There are a number of components to the tummy tuck procedure that I believe strongly contribute to the overall safety and outcome of the procedure.
Who is a candidate?
Removal of excess skin and fat from the belly after childbearing or weight loss is a surgery often performed by board certified plastic surgeon. Though the overall challenge posed by these patients share a common theme, there are some nuances that can be discussed that effect clinical decision making. These factors include patient pre-existing comorbidities (diabetes, smoking, excessive weight, blood clotting disorders), as well as the goals meant to be achieved by the patient. For safety reasons, I do not operate on obese individuals, poorly controlled diabetics, or smokers. A very useful risk calculator can be found at http://abdominoplastyrisk.org that can help you understand why these patients are not candidates.
Is liposuction part of a tummy tuck?
In the past there has been variation in thoughts regarding what liposuction can be done safely in conjunction with a tummy tuck. Historically the surgical approach dissected the skin and fat away from the abdomen at the level of the rectus fascia (the six pack muscles). This left the remaining skin dependent on blood from the vessels located along the flanks. This precluded the use of liposuction along the flanks, as this would threaten the viability of the central abdominal skin.
In recent years, a more conservative approach, coined “Lipoabdominoplasty” by Osvaldo Saldanha has increased our flexibility in achieving the desired result. The focus is on preserving scarpas fascia overlying the rectus muscle. Scarpas fascia acts as a drain for lymphatic fluid, reducing the chance of fluid collections under the operated skin. Also, there is emphasis on preserving the central blood supply located on either side of the six pack muscles. If this blood supply is preserved, the surgeon can now safely perform liposculpture of the flanks (“love handles”) to achieve an hourglass shape in addition to liposuction of the area midline above the belly button. For this reason, I perform liposuction of the flanks ("love handles) and area midline above the belly button as a standard part of the tummy tuck procedure. It is important to note that liposuction can only address subcutaneous fat, the fat just underneath the skin. It cannot address the visceral fat under the muscles surrounding the organs. The only way to address visceral fat is through diet and exercise.
What about tightening the abdominal muscles?
During the consultation, I exam the abdomen to look for diastasis recti (separation of the abdominal muscles). If there is in fact true diastasis recti I will repair that during the tummy tuck procedure. I can also diagnose hernias during physical exam and repair them as part of the procedure. However, if a patient does not have abdominal muscle separation I do not stitch the muscles together. The most important reason for this is because any suturing of the abdominal muscles increases the risk of deep vein thrombosis and pulmonary embolism. Optimal results can still be achieved without suturing the abdominal muscles.
How do I approach pain management?
Pain is one of the main fears that dissuades patients from considering the procedure. Historically, this surgery had been known to be quite uncomfortable during the initial two weeks, as there is a large incision involved, and the surgical area has been significantly tightened. Over the past 15 years this has largely been overcome. The first approach was to use an external lidocaine pump to drip anesthetic into the surgical site. This has since been supplanted in Dr Camp’s practice by using a long acting time release medication. This medication is injected into the surgical site during the procedure and makes the area generally numb for two to three days. In the absence of the initial post-surgical pain, patients require much less oral pain medication, and avoid the severe constipation and other potential problems associated with powerful opioid based medications.
What is recovery like?
The general expectation is to return to home the day of surgery and be able to get around the house. One week after surgery drains are removed and most patients are able to return to work at a desk job between 10 and 14 days after surgery. Compression garments are provided after surgery. Scar gel treatment is initiated 3 weeks after surgery to fade the abdominal scar. The result is a pleasing contour with minimal downtime.
Dr Matthew C Camp
Board Certified Plastic Surgeon
Member, American Society of Plastic Surgeons