Tummy Tuck (Abdominoplasty)
A tummy tuck, also referred to as an abdominoplasty, is a surgical procedure. The goal of an abdominoplasty is to remove extra fat and skin from the abdomen. In the majority of cases, separated or weakened muscles are restored to create an abdominal profile that is firmer and smoother than before.
Dr. Tal Roudner routinely performs tummy tucks and is one of the premier plastic surgeons in Miami. He is a member of the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgeons. Dr. Roudner’s surgical goal for a tummy tuck is to revive the youthful appearance of the abdomen by restoring the shape, curves and tightness while minimizing visible scars.
Tummy Tuck (Abdominoplasty) Overview
The aesthetic goals of a tummy tuck procedure (abdominoplasty) are to improve contour of the abdominal wall, to minimize scarring, and to maintain a natural-appearing “belly button” (umbilicus). The reconstructive goals are to re-establish the appropriate anatomy of the muscular layer and to prevent recurrence of hernias and laxity of the abdominal wall. Ideally to improve the overall contour and restore the structural integrity of the abdominal wall, the surgeon will perform a maximal but safe resection of excess skin, a sufficient volume reduction of subcutaneous fat, and tightening of the abdominal wall laxity as needed.
The female body habitus follows a gynoid or “hourglass” shape. It is narrow at the waist and wider at the hips with fat accumulation in the lower trunk, hips, thighs, and buttocks. Ideally, the female waist-to-hip ratio is approximately 0.7. The abdomen has small fullness just above the pubis with a scaphoid contour from just below the umbilicus to the costal margin.
The ideal male trunk contour has an android pattern, becoming narrower with descent from the chest to the hips in a V shape. The anterior abdomen is flat with indentations visible at the transcriptions of the muscle and along the midline. Fat accumulation tends to occur circumferentially around the abdomen and flanks.
Patients seek treating the trunk region for various reasons most commonly due to fat accumulation when their calorie intake exceeds the calorie expenditure. During pregnancy, significant abdominal wall stretching can occur, leaving stretch marks (striae) in locations where the dermis of the skin has been disrupted. After pregnancy (Post partum) or after weight loss, the skin may remain flaccid/lose with a significant loss of elasticity. Women demonstrate weight gain in the region of the lower trunk and hips; in men, excess fat is seen primarily with an increase in abdominal girth.
The change in the quality of the skin, often referred to as cellulite, is indentations or “dimpling” of the skin at areas of fibrous attachments and is more common in women. It is most frequently seen in the region of the posterior thigh.
Protrusion of the abdominal wall at the midline between the right and left rectus abdominis muscles represents weakness of the fibrous tissues connecting the muscles (linea alba) and is known as a diastasis recti. It can present after increased intra-abdominal volume and may occur in conjunction with an epigastric hernia.
Almost everyone desires a toned, flat stomach. Unfortunately, diet and exercise alone cannot always accomplish this. Even if you are at your recommended body weight, you can have an abdomen that is saggy and loose or protruding.
Some of the common causes include:
- Significant weight fluctuations
- Prior abdominal surgery
What a Tummy Tuck Cannot Do
A tummy tuck cannot be used as a substitute for an exercise program or weight loss. An abdominoplasty will not correct stretch marks; however, stretch marks beneath your belly button may be removed if they are in the area of your excess skin.
Tummy Tuck Candidacy
An abdominoplasty is a great option if you:
- Do not smoke
- Are at a steady weight and in good physical health
- Have reasonable expectations as to what a tummy tuck procedure can do for you
While the results of an abdominoplasty are considered permanent, a continued positive outcome can be diminished if your weight fluctuates significantly. Consequently, if you are planning a future pregnancy or substantial weight loss, Dr. Roudner may advise you to postpone your tummy tuck.
What to Expect During Your Tummy Tuck Consultation
The safety of your tummy tuck procedure depends greatly on your candidness during your consultation with Dr.Tal Roudner. Your candidness also affects the result of your tummy tuck procedure. Dr. Roudner will ask you several questions in relation to your lifestyle, health and desired outcome.
You should be prepared to discuss:
- Your drug allergies, medical conditions, previous surgeries and medical treatments
- Medications, herbal supplements and vitamins you are taking
- Any tobacco, recreational drugs and alcohol use
- Why you want a tummy tuck procedure
- What your desired outcome is
Dr. Tal Roudner will:
- Take photographs to place in your medical record
- Evaluate your current health, risk factors and pre-existing health issues
- Talk about your options and discuss what he recommends for your course of treatment
- Address any potential complications or risks associated with your tummy tuck procedure
- Discuss what to expect following your tummy tuck procedure, including the results
Preparing for Tummy Tuck Surgery
Before your abdominoplasty, you may be asked to:
- Adjust or refrain from taking certain medications
- Stop smoking several months prior to your tummy tuck because it inhibits your body’s ability to recover
- Have lab tests performed
- Undergo a medical evaluation
- Avoid taking anti-inflammatory medications, aspirin and herbal supplements because they may increase bleeding
You will receive special instructions to follow the day of your tummy tuck procedure.
The Tummy Tuck Surgery
A full tummy tuck procedure requires Dr. Roudner to make a horizontal incision above the pubic hairline. He will determine the length and shape of the incision by the degree of correction he is making.
He may repair and suture weakened abdominal muscles, as well as remove excess tissue, fat and skin. Removing excess skin in the upper lateral abdomen may require a second vertical incision. A series of different procedures may be performed while removing excess skin and fatty tissue, such as: repositioning the belly button (umbilicus), performing liposuction of the flanks and placating the anterior abdominal wall fascia.
Dr. Roudner may use skin adhesives, sutures, clips or tapes to close incisions following a Miami tummy tuck procedure.
Recovery and Results from Tummy Tuck Surgery
After your tummy tuck surgery at our Miami office, dressings will be placed over your incisions. In some cases you will also be given a compression garment to support your abdomen as it is healing and minimize swelling.
Dr. Tal Roudner may place small, thin tubes beneath your skin to drain excess fluid or blood that collects. This minimizes swelling after your Miami abdominoplasty. You will receive instructions as to how to care for your drain and surgical site. The drains are temporary and will be removed once the drainage stops.
The patient needs two weeks of work to recover after a tummy tuck procedure and will take a full six weeks prior to return to full normal activities.
Post operative instructions will include:
- Which medications to apply to your incision or take by mouth to reduce the possibility of infection
- Specific characteristics to look for in your health (i.e. a fever) and at your Miami tummy tuck’s surgical site (i.e. opaque white or green drainage)
- When to follow-up with Dr. Roudner
Your Miami tummy tuck results may be hard to see initially due to swelling and the inability to stand straight. However, within a few months you should be able to appreciate the results of your abdominoplasty.
Preoperative Classification System
Prior to surgery Dr. Roudner will evaluate the patient according to the preoperative classification system in order to decide which type of procedure will be the most appropriate to perform.
Patient is typically younger, with good skin elasticity and isolated abnormal fat distribution (lipodystrophy). Good muscle tone and no abdominal wall separation/laxity (diastasis).
Patient is one who usually has had at least one pregnancy. There is mild lower abdominal laxity and muscle separation (diastasis recti). Abnormal fat distribution (lipodystrophy) is mild to moderate and most notable inferior to the belly button (umbilicus).
Patient has muscle wall laxity including separation (diastasis of the rectus muscles). The redundant skin and abnormal fat distribution (lipodystrophy) is significant, particularly below the belly button (umbilicus). Significant stretch marks (striae) after multiple pregnancies.
Patient has severe upper and lower flaccidity/laxity of skin and muscle with excess fat throughout. Muscle wall laxity including separation (Diastasis recti) is significant to severe, and the patient is often mildly to moderately obese. The belly button (umbilicus) may be located below the ideal location with relationship to the iliac crest.
Preoperative evaluation will include examination for respiratory, urinary, and bowel diseases because these can contribute to the formation of acquired hernias such as true ventral hernias from postoperative incisional hernias and exacerbation of congenital epigastric and umbilical hernias that will need to be corrected. The abdominal exam will also be performed to identify any: infectious processes such as infection of the bully button (omphalitis) that results from poor hygiene and resolves with cleaning and local care of the belly button (umbilicus). Both benign and malignant tumors should be ruled out prior to surgery as well as cutaneous neoplasms and sarcomas, which are uncommon and are best treated by surgical excision. The patients medical history will be evaluated as well as medications and allergies. A medical clearance will be obtained from the primary care physician in patients that require clearance prior to surgery. Patients that are over weight according to BMI (Body Mass Index) values will be placed on a dietary and exercise program in order to attain a proper weight prior to surgery.
Aesthetic Abdominal Procedures by Classification
Dr. Roudner will perform surgery according to the evaluation he performed in the preparations prior to surgery. The procedures described below are used according to the classifications described above in the preparation section.
The deformity can usually be treated with liposuction alone. Several small access incisions in the belly button (umbilicus), at the top of the pubic hairline, and laterally within the bikini or underwear line. Care is taken to avoid intra-abdominal penetration. Standard liposuction, ultrasonic suction and power-assisted suction can be used.
A mini-tummy tuck (mini-abdominoplasty), combines minimal-length abdominal incisions to allow resection of redundant infra-umbilical skin, it is suitable for type II deformities and includes conservative liposuction with resection of the lower abdominal skin. Variable sharp resection can be combined with liposuction to remove fat. Dissection along the midline below the belly button (umbilicus) allows tightening of muscle laxity. The umbilical stalk is preserved.
A modified-tummy tuck (modified-abdominoplasty) involves elevation of a skin flap from the pubis to the subcostal margin and is indicated for type III patients. The belly button (umbilicus) is detached from the fascial (layer of fibrous tissue) midline, and the upper abdominal laxity is removed. The belly button (umbilicus) is lowered, but care must be taken to avoid lowering it to an unnaturally lower location. The redundant lower skin margin is resected/removed. Fat resection is performed sharply rather than by liposuction. The fascial (layer of fibrous tissue) midline is tightened to address muscle laxity both above and below the belly button (umbilicus). The wound is closed in layers with the patient in the semi-Flexed position to avoid any tension at closure. Closed suction drains and compressive dressings are used.
Standard abdominoplasty requires aggressive elevation of the upper abdominal flap to the level of the subcostal margin. A resection of the entire skin flap inferior to the belly button (umbilicus) is performed. Liposuction is avoided because the risk for flap necrosis (skin death) is greatly increased.The belly button (umbilicus) must be transposed. It is detached from the abdominal skin and left attached to the underlying fascia. A semi-Flexed sitting position is used to facilitate resection of the skin up to the level of the original belly button (umbilicus). Attempt to preserve a layer of subcutaneous lymphatic tissue over the fascia decreases the incidence of seroma (fluid collection) formation. The fascial (layer of fibrous tissue) midline is tightened to address muscle laxity both above and below the belly button (umbilicus). The skin is temporarily closed with staples, leaving enough room to palpate the umbilical stalk and transpose its location to the neo-umbilical wall. A mark is placed, and the location of the new belly button (umbilical) window is checked to ensure that it is in the midline and that it is properly positioned in relationship to the iliac crest, xiphoid, and pubis.
Type II and type III and even some type IV, with appropriate management aggressive liposuction of the abdomen and flanks, including the infraumbilical region is performed. Resection is performed in a small area below the umbilicus. Undermining is limited to the midline in a 4- to 5-cm region from the upper portion of the resection to the xiphoid. The umbilical attachments can be preserved or released, depending on the location of the umbilicus and the exposure required. Resection of the skin is limited to a small area above the pubis.
Simple panniculectomy is effective to address the lower abdomen, particularly in patients who have medical comorbidities that prohibit lengthy surgery.
Midline scar can be used to make a vertical midline incision to tighten the upper waist and flanks in the horizontal direction. Vertical tightening can be obtained by use of the circumferential belt dermolipectomy which improves the upper thigh, buttock, and upper abdomen.
Additional Information Regarding Tummy Tuck Surgery
A retrospective analysis of complications associated with combined abdominoplasty and lipoplasty in a single practice: Rates of minor complications (seroma, hematoma, dehiscence, infection, dog-ear) were not significantly different in the abdominoplasty alone cases (11/57; 19%). as compared to the abdominoplasty, plus lipoplasty cases (50/349; 14%). complication rates in patients subdivided according to amount of material removed were not significantly different, and no specific complication was significantly more common in patients receiving lipoplasty. addition of suction-assisted lipoplasty is not consistently associated with increased morbidity in patients receiving abdominoplasty. They credit their low complication rates to improved methods for hemostasis, efficient operative times, improved pain-management, and early ambulation. They also highlight the importance of lower extremity sequential compression devices to reduce the risk of deep-vein thrombosis and pulmonary embolism.
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