ABDOMINOPLASTY

M. TAVALLALI, M.D.

Abdominoplasty, known more commonly as a “tummy tuck”, is a surgical procedure to remove excess fat and skin from the abdomen, and also to tighten the muscles of the abdominal wall. The procedure, sometimes in conjunction with liposuction, can dramatically improve the appearance of a protruding abdomen and waist, restoring a more pleasing shape to the body.

For the greater part of this century, the aesthetic ideals representing the desired human form in society have been based on a slim figure. Despite their efforts, people continue to have problems with excess weight, and its physical and psychological sequalae. Dr. Tavallali can assist those patients who have large fat deposits that do not respond to diet or exercise and who wish for a change in their physical appearance in achieving their physical contour that more closely resembles the self- image which they have.

The first abdominoplasties were performed in the 1890’s, but it was not till the 1970’s that the procedure gained wider acceptance to the point that it has become a safe and effective operation in the hands of competent Plastic and Reconstructive surgeons.

In my approach to the patient requesting abdominoplasty, I begin with a thorough medical history in order to identify those patients that may be at increased risk for complications. Diabetics, smokers, those with previous abdominal surgery, or a history of pulmonary embolism may not be suitable surgical candidates, and steps can be taken to decrease the risks in these patients. Patients who intend to lose a great deal of weight are encouraged to do so by means of diet and exercise before contemplating surgery. Also, women who plan future pregnancy should postpone any surgery till at least six months after delivery to prevent the separation of the abdominal muscles that are tightened with a standard abdominoplasty.

During the examination, particular attention is directed to the quality of the skin of the abdomen, looking for stretch marks and surgical scars. The quantity of the excess fatty tissues of the abdomen is assessed, and a careful search made for signs of skin infections.

Based on my examination and discussion with the patient regarding his or her wishes and expectations, I then consider one of the procedures which are available to the surgeon in reducing the size of the abdomen.

If the patient has a small to moderate excess of fatty tissue, with normal skin elasticity (no or few stretch marks) liposuction may be the desired approach. In this procedure, fat is suctioned from the skin through small incisions. The skin then redrapes over the contoured fat with astonishing results. No skin is excised.

For the patient with poor skin elasticity and moderate excess fatty tissue, one of the variants of an abdominoplasty may be required. If the excess fatty tissues are limited mainly to the lower abdomen and the abdominal muscles are not weak, the patient may benefit from a mini-abdominoplasty. In this operation, the excess skin and fat of the lower abdomen are surgically removed through an incision above the pubic area with care being taken to hide the scar within the “bikini line”. The upper abdomen is then liposuctioned to achieve a harmonious abdominal profile.

Both of the above procedures can be carried out as an out patient and typically last two to three hours. Within three to five days, recovery is usually enough to allow the patient to return to sedentary work. Exercise is allowed in one month.

When the patient has a combination of poor skin quality, excess fat and weakened abdominal muscles, then the procedure of choice is a full abdominoplasty. In this procedure, the surgeon tightens the abdominal muscles and removes the excess fat and skin, stretching the full length of the abdomen. Typically the amount of skin removed is the distance between the umbilicus and the pubis. The umbilicus is kept on a stalk and a new position is created for it on the abdominal wall. This procedure, like the mini-abdominoplasty leaves a horizontal scar in the “bikini line”. The procedure is typically performed in a hospital or surgical facility as either an inpatient or outpatient and takes two to three hours to perform depending on the amount of work required. Drains are frequently required and are removed after three to seven days. Discomfort is controlled with oral medication, and most patients are back to work within one to two weeks, although swelling and soreness may persist for months. Exercise is permitted one month after surgery.

As in any surgical procedure, there are certain risks that must be assumed when undergoing surgery of the abdomen. Thousands of abdominoplasties are performed successfully each year and the results are generally very satisfying. Luckily, major complications are rare and minor complications, when they do occur are easily treated. Infections, fluid collections and minor wound healing problems are usually self-limited. The most serious complication, that of a pulmonary embolus due to blood clots that develop in the legs, is also one of the most rare, and its treatment may require hospitalization. Smokers are advised to stop smoking for at least two weeks before surgery.

The options available for surgery of the abdomen to improve appearance are multiple, and the patient must have reasonable expectations and understanding of possible results after the surgery as well as of the pre and post operative regimens. The trade off of scars for an improvement of shape must be accepted, but excellent results can be obtained for patients with excess fat, skin and /or weakened abdominal muscles. The results are long lasting and allow patients who sometimes find themselves limited in activities and lifestyle, to once again become confident, active members of society.

Hopefully, this information has given you a better understanding of abdominoplasty. Please feel free to call our office at 703-876-9400 or 301-907-3838 to schedule a complimentary consultation with Dr. Tavallali. We look forward to seeing you soon.

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