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Abdominoplasty
Among the popular
procedures of cosmetic surgery, the "tummy tuck" or
abdominoplasty operation is high on the list. The
tummy tuck removes excess skin and fat from the
abdominal wall. At the same time, the muscles of the
abdomen are tightened and reinforced. Though it does
remove fat, it is not considered a method to reduce
obesity. Primary goals are contouring, tightening,
and flattening of the flaccid abdominal wall. One of
the side effects of the surgery, particularly for
women who have had children or massive weight loss,
is the removal of a large number of the stretch
marks that are common on the lower abdomen.
Many of these patients
only require what is referred to as a Mini Tummy
Tuck (mini-abdominoplasty). Where there is minimal
extra skin and abdominal wall weakness this patient
may only need a mini tummy tuck procedure. A mini
tummy tuck requires a small incision above the pubic
area. From 1997 to 2002, the number of tummy tucks
has increased by 70%. This indicates the trend
toward reducing the bulging middle by surgery rather
than the perhaps impossible reduction in girth by
extreme exercise, regardless of what the ads tout on
television with their new exercise machines.
Notice the slight bulge
to the abdominal region of the trunk that required
only a mini tummy tuck.
A varied group of people
seeks abdominoplasty. Some are relatively thin women
who have had multiple pregnancies. They may have had
just one pregnancy, but the skin and muscle was
severely stretched. Exercise and diet alone will not
achieve a flat tummy without stretch marks. Also,
there may be a lower abdominal protuberance that is
covered with stretch marked and wrinkled skin.
Others include men and women who have lost a massive
amount of weight. Diet, stomach stapling, gastric
bypass, or exercise may have achieved large weight
loss. Nevertheless, a prolonged skin stretch and/or
aging may have decreased the skin’s ability to
contract. The patient is now faced with a hanging
apron or panniculus of skin. No matter how much the
weight loss or exercise performed, the apron of skin
will not shrink. There are also people who seek
improvement of their abdominal wall who have
undergone multiple surgical procedures that have
resulted in pouches or overhanging skin. In some
cases, liposuction may be able to flatten the
bulges; however, an abdominoplasty can remove excess
skin and tighten the muscles of the abdominal wall
at the same time. There are a variety of methods to
treat defects: some require suction of fat, others
require a smaller or greater amount of skin removal,
while others will want to have the casing of the
muscles tightened for the maximum flatness and
waistline reclamation. The latter is not done if a
woman is still going to bear children.
Procedure
Most tummy tuck surgeries are
performed under general anesthesia. The procedure
can take place either in the surgeon’s surgical
center or hospital. The procedure takes two to four
hours. Full recovery to vigorous activity may take
three to six weeks or longer, depending on the
patient’s recuperative ability.
Varied incisions are often
utilized in tummy tucks. The classic "bikini"
incision starts just above the pubic hair, follows
the groin lines and over the hipbones. The low cut
swimsuit is designed to fall within this small area
below the navel. The surgeon is careful to make the
incision below this line. A modification of this
design is to sweep the sides higher on the outer
abdomen in order for the incisions not to be visible
in the higher sided French-cut bikini style. It is
best to bring the style of bathing suit that you
like to wear in to your surgery so that the surgeon
can make his/her markings based on the style of
clothing that you wear. The second type of incision
is often used in males or patients with a hanging
apron of skin. The skin-line incision follows the
natural curve that is found just beneath the fold of
abdominal skin. This can lead to a more visible
incision once the pannus is removed. After making
the incisions, skin and fat are lifted off the
abdominal muscles to a level above the ribs. The
navel is detached from the skin and left attached to
the abdominal wall. Stretched and lax muscles are
then repaired.
When the skin has been lifted,
tightening the casing (fascia) overlying the muscles
tightens the abdominal wall. This results in
flattening and tightening of the entire structure of
the abdomen. This can be done in various
orientations in order to help to cinch the abdomen
and make the waist smaller and longer.
Liposuction often plays a part
in this procedure. It is employed to thin the waist
and hips at the time of surgery and allows for
better contouring and shorter incisions. Other areas
in need of fat removal can often also be addressed
at this time.
High Lateral Lift
There is another very different
modification of the tummy tuck procedure where a
high lateral lift is made, essentially in the area
high above the thighs. This type of procedure is
necessary for those who have had a falling of much
of the skin of the buttocks and thigh. It is often
coupled with a thigh lift (on the inner aspect of
the thigh). This procedure is major, requires 8 to
10 hours of general anesthesia and involves a great
deal of blood loss and healing time. Usually
patients give their own blood prior to the procedure
so that it can be transfused as needed during the
procedure. Most of these procedures are performed in
the hospital and require hospitalization for a few
days afterwards. The risks are great but in those
individuals requiring and desiring this type of
surgery are pleased.
Other procedures involving the
surgical removal of skin and fatty tissue from
different areas of the body are less frequently
performed. Thigh lifts, buttock lifts and
brachioplasty (upper arm skin tightening) are all
performed occasionally for the select patient. The
biggest down side of all of these procedures is the
scar that must be made for the skin removal. In
time, there may be lasers that will allow for skin
tightening without the surgical removal of skin and
therefore make scarring a non-issue. In many cases,
the supporting structure of the skin will still need
to be addressed but this will be possible through
less conspicuous incisions.
Risks
Patients who
undergo this surgery must recognize that the
surgical incision always results in a scar that
crosses the pubis and may extend from hipbone to
hipbone. Smaller incisions (mini-abdominoplasty) can
often be performed in patients with less abdominal
laxity; the resultant scar can be limited to the
pubic area. This is only possible if there is
moderate skin excess. In those individuals who have
laxity of the muscle but no skin excess, the muscle
can be tightened through rather small incisions
without the long scars necessary when skin removal
is an important part of the procedure. Horizontal
incisions often heal better than up and down
(vertical) incisions. It is true that any surgery is
subject to asymmetry, wide scars, bleeding,
infection, and poor healing. All of these rarely
occur.
The surgery is dramatic,
with resulting scars, but the reward for so many who
have it done are great.
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