Overview of Abdominoplasty
The abdominal trunk, or the area between the lower part of the breasts and the beginning of the pelvis, is important for plastic surgeons who perform body contouring. A common procedure in this area is the abdominoplasty, also known as a “tummy tuck.” This surgery is performed to remove excess skin and fat from the abdomen and to tighten the muscles of the abdominal wall. The aim is to create a more visually appealing abdomen. The procedure may involve cutting away excess skin or using liposuction, a technique to remove fat. With more people undergoing weight loss surgery, the tummy tuck has become very useful for dealing with extra skin left after significant weight loss.
Anatomy and Physiology of Abdominoplasty
The fat on the trunk of your body is divided into two main layers by a thin lining called Scarpa’s fascia. This lining helps separate the superficial layer, which is closer to the skin surface, from the deep layer. The blood flow to the skin and fat in this area comes from small branches of the larger superior and inferior epigastric vessels.
There are also certain areas that provide extra support to the skin of your abdomen. These include the anterior superior iliac spine (a bony point on your pelvis) and the umbilicus (your belly button). Additionally, there are specific regions such as the inguinal area (near the groin) and mons pubis (the fatty area above the genitals) that are crucial in maintaining the shape and structure of the abdomen, especially after surgeries like abdominoplasty, which reshapes and tightens the abdominal area.
Why do People Need Abdominoplasty
Abdominoplasty, commonly known as a tummy tuck, is a surgical procedure undertaken for various reasons. Some people choose this surgery to enhance the appearance of their abdomen. Women who have had multiple pregnancies may find it helpful for tightening loose skin and muscles in their abdominal area. Additionally, individuals who have lost a significant amount of weight, often through bariatric surgery, might undergo abdominoplasty to remove excess hanging skin.
Before someone can have this surgery, doctors need to ensure they are good candidates by reviewing their medical history. It’s crucial that the patients are healthy overall and have good nutritional status to heal properly after the surgery. Those who have lost a lot of weight present unique challenges; they might have a lot of loose skin that could require not just a tummy tuck but also other surgeries to lift different parts of the body like the thighs and arms to keep everything in proportion.
People with lower body mass index (BMI) generally see better results from this surgery. However, those with diabetes may experience more complications. For individuals who mainly have fat and no loose skin in their lower abdomen, a less invasive procedure called “mini-abdominoplasty” might be sufficient. In contrast, people with significant loose skin and weakened abdominal muscles might need a more extensive procedure known as a full abdominoplasty.
When a Person Should Avoid Abdominoplasty
If a person has certain serious health conditions like advanced heart or lung disease, severe liver disease (cirrhosis), or uncontrolled diabetes, they might not be suitable candidates for an abdominoplasty, which is often referred to as a tummy tuck. This surgical procedure requires a good blood supply to heal properly, and smoking can greatly harm this, making it particularly risky. Due to this risk, many plastic surgeons will not perform the surgery on people who currently smoke.
Equipment used for Abdominoplasty
This surgery typically takes place in an operating room suite with all the usual tools needed . However, if liposuction is included in the process, the appropriate equipment for liposuction should be on hand. Additionally, closed-suction equipment, which helps remove fluids from the surgical area, should also be readily available.
Who is needed to perform Abdominoplasty?
During a tummy tuck surgery, besides the main surgeon, there should be an assistant to help. This assistant supports the surgeon by holding back tissue (retraction) to provide a better view during the procedure. They also help in stitching up the various layers of tissue that have been operated on. This teamwork helps ensure the surgery is performed smoothly and safely.
Preparing for Abdominoplasty
Before having surgery, it’s important for a patient’s overall health to be in good condition. Doctors will conduct thorough medical checkups ahead of time to uncover any existing health issues that might make the surgery risky or complicated for the patient. These pre-surgery checks consider each patient’s unique medical background.
Additionally, to protect against infections, patients are given specific antibiotics before the surgery starts. These antibiotics help in reducing the risk of bacteria that normally live on the skin from infecting the surgical wound.
How is Abdominoplasty performed
An abdominoplasty, commonly known as a tummy tuck, involves making a large cut from one hip bone to the other, just above the pubic area. This positioning of the cut often allows the resulting scar to be concealed under a bikini. During the surgery, a layer of skin and fat is carefully lifted off the underlying muscles, going up to the ribcage, and the belly button is carefully adjusted to remain connected to the blood supply to prevent damage to it.
The surgeon might choose either long-lasting absorbable stitches or permanent stitches based on your specific case and the surgeon’s preference, although there are some reports of reactions to permanent stiches. The excess skin and fat that has been marked earlier is then removed, and the remaining skin is stitched back together carefully in layers to make the closure strong but gentle on the skin, helping the scar heal better. The belly button is then placed back in a position that looks natural. This whole process can be customized to fit individual needs, such as adding liposuction or modifying the surgery for those who do not require extensive muscle tightening.
Particularly, individuals who have lost a significant amount of weight may undergo a version of this surgery that involves less undermining of the skin to ensure good blood supply. For women with minor laxity below the belly button due to childbirth, a ‘mini-abdominoplasty’ might be more appropriate, which involves less extensive surgery.
After the surgery, it’s crucial for the patient to rest in a slightly bent position for two weeks to reduce stress on the surgical area and lower the risk of developing thick scars. Additional procedures, like a belt lipectomy—which extends the contouring around the hips, buttocks, and thighs—may be considered for comprehensive body reshaping. Drains and antibiotics might be used to prevent fluid accumulation and infection, although their effectiveness can vary.
Possible Complications of Abdominoplasty
Seromas (fluid-filled pockets) and hematomas (clotted blood under the skin) are relatively usual problems that can happen after surgery, affecting up to one-third of patients. If these issues are not treated, they can lead to serious complications such as the death of tissue due to lack of blood supply or infections that could threaten life and destroy the operated area. To help reduce the build-up of these fluids, doctors sometimes use closed-suction drainage systems, although there is not a lot of high-quality evidence to prove their effectiveness completely.
Another important issue to prevent is damaging the blood supply to the belly button (umbilicus) during surgery. Surgeons try to be very careful while cutting around the belly button to ensure that it still has enough fat and tissue around it to maintain good blood flow. However, complications like infections and wound openings (dehiscence) are still the most common problems, especially if there is too much tension on the skin and just under the skin layers when closing the wound.
To minimize these risks, patients are often placed in a “Semi-Fowler” position, which is a way of sitting up slightly, during recovery. This position helps lessen the strain on the surgical site, but the complications are still notably common.
What Else Should I Know About Abdominoplasty?
Abdominoplasty, commonly known as a tummy tuck, often leaves patients feeling happy with the results when done by skilled surgeons on the right candidates. However, maintaining the results is just as important as the surgery itself. Patients are advised to lead a healthy lifestyle to prevent fat from building up again around the waist. This includes regular physical activity, eating nutritious foods, quitting smoking, and limiting alcohol intake.
