Texas Tummy Tuck

 

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What is abdominoplasty?
I am glad you asked that question. An abdominoplasty is the formal name for the procedure most people call a “tummy tuck.” This procedure is most often considered by women, even though now more and more men are considering the procedure.

An abdominoplasty is a procedure that is considered by many women several years after the birth of their children, when their body weights have returned to normal and they find that they have a “pooch” or a saggy area around their mid abdomen. This also is a consideration by many men and women who have now regularly gone to the gym and find that they are successful with their weight loss and find that they| are now left with a lot of loose skin. The last group are the women who fortunately have been successful with their weight loss but find that they are now left with a great deal of stretch marks that simply will not fade away. For all of these groups, an abdominoplasty procedure
is a possibility.

As for the procedure itself, it involves making a cut from one side of the abdomen to the other. Of course, this is done under general anesthesia so as to make sure the patient has no pain. The incision is made to the layer above the muscle layer and the dissection is then carried out all the way up to the ribs or the costal margin in a triangular fashion. The umbilicus or the belly button is freed and preserved still attached to the abdominal wall. When the tissues are freed up, one would be surprised at how much the skin will then stretch. In some cases the skin is able to stretch up to 6 to 8 inches. When this is done, the patient is then placed in a flexed position and the old and the new area are put together. In this way the saggy skin or the stretch mark area is taken off. The patient is left with good, nice, non-saggy, non-stretched skin. Once the skin is attached, the belly button is brought out through a new hole and reattached.

Once it is said and done, the patient (you) is left with an incision going from one side of the abdomen to the other, and an incision around the belly button. The sutures used are absorbable and do not need to be removed. We do also use some staples in some cases for support but these are usually removed by the end of the first week.

How painful is the procedure?
Like any surgical procedure, there is pain involved. Most patients comment that they have a moderate amount of pain but compare it to a C-section. Most note that the pain accompanied by a C-section is more than an abdominoplasty. Also to help with the pain, we regularly give patients oral pain medicine upon their discharge from the hospital. In an attempt to also help with the more immediate post-operative pain, we place indwelling pain pump catheters. These are placed during surgery and enable a self-contained system to dispense local numbing medicine (marcaine) into the area of the incision and help with anesthetizing the incision and wound area for the first 48 to 72 hours. The pain pump is heat activated so as long as it is taped to the body it will work. It is a continuous pump and does not need to be activated or regulated by you, the patient.

How long do I have to take off from work?
Great question. Most often I suggest to patients that they consider taking about 2 to 3 weeks off from work. Each patient is different but in my experience I have seen most patients be active and up to most of their usual tasks by 3 weeks after surgery. Again each person and each body is different. One thing I need to mention is that I would require as most plastic surgeons do that you wear an abdominal binder, a corset of types, to give you additional support during your recovery period. I would recommend you wear this binder for approximately 6 weeks time

Can I combine this procedure with any other procedure?
Yes and no. Like any surgical procedure, there are limits to what can be done and what is safe. As for the yes, it can be combined with some other procedures. For example, I routinely do this procedure with a hysterectomy. Most of the OB/Gyns in the area can easily do their part of the surgery and then I can complete the procedure with an abdominoplasty, allowing for a precise plastic surgical closure. I also routinely do an abdominoplasty with a breast augmentation or a breast lift. Any procedure that may be too long or too arduous and place the patient at risk for significant bleeding or significant anesthetic exposure would have to be deferred and done in two stages. Please understand I say this without knowing exactly what you, the patient, may have in mind. I can only speak from my experience.

What are the possible complications?
I am glad you asked that question. An abdominoplasty has several possible complications. Of these the most common seen are infection, bleeding, seroma, numbness and dehiscence. One by one we will discuss these. Infection is an issue here because most of these operations leave the patient with large incisions. We do our best to hide the incisions but we cannot make them smaller. Therefore, we do our best to give the patient the best coverage and anti-bacterial support with preoperative, intra-operative and postoperative antibiotics. This helps to reduce the chances of getting an infection. The patient also helps with this by being diligent with the care of the incision. Bleeding is a possibility. However, this tends to be easily managed in the operating room. We are diligent in stopping all bleeding points that we can see. As for bleeding however, the patient plays the most important role; Bleeding can best be prevented by the patient. Patients need to be off of any type of blood thinners such as coumadin, aspirin, plavix, and must also be off of vitamins and additives for at least three weeks. It may sound strange but many of the bleeding complications seen are due to the use of vitamins. So again the patient by being diligent and thoughtful can be the best asset.

Seroma is a fluid collection and its formation is understandable when there are incisions on the body and a large dissected pocket. A seroma tends to accumulate in an area with an open space. In patients undergoing an abdominoplasty, this can be a definite problem. To help with this, we tend to keep drains in place for several weeks. These drains help to evacuate any excess fluid and keep the underlying tissues as dry as possible allowing for maximal healing. The abdominal area is also usually helped with the use of an abdominal binder that can help tighten tissue spaces and hinder the formation of a fluid collection. So again patient compliance can help reduce the chance of this complication.

Dehiscence is the breakdown of a wound following surgery. This can occur when two areas are tightly forced together. To prevent this we do exact measurements of the patient’s body contour and mark our incisions carefully. This gives the patient a certain amount of leeway and ensures that stress and movement do not cause breakdown in the incisions.

Last but not least, numbness. Numbness is common in and around the incision areas. This again is not unexpected. When incisions are made and tissues are moved, nerves can in some cases be cut and in other cases stretched. Because of this numbness is an expected complication. Most often the nerve sensation returns in time. Unfortunately, when exactly the function returns is unknown. Most often nerve sensation returns within 6 months to a year.

What is a “mini-“ tummy tuck?
Another commonly asked question. To clear up any confusion, there is a difference between a “mini-“ tummy tuck and the regular tummy tuck. As opposed to the regular tummy tuck, a mini tummy tuck is considered in some patients who have an excess amount of skin and not a great deal of underlying fat. This is a critical difference. In all my years of education and training, I think I have only seen a few patients that may again may be candidate for a mini tummy tuck. I will explain. A mini-tummy tuck only involves resecting the skin without doing any major dissection or any major mobilization of the underlying skin and tissues. Some patients may consider this a plus. However, as everyone knows, no one can escape gravity. As time goes on, many of these patients who underwent a mini- procedure return, and want to get the regular abdominoplasty. So in the long run, they have not really saved themselves any money or time. They end up undergoing two procedures and getting charged twice.

Am I a good candidate?
Plastic surgery is not for everyone. It involves certain risks like any operative procedure. As long as you are aware of this fact, you can be considered for the procedure. However, in every case, the patient is best served by a thorough evaluation of their history, their body and
their overall expectations. You as a the patient have to be realistic and cognizant of what is possible and what is reasonable. Trust me I am from Beverly Hills and I have had the privilege of working with many of the famous groups of plastic surgeons in LA. I can simply tell you there is no magic. We offer an opportunity to help you with surgical procedures in correcting what you may think is abnormal about your body. Also please understand that for many patients no surgery is needed; just a friendly word of encouragement and confidence from the local amarillo plastic surgeon.