What Is Abdominoplasty.This cosmetic surgery, some¬ times called a "tummy tuck," reshapes and slims the area of the body between the chest and the pelvis to give the patient a trimmer body. This sur¬ gery may be done by removing a fat deposit that does not respond to diet; or by cutting away excess skin left after extreme weight loss; or by reducing sagging due to pregnancy or natural age-related loss of skin elasticity; or by tightening muscles stretched by multiple pregnancies; or by repairing a pregnancy-related separation of muscle from the abdominal wall. Procedure The common types of abdominoplasty are traditional abdominoplasty (also known as complete abdomi¬ noplasty or full abdominoplasty), fleur-de-lis (lys) abdominoplasty, endoscopically assisted abdominoplasty, high-lateral-tension abdominoplasty, partial abdomino¬ plasty (miniabdominoplasty or mini-tummy tuck), and dermolipectomy. Another procedure, circumfer¬ ential abdominoplasty (midbody lift), is used in cases where extreme weight loss has left excess skin around the entire midsection of the body. All forms of abdominoplasty are considered major surgery, most often performed under gen¬ eral anesthesic and usually in a hospital setting. Some patients may be released within hours after a partial abdominoplasty, but most abdominoplasty patients spend a day or two in the hospital.
Traditional abdominoplasty is surgery to remove a large amount of excess skin and fat. The surgeon makes one long incision from hip to hip, just above the pubic bone, then lifts the skin up and away from the underlying tissues. She next removes excess fatty tissue; repairs the rectus abdominus muscle separation and sutures it into a tighter posi¬ tion, bringing the edges of the incision together and removing excess skin to make a smooth closure. If necessary, she repositions the navel and closes the incision with sutures or surgical staples. The pro¬ cedure for a partial abdominoplasty is similar to that for a traditional abdominoplasty, but the incision is shorter; less skin and fatty tissue are removed; and the navel is not likely to be repositioned. Fleur-de-lis abdominoplasty is also surgery to remove large amounts of excess skin and fat. The procedure is named for the shape of the two-part, T-shape vertical and horizontal incision in the cen¬ ter of the abdomen, which resembles the flower of Lyons (fleur-de-lis [lys] in French), a heraldic device used by French kings. As with a full abdomino¬ plasty, the surgeon lifts the skin; removes excess fat; tightens the muscle; brings the edges of the incision together; repositions the navel (if neces¬ sary); and closes the incision. Endoscopically assisted abdominoplasty is a proce¬ dure used to tighten the abdominal muscles with¬ out removing much skin or fat. The surgeon makes several small incisions across the abdomen; inserts an endoscope (see endoscopy) (a flexible tube with a light that enables the surgeon to see under the skin) through one incision and a second instru¬ ment to lift the skin away from the muscle through another incision; stitches and tightens the muscle; and closes the incisions.
Miniabdominoplasty is a procedure most often used when the abdominal fat is found only in the area under the navel. The surgeon makes a short incision just above the pubic region, lifts the abdominal skin up toward the belly button, trims away excess skin, tightens muscles if required, and sutures the skin in place under the navel. Dermoli- pectomy is similar to miniabdominoplasty, except that it may remove more skin but does not involve tightening the abdominal muscles; the procedure is used for patients whose abdominal skin is looser than those for whom the miniabdominoplasty is sufficient. Circumferential abdominoplasty removes excess skin from the stomach, thighs, and buttocks in a single procedure. The surgeon makes an incision across the abdomen in the area of the navel, frees and lifts the skin toward the middle of the abdo¬ men, cuts away excess tissue, repositions the navel if necessary, and closes the incision. She next turns the patient over on the operating table, makes an incision across the lower back at a point cor¬ responding to the incision on the abdomen, and repeats the procedure. Note: Several months after this surgery, the patient may undergo additional procedures to trim excess skin from under the upper arms, breast area, thigh, neck, and face. Note: Before closing the incision(s) after abdom¬ inoplasty, the surgeon may insert a drain to allow blood and other liquids to flow out of the wound rather than pool under the skin. Risks and Complications Common side effects include pain, tenderness, loss of sensation at the site of the incision, and/or swell¬ ing of the abdomen, the labia (women), and the scrotum (men) for up to six weeks after surgery. Possible complications include continued bleed¬ ing that may cause a hematoma (pooling of clotted blood under the skin) that may become infected, or a seroma (pool of fluid under the skin that may require surgical drainage), or blood loss severe enough to require a transfusion. As the wound heals, the stitches may fail to dissolve properly. The navel may be off-center or otherwise oddly positioned due to contraction of the various scars, and the blood supply to the newly positioned navel or to the abdominal wall may fail to develop properly (more commonly in people with vascular problems), leading to tissue death requiring a skin graft. The death of fat cells/fatty tissue under the skin may cause infection requiring further surgery. The incision may separate, creating a thicker-than- normal scar requiring surgery to reduce it. As with all major surgery, there is a risk of life-threatening blood clots in legs and lungs, as well as a reaction to the anesthetic. Because circumferential abdomi¬ noplasty is a more complex procedure than other forms of abdominoplasty, it carries a higher risk of possible complications. Outlook and Lifestyle Modifications This surgery is most effective for healthy adults. It is not a substitute for proper diet and exercise to achieve weight reduction. It is not recommended for people who are extremely obese or for those who plan to lose more weight or for women who plan to become pregnant again, because the abdominal muscles may separate from the abdomi¬ nal wall during future pregnancies.
