Topic – Tummy Tuck

I am seeing more patients in my practice now, who have a lot of loose abdominal skin, than ever before.  Traditionally, tummy tucks were performed on women, after childbearing age, who had a lot of loose skin. Because of the increased frequency of bariatric surgery i.e. gastric banding and gastric bypass, many patients have lost significant amounts of weight and now have loose skin.  In those situations, it is not only the abdomen but also the arms, breasts, thighs, and even the back that are loose.Over the last 10 years, the number of abdominoplasties, performed by board-certified plastic surgeons, has increased from 34,000 to approximately 200,000. Women still outnumber men 40:1.

There are different techniques of abdominoplasty and an experienced board-certified plastic surgeon knows how to choose the right technique for the patient.  In most cases, the patient not only has loose skin but also has some excess fat, particularly in the love handle and lower back area, as well as lower abdomen.  They also have laxity of the abdominal muscles.  All of these problems need to be addressed.  To help flatten the abdomen effectively, the fascia directly overlying the rectus muscles is plicated, or sutured together to prevent the abdomen from distending.  In addition, liposuctioning is done to a limited degree in the abdomen, as well as love handle and lower back as necessary.

The length of the incision and tightening of the musculature determines the difference between a “mini tuck” and a standard abdominoplasty.  For the standard abdominoplasty, the muscles are usually tightened from just below the breast bone down to the pubic bone.  For the mini tuck, all the work is done below the belly button or umbilicus. In the standard abdominoplasty, the skin and fat are elevated off the underlying muscle to the level of the ribs.  The hips are then flexed on the operating table and the excess skin is pulled down.  An opening is made in this skin flap and the belly button, which is preserved on its stalk, is then pulled up so that the belly button stays at the same position on the abdominal wall.  In a mini tuck, the skin and fat are only elevated up to the level of the belly button and then the excesses are resected.  In an extended abdominoplasty, the incision extends past the hip bone to also lift the thigh and the lateral hip at the same time as flattening the belly.

I explain to my patients that the length of the incision is not critical, as long as I can be hidden within the panty line.