Posted by Dr. Hardesty

Abdominoplasty (“Tummy Tuck”) – Body Contouring

Goal

The abdominoplasty procedure is designed to contour the abdomen by:

1. Removing excess skin and fat.
2. Reestablishing the position of the rectus abdominis muscles (or abs).
3. Contouring the diet-resistant fat accumulation of the flanks (when needed) using liposuction.

Unfortunately, diet and exercise often cannot restore the abdominal contour after pregnancy or weight loss. The two central muscles spanning the abdomen from the breast bone to the pubic bone are known as rectus abdominis muscles or “six pack ” muscles. These two muscles are designed to and often separate during internal abdominal weight gain or pregnancy to accommodate the increased internal size of the abdominal cavity. This separation is called “diastasis recti.”

Despite diet and intense exercise, one cannot always return the muscles to their original position or tighten the loose, stretched-out skin. This results in a protruding abdominal wall referred to as a “pouch,” “potbelly” or “baby bump.”  In addition, it’s not unusual after pregnancy or weight loss to have areas of diet-resistant fat along the flank area, also known as “muffin tops.”

Examples of Preoperative Appearance

In general…

1. Patient satisfaction is one of the highest as documented by RealSelf.com at 97 percent of patients surveyed.

2. Incisions are usually placed as low as possible. I personally ask patients to bring a bathing-suit bottom or panties of their choice to ensure the placement of the incision is where they want it.

3. In thin patients with long torsos and little redundant skin, a small vertical scar centrally located may be required; this is where your original umbilicus was located. The trade-off is to have a lower horizontal scar or a temporary small vertical scar — the small vertical scar can often be resected under local anesthesia and converted/combined with the horizontal scar 9-12 months later (under local anesthesia) when the skin relaxes.

Types of Abdominoplasties

There are five types of abdominoplasties. Types A-C listed below all have horizontal incisions, whereas option D has a significant vertical incision, and the E option horizontal scar is in the infra mammary fold (IMF), also known as the breast crease (where the abdomen meets the breasts). With options A and C, the umbilicus is not translocated (incised around the umbilicus, preserved and repositioned).

A. Mini – muscle tightened only below umbilicus to pubic bone.

B. Standard – muscle tightened from breast bone to pubic bone.

C. Extended – as with the standard, but the incision is longer to excise excess skin/fat in the outer thigh area.

D. Fleur de lis – same as the standard but in addition excess skin/fat is excised in a
vertical direction.

E. Reverse Abdominoplasty

A very rare form of abdominoplasty for isolated excess fat and skin located over the lower rib cage and under the bra line/inframammammarry fold. The resultant scar is under each breast and often crosses the midline with a often noticeable scar scar under the cleavage point of the breasts.

Pain Control

1. Intraoperative injection of muscles and nerves with long-acting local anesthesia.
2. Intraoperative insertion of small catheters connected to an external reservoir that contains and delivers
(using a pump) local anesthesia directly to the surgical site continuously for several days.
(“On-Q Pain Pump” is a popular brand.)
3. Postoperative oral narcotics

Recovery

See our blog post on Abdominoplasty recovery. Click here for a testimony/review.

Conclusion

An abdominoplasty not only restores contour but repairs diastasis that diet and exercise cannot often succeed in accomplishing. It’s one of the most satisfying procedures for both the patient and the plastic surgeon.

The Staff of Imagine Plastic Surgery serving many of the communities of the greater Inland Empire including but limited to Riverside, CA and Inland Empire, Redlands, Rancho Cucamonga, Ontario, Corona, Upland, and Chino Hills.