Abdominoplasty (Tummy Tuck)
Abdominoplasty, one of the most commonly performed aesthetic procedures, has undergone a significant evolution over the past several decades. Abdominoplasty or “tummy tuck” is a cosmetic surgery procedure used to make the abdomen thinner and more firm.
This type of surgery is usually sought by patients with loose or sagging tissues after pregnancy or major weight loss.
The abdominal deformity is excess skin and subcutaneous tissue and laxity of the abdominal wall musculature. The most common cause of abdominal deformity is pregnancy, most often multiple pregnancies. Pregnancy stretches the skin beyond its biomechanical capability to spring back and stretches the musculoaponeurotic structures of the abdominal wall. The result is stretching and thinning of these structures and diastasis of the rectus muscle. Postpartum weight loss also contributes to the process. If skin retraction has not occurred in approximately 6 months, it probably will not occur. Massive weight loss, whether from dieting or after a gastric bypass surgery, also plays a role in excess skin and laxity of the abdominal wall.
The pathophysiology of the abdominal deformity is 2-fold. It includes (1) excess skin and subcutaneous tissue and (2) laxity of the abdominal wall musculature.
The most significant area of the defect is around and below the umbilicus, where excess skin over a diastasis of the rectus muscles is most apparent.
The large number of different excisional designs is an indication that abdominoplasty is not an exact science. However, some guiding principles must be noted. First, ensure that the incision and subsequent excision address the deformity. For patients with a small amount of lower abdominal skin and fat excess and a minimal amount of lower abdominal laxity, a mini abdominoplasty can be performed.
This consists of a short suprapubic incision, elevation of abdominal skin to the umbilicus, plication of the fascia (if needed), and excision of excess skin.
Numerous designs for abdominoplasty are available. Recently, suction-assisted liposuction (SAL) has been added to the procedure.
9 major points: (1) incision selection, (2) panniculus elevation and SAL, (3) diastasis recti plication, (4) closure, (5) umbilicus tailoring, (6) upper abdomen suctioning, (7) adjacent deformity suctioning, (8) flap trimming, and (9) drain and dressing placement.
The studies below are performed at the surgeon’s discretion. Each institution’s preoperative anesthesia workup protocol should be followed to minimize cancellations.
- Basic metabolic panel
- Beta human chorionic gonadotropin (b-HCG) level
- Albumin level, , and total protein level (if indicated)
- Prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR) (if indicated)
- Urine cotinine level to gauge patient compliance with smoking cessation (if indicated) Complete abdominoplasty
In general, a complete (or full) abdominoplasty follows these steps:
An incision is made from hip to hip just above the pubic area. Another incision is made to free the navel from the surrounding skin. The skin is detached from the abdominal wall to reveal the muscles and fascia to be tightened. The muscle fascia wall is tightened with sutures. Liposuction is often used to refine the transition zones of the abdominal sculpture. A dressing and sometimes a compression garment are applied and any excess fluid from the site is drained.