal Marcaine, an injection placed at the time of surgery that slowly breaks down and releases long-acting local anesthetic for the first 72 hours after surgery. It has been shown to decrease the need for narcotics after surgery by 70%.
Her case illustrates the challenge of a relatively high umbilicus ( belly button). When the umbilicus is lower, and the skin is looser, then the skin is removed entirely from just above the umbilicus to the mons pubis. When the skin is not as loose and the umbilicus is higher, then this skin that was originally around the umbilicus is still present at the end. If the upper abdomen was not loose, then a cut could be made deep to the umbilicus , puling it down a little lower, a so called “umbilical float” or a “floating of the umbilicus”. This would not have allowed us to “ pull the sheet tight” and smooth her upper abdomen. Another option would have been to place the lower abdominal scar much higher, in the mid-abdomen. This is usually not a good tradeoff, because it is more attractive to have this lower scar in the “thong position” where the lower edge is 6 ½-7 cm from the vaginal area. The third option, which was chosen in her case, is to close the small opening from the skin that previously surrounded the umbilicus. as a small vertical slit. This does leave a small scar somewhere between the umbilicus position and lower abdominal scar, but is the best tradeoff in her case.
This scar as with all of the scars will continue to fade and improve for two years or more after surgery. Her umbilicus was initially deviated to the right. During surgery I use a “plumb line” of a temporary silk suture while I tighten the muscles that are stretched by pregnancy to guide me in trying to bring the umbilicus back to the middle.
Abdominoplasty/Massive Weight Loss – Patient 162
A mother of 2 in her later 50’s who had a lap band in 2007, that was removed in 2014 and then had an endoscopic gastric sleeve in 2014. She has lost 100 lbs and been at a stable weight for the last 2 years. She is bothered by fullness and laxity of the abdominal skin and would like to be able to wear fitted clothing.
She is shown before and again, nearly 7 months after an extended abdominoplasty with the removal of nearly 5 lbs of skin. She was 5 feet tall and 139 lbs before her surgery. She is thrilled with the improvement of her abdomen and loves catching sight of herself in a mirror now when she walks by in her fitted clothing. Exparel was used to limit her need for narcotics after surgery, and progressive tension sutures were uses to decrease her risk of seroma formation. Her scar is placed low, in a thong position, where it is most easily hidden by clothing.
As is typical in a patient with significant weight loss she continues to have some looseness of the skin of the
upper abdomen, but not enough in her mind to trade it for a vertical scar ( Fleur de Lis abdominoplasty)
How is an abdominoplasty performed?
How your abdominoplasty procedure is performed will depend on your specific needs and body concerns. Patients choosing to undergo abdominoplasty surgery have the choice of intravenous sedation and general anesthesia, and Dr. Hall will recommend which choice is best for you. During the surgery, Dr. Hall creates a horizontal incision between the belly button and the public hairline, where a bikini can easily cover. The skin is then lifted, and the weakened abdominal muscles will be tightened. Depending on how much excess skin is being removed, a second incision around the naval may be necessary. Skin on the upper abdomen is pulled down, and a new opening for the belly button is created. Incisions will be closed with sutures, tapes, or skin adhesives.
What should I expect during recovery?
During abdominoplasty recovery, dressings are applied to incision sites and a compression garment may be worn to minimize swelling and provide support. Small tubes may also be inserted to drain any excess blood or fluids. You can expect to be assisted with walking as soon as the next day to prevent the formation of blood clots, however, you should be resting for the first week or two after surgery. After your procedure, you will likely experience some swelling and discomfort. Dr. Hall can provide you with prescription medication to manage your pain and make your recovery more comfortable. You will also have some activity restrictions in the first few months. You should avoid strenuous activity or movement such as bending at the waist, that might strain the incision site. Dr. Hall will provide you with specific instructions about your recovery and activity restrictions.
The result of your abdominoplasty can be distorted due to swelling in the first few weeks, however as swelling diminishes you will begin to notice your results and can enjoy a toned abdominal area. Abdominoplasty results are permanent, although substantial fluctuations in weight can greatly diminish these results. Patients who are planning on losing a substantial amount of weight or future pregnancies are advised to delay tummy tuck surgery.
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