Technical details of the operation are as follows:
Under general anesthesia the skin is prepped and
the patient is draped in a sterile fashion. A transverse lower abdominal
incision is made from hip to hip the width of the incision being determined
by the amount of skin to be excised. An incision is made around the umbilicus
(belly button) leaving it in place. The skin is lifted from the abdominal
wall all the way up to and beyond the rib margins. The abdominal wall musculature
is repaired with permanent suture. The excess skin is pulled down, measured
against the lower abdominal incision and excised. Excess fat of the skin
is excised either directly or by liposuction. Drains are inserted through
separate incisions, the skin is sutured together and securely taped. A
small incision is made over the umbilicus (belly button) and excess fat
around the incision is excised and then the umbilicus sutured directly
to the skin. The resultant (belly button) looks quite natural, sometimes
even better than the preoperative condition. All sutures of the lower abdominal
incision are internal and need not be removed. Belly button sutures will
be removed in two weeks.
The surgery is performed as an outpatient. Five
of my patients have returned to work four days after surgery and many within
a week. Most, however, take off two weeks before resuming their usual duties.
Pain and discomfort are moderate and easily controlled by oral medications.
Serious complications are rare and include the usual complications of all
surgery: bleeding, infection, skin necrosis, thrombophlebitis and pulmonary
complications. A minor complication which occurs with some frequency is
persistence of fluid. Because a large flap of skin has been raised from
the abdominal wall it is necessary to insert drains which remain in place
for two weeks. Even with this prolonged period of drainage, in approximately
20% of the patients fluid will collect under the flap after the removal
of the drains. This necessitates periodic aspiration done under local anesthesia.
This requires only about five minutes but it is necessary for the patient
to return every few days to have this situation reassessed and if necessary
repeated. This fluid can persist for only a few days or for weeks. While
of its self more an aggravation and inconvenience than any thing else,
it must be attended to in order to avoid the development of "pseudobursa"
in the lower abdominal region. The development of this fluid filled endothelial
lined space in the lower abdominal region may at some time in the future
demand excision for total eradication.
A variation of the standard abdominoplasty (tummy
tuck) is the "mini tuck". Ideal candidates for this operation
are those having little excess skin and abdominal wall laxity limited to
the area below the umbilicus (belly button) In these patients a very satisfactory
result may be obtained by excision of skin and repair of the abdominal
wall laxity. In some instances liposuction of the upper abdomen and lower
abdomen is necessary for optimum results.
It should be emphasized that tummy tuck, liposuction
and mini tuck are adjuncts to obtaining and or reobtaining the desired
figure and not a substitute for concomitant proper nutrition, weight management,
exercise, training and proper posture.
Patient III