Abdominoplasty (Tummy Tuck)
Abdominoplasty (frequently called a tummy tuck) is a procedure designed to improve appearance of the abdomen by tightening of abdominal muscles and removing excess skin and fat.
It is one of the most common plastic surgery procedures. According to the American Society of Plastic Surgeons ® Statistics Report, there were approximately 116,000 abdominoplasties performed in 2011 in the USA by board-certified plastic surgeons (an 85% increase since 2000).
Abdominoplasty is frequently performed on women that experienced stretching of the skin as well as development of stretch marks and abdominal bulge secondary to pregnancies. It is often combined with a procedure that improves shape of the breast (breast augmentation, lift or combination of both), also altered by pregnancy-related changes - the combination is commonly referred to as "mommy makeover".
It is also a common procedure performed on massive weight loss patients (men and women).
Abdominoplasty is not a small procedure, and the risks and benefits of it should be considered very carefully. Patients contemplating undergoing this procedure should also consider their social environment (i.e. available help within the initial post-operative period).
Abdominoplasty in massive weight loss patients
Obesity changes the quality and dynamics of abdominal wall tissues, fat, and skin. Larger volume requires a larger amount of skin, which causes skin-stretching, relaxation of supporting elements, formation of striae ("stretch marks"), as well as a weakening of abdominal musculature. Increased intra-abdominal fat content leads to abdominal distention and diastasis recti (separation of recti muscles in the midline, especially pronounced in women that experienced a pregnancy).
It is not uncommon to see abdominal hernias in this patient population, either within previous abdominal incision sites or even spontaneously. Weight loss decreases the amount of fat in the patient's body, especially within the subcutaneous layer. If the weight loss is more rapid than gradual (like in the case of patients who had undergone a weight-reduction surgery), the skin may not be able to follow the volume decrease (i.e. "to shrink over the smaller body"), and can become redundant and saggy.
Several patterns of abdominal/torso deformities have been described: from minimal panniculus ("overhang") anteriorly, over the pubic area to massive circumferential skin excess. The situation is complicated by the fact that fat "melting" may occur at a different rate in different body areas, sometimes not corresponding to skin redundancy (for example: a patient with a large amount of skin in the front of the abdomen and thin layer of subcutaneous fat, but still very large hips and thighs - so called "pear type", as oppose to a patient with thin, "skinny" arms and legs, but with residual fat limited to the abdominal area - "apple type").
These differences demand an individualized approach to the abdominal contouring of a patient who experienced massive weight loss.
AM I A GOOD CANDIDATE FOR ABDOMINOPLASTY?
Like with most other post-bariatric body contouring procedures, a good candidate for the surgery is:
- In reasonably good health
- Has some established weight loss
- Has realistic expectations and a positive outlook
- Is not a smoker
The presence of scars from previous surgeries may limit some options (although in some instances it may help to choose one technique over another). The procedure should also be postponed if an active infection is present.