Abdominoplasty (Tummy Tuck)

If you are considering a tummy tuck …….

Abdominoplasty, known more commonly as a “tummy tuck,” is a major sugical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The procedure can dramatically reduce the appearance of a protruding abdomen. But bear in mind, it does produce a permanent scar, which, depending on the extent of the original problem and the surgery required to correct it, can extend from hip to hip.

“Mommy Makeover” includes a wide array of cosmetic surgery options, including tummy tuck, breast lift, breast augmentation, body sculpting with liposuction and skin rejuvenation procedures. These procedures, which can dramatically improve how you look and feel.

If you’re considering abdominoplasty, this will give you a basic understanding of the procedure-when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask Dr. Rieger about anything you don’t understand.

The best candidates for abdominoplasty
The best candidates for abdominoplasty are men or women who are in relatively good shape but are bothered by a large fat deposit or loose abdominal skin that won’t respond to diet or exercise. The surgery is particularly helpful to women who, through multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where they can return to normal. Loss of skin elasticity in older patients, which frequently occurs with slight obesity, can also be improved.

Patients who intend to lose a lot of weight should postpone the surgery. Also, women who plan future pregnancies may consider waiting, as vertical muscles in the abdomen that are tightened during surgery can separate again during pregnancy. If you have scarring in the upper part of the abdomen from previous abdominal surgery, your doctor may recommend against abdominoplasty or may caution you that scars could be unusually prominent.

Abdominoplasty can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Rieger.

All surgery carries some uncertainty and risk
Thousands of abdominoplasties are performed successfully each year. When done by a qualified plastic surgeon who is trained in body contouring, the results are generally quite positive. Nevertheless, there are always risks associated with surgery and specific complications associated with this procedure.

Post-operative complications such as infection and blood clots are rare, but can occur. Infection can be treated with drainage and antibiotics, but will prolong your hospital stay. You can minimize the risk of blood clots by moving around as soon after the surgery as possible.

Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers should be advised to stop, as smoking may increase the risk of complications and delay healing.

You can reduce your risk of complications by closely following your surgeon’s instructions before and after the surgery, especially with regard to when and how you should resume physical activity.

Planning your surgery
In your initial consultation, your surgeon will evaluate your health, determine the extent of fat deposits in your abdominal region, and carefully assess your skin tone. Be sure to tell your surgeon if you smoke, and if you’re taking any medications, vitamins, or other drugs.

Be frank in discussing your expectations with your surgeon. He or she should be equally frank with you, describing your alternatives and the risks and limitations of each.

You may, on the other hand, benefit more from partial or complete abdominoplasty done in conjunction with liposuction to remove fat deposits from the hips, for a better body contour. Or maybe liposuction alone would create the best result.

In any case, your surgeon should work with you to recommend the procedure that is right for you and will come closest to producing the desired body contour.

During the consultation, your surgeon should also explain the anesthesia he or she will use, the type of facility where the surgery will be performed, and the costs involved. In most cases, health insurance policies do not cover the cost of abdominoplasty, but you should check your policy to be sure.

Preparing for your surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins, and medications.

If you smoke, plan to quit at least two weeks before your surgery and not to resume for at least two weeks after your surgery.

Avoid overexposure to the sun before surgery, especially to your abdomen, and do not go on a stringent diet, as both can inhibit your ability to heal. If you develop a cold or infection of any kind, your surgery will probably be postponed.

Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two after you leave the hospital, if needed.

Where your surgery will be performed
Dr. Rieger prefers to perform the operation in a state-of-the art accredited outpatient surgery center. Dr. Rieger prefers to allow patient a 23 hour stay in the surgery center. The center combines state-of-the-art technology with an exceptional degree of confidentiality, personalized attention, convenience and affordability. These centers offer overnight accommodations with round-the-clock nursing care.

Types of anesthesia
 General anesthesia is usually selected, so you’ll sleep through the operation.

The surgery
Complete abdominoplasty usually takes four to five hours, depending on the extent of work required.

Abdominoplasty diagrams

An incision just above the pubic area is used to remove excess skin and fat from the middle and lower abdomen.

Most commonly, the surgeon will make a long incision from hipbone to hipbone, ,just above the pubic area. A second incision is made to free the navel from surrounding tissue.

Skin and fat from the pubic hairline bikini area incision to the umbilicus (diamond shaped area in light green) is removed

Next, the surgeon separates the skin from the abdominal wall all the way up to your ribs and lifts a large skin flap to reveal the vertical muscles in your abdomen. These muscles are tightened by pulling them close together and stitching them into their new position. This provides a firmer abdominal wall and narrows the waistline.

The surgeon draws underlying muscle and tissue together and stitches them, thereby narrowing the waistline and strengthening the abdominal wall.

The skin flap is then stretched down. A new hole is cut for your navel, which is then stitched in place. Finally, the incisions will be stitched, dressings will be applied, and a temporary tube may be inserted to drain excess fluid from the surgical site.

Dr. Rieger places most of the stitches under the skin surface to improve the appearance of the incisions.

To improve the appearance of incision scars, Dr Rieger uses a new skin closure technique that does not require old fashioned metal staples.  This new technique uses the INSORB® Absorbable Skin Stapler which represents a revolutionary new skin closure modality. The INSORB® Absorbable Staple is comprised of a co-polymer which is absorbed over a period of 4-6 weeks.In most cases only simple butterfly paper tapes (steristrips) are placed on the skin and in most cases no sutures require removal ! 

Abdominal skin is drawn down and excess is removed. With complete abdominoplasty, a new opening is cut for the navel. Both incisions are stitched closed.

Abdominoplasty type ‘3’ vertical scar closure of belly button opening diagrams

Abdominoplasty “type 3” vertical scar closure of the umbilicus opening technique removes excess skin and fat in the abdominal area and the abdominal muscles are tightened. The excess skin above the belly button is limited and will not stretch all the way to the pubic hairline like in a “regular” tummy tuck. So the old opening of the umbilicus is closed in a vertical scar pattern just above the public hairline. Compare this album to the “regular” tummy tuck above.

Tummy Tuck Type ‘3’