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Tummy Tuck

A tummy tuck, or abdominoplasty, is a procedure that is designed to safely remove excess fat and skin from the central and lower abdomen, while restoring weakened or separated muscles. This creates a desirable abdominal profile that is smoother, flatter, and firmer.

Patients who benefit the most from an abdominoplasty procedure are those who are in good physical shape, but find that their abdomen possesses excess skin and fat. Even individuals of otherwise normal body weight and proportion can develop an abdomen that protrudes or is loose and sagging. The most common causes for this include pregnancy, aging, weight changes, heredity, and sometimes prior surgery. In many cases, the abdomen has been stretched to a point where dieting and exercise have no effect on changing its appearance. A tummy tuck is the procedure that offers a solution and allows an individual to achieve the flat abdomen they desire. In certain patients, mini tummy tuck procedure can help those who are dissatisfied with their abdominal appearance below the navel. Liposuction is routinely performed during the abdominoplasty procedure to refine the contour of the lower abdomen and trunk.

More Information about the Tummy Tuck Procedure – by Dr. Erik Miles

ABDOMINOPLASTY

What is an abdominoplasty?

An abdominoplasty, also referred to as a “tummy tuck,” is one of the most common cosmetic surgical procedures performed in the United States, with over 150,000 procedures performed each year. The procedure has been commonly performed since the 1960s. This surgical procedure is designed to safely remove excess fat and skin from the central and lower parts of the abdomen, while restoring weakened or separated muscles to their normal, more anatomic positions. This creates a desirable abdominal profile that is smoother, flatter, and firmer. A flat, well-toned abdomen is something many people strive for through exercise and weight control, however these methods alone often cannot achieve these goals. Sometimes these conditions are inherited. In other instances, substantial weight loss may cause abdominal skin to become flaccid. Abdominoplasty also can tighten muscles that have been separated and weakened by pregnancy. The procedure may also improve the appearance of stretch marks, especially those located below the navel.

Is an abdominoplasty safe?

Abdominoplasty is extremely safe when performed by a qualified and experienced surgeon such as Dr. Miles. Prior to any surgery, all patients undergo a thorough medical history screening during the consultation process. Smokers should stop smoking in advance of surgery. Aspirin and other anti-inflammatory drugs such as ibuprofen can cause increased bleeding risks and should be avoided prior to surgery. Dr. Miles will provide specific instructions to optimize outcomes. Medical testing and clearance for surgery from other providers is sometimes necessary. Dr. Miles performs the surgery in the hospital setting under general anesthesia using board certified anesthesiologists. He also works with an experienced and highly qualified team of assistants that have assisted with these procedures for many years. Dr. Miles is a double board certified surgeon who has extensive experience with tummy tuck surgery. Although complications can occur with any procedure, they are rare with abdominoplasty. The procedure does not require deeply invasive surgical maneuvers near vital structures that could potentially place patients at increased risks. In rare instances when complications related to the procedure do occur, they are usually minor and can be managed effectively in the office based setting without a return to the operating room.

Safety is the foremost priority with any surgical procedure at North Charlotte Plastic and Reconstructive Surgery. It is our position that plastic surgery procedures should only be performed by surgeons who are board certified by the American Board of Plastic Surgery. Surgeons with this qualification have met the highest standards of training and board certification. Dr. Miles has these qualifications.

How long does an abdominoplasty usually take to perform?

Abdominoplasty surgery generally takes 3-4 hours. The surgical time will vary depending on the exact techniques used and the extent of skin resection. Liposuction also adds time to the procedure. Because every patient is different and has different goals, the time to complete the surgery will vary. Attaining an aesthetically pleasing result is a high priority, and Dr. Miles will devote the necessary time to every patient to accomplish this goal.

How do you perform an abdominoplasty?

Every abdominoplasty procedure is tailored to meet the needs of the specific patient. There are various techniques that are used for abdominoplasty surgery. The goal of any tummy tuck is to tighten and flatten the abdomen to achieve an aesthetically pleasing shape. The specific technique used will be determined by the amount of excess skin to be removed, as well as individual factors such as surgical history and patient goals. During the consultation process, Dr. Miles will examine your abdomen to assess the degree of loose skin, the amount of excess fat, and the condition of your abdominal muscles.

Dr. Miles performs abdominoplasty procedures at the hospital under general anesthesia with a team of highly experienced anesthesiologists and surgical assistants to safely and efficiently perform each surgery. A thorough understanding of abdominal anatomy, blood supply, and innervation is essential to minimize complications. The procedure starts with a low, transverse incision that is placed in the pubic area and extends to each side. Centrally, this usually corresponds to a position at or below the top of the pubic hair. The length of the incision depends largely on the amount of skin to be removed. The course of this incision will vary slightly from patient to patient based on individual anatomical differences. Dr. Miles understands the concern regarding the appearance of the incision and can usually keep the incision concealed below undergarments and bathing suits. A very small incision is also made around the navel. The skin and fat of the abdomen is then precisely separated from the abdominal wall muscles. This allows for tightening of the muscles along the entire midline of the abdomen and allows for the maximum amount of extra skin and fat to be removed. Dr. Miles brings the abdominal wall muscles together with sutures to tighten them without deep or invasive incisions into areas where the vital organs of the abdomen are located. The excess abdominal skin and fat is removed and the incision is precisely closed with only absorbable sutures. The position of the navel does not change. Generally all of the skin below the level of the navel is removed, and the upper abdominal skin is stretched out flat to cover the entire abdomen with this procedure. The stretch marks, or striae, on the lower abdominal skin will also be removed. Any remaining stretch marks from the upper abdomen will be moved to a lower position on the abdomen, giving them an improved appearance that is easier to conceal. Many scars from prior surgery in the lower abdomen are also removed. Dr. Miles will usually perform liposuction of the flanks in conjunction with the tummy tuck to provide patients with the best aesthetic result.

Who is a good candidate for an abdominoplasty?

Abdominoplasty procedures benefit a wide variety of patients. Both women and men of all adult age groups and with many different body types have achieved good results from the surgery. Patients who benefit the most from an abdominoplasty procedure are those who are in good physical shape, but find that their abdomen possesses excess skin and fat. The procedure is also an excellent way to correct an abdomen that protrudes due to abdominal muscles that have been separated and weakened. Even individuals of otherwise normal body weight and proportion can develop an abdomen that protrudes or is loose and sagging. The most common causes for this include pregnancy, aging, weight changes, heredity, and sometimes prior surgery. In many cases, the abdomen has been stretched to a point where dieting and exercise have no effect on changing its appearance. A tummy tuck is the procedure that offers a solution and allows an individual to achieve the flat abdomen they desire. A tummy tuck can also reduce scars after other surgeries in the abdominal area (especially gynecologic surgery) and partly reduce stretch marks. Patients who plan to become pregnant or lose a significant amount of weight should discuss this with Dr. Miles, as these conditions can affect the long-term results after abdominoplasty. Large incisional scars from previous surgery on the upper abdomen may limit the techniques available for abdominoplasty. Smokers should stop smoking prior to abdominoplasty surgery to decrease wound healing complications.

Does insurance cover abdominoplasty surgery?

Abdominoplasty is a cosmetic procedure that is generally not covered by insurance providers. Some insurance companies will cover only the removal of severely overhanging lower abdominal skin if some very strict criteria are met. These patients must have significantly overhanging skin and documentation of infections caused by the overhanging skin. This procedure, called a panniculectomy, does not tighten the abdominal skin or underlying muscles, and therefore the cosmetic results of panniculectomy are usually inferior to a traditional abdominoplasty. In some instances, however, a patient may have a hernia and not just a spreading of the abdominal muscles. Insurance reimbursement may be available for that portion of the procedure that is not cosmetic. Many factors determine your eligibility for coverage, including the specific terms of your insurance policy. A letter of predetermination may be required prior to surgery.

What are realistic expectations for a patient having an abdominoplasty?

Abdominoplasty is one of the most commonly performed cosmetic procedures in the United States due to excellent results and high patient satisfaction. Abdominoplasty enhances a patient’s body contour by making the abdomen firmer and flatter. Most patients feel more comfortable in clothing and are more confident about their appearance.

During the initial consultation, Dr. Miles will listen to patient concerns and make recommendations about how to best meet a patient’s goals. Pictures will be taken to enhance the discussion and give patients different views of their bodies. Dr. Miles will perform a thorough examination of every patient’s abdomen to assess skin excess, skin elasticity, integrity of the muscles, and existing scars from prior surgery. It is important for patients to honestly discuss their expectations with Dr. Miles prior to surgery so he can determine whether or not they can be realistically achieved.

Fortunately, significant complications from abdominoplasty are rare and most patients are very pleased with their results after the procedure. Anyone considering surgery, however, should be aware of both the risks and benefits. Potential complications include bleeding, infection, and fluid accumulation (seroma) under the skin. Patients who smoke or have medical conditions such as diabetes are at a higher risk of delayed wound healing or tissue loss along parts of the incision. These complications can usually be managed in the office without further surgery, but recovery can be prolonged when they do occur.

The incisions from the procedure will fade and become less noticeable over time. It is important to realize, however, that the incision lines will be permanently visible. Most scars heal and mature to become faint lines, however scarring can be more perceptible in some patients. Although not commonly required, minor revisionary surgery can be performed in the office under local anesthesia to address incisions that have healed poorly. Fortunately, abdominoplasty incisions are placed in locations easily concealed by most bathing suits and undergarments. Abdominoplasty cannot always remove all stretch marks, especially those located above the belly button. The results after abdominoplasty are long-lasting. Tummy tucks are not a substitute for weight loss or an appropriate exercise program. Significant weight changes or pregnancy can alter the firmer, flatter abdomen that has been achieved.

What is a “mini” tummy tuck?

In certain patients, if the skin laxity is isolated to the lower abdomen and the abdominal wall muscles do not require tightening, a limited, or “mini,” tummy tuck might be indicated. This procedure involves only the removal of skin from the lower abdomen, and works best when the amount of loose skin is minimal and the excess fat deposits are located below the navel. The incision is often shorter using this technique. No surgery is performed around the navel. Although a mini abdominoplasty sounds desirable to many patients, the best results are usually achieved with a traditional abdominoplasty procedure. Dr. Miles will discuss which technique he recommends to achieve the best results for your individual body type.

What are the common reasons why a patient wants an abdominoplasty?

Patients who seek abdominoplasty are universally unhappy about the appearance of their abdomens. They generally have physical changes related to pregnancy, aging, weight loss, heredity, and sometimes prior surgery. Most patients have overhanging and redundant skin and fat of the lower abdomen. Sometimes the abdomen protrudes due to abdominal muscles that have been separated or weakened. A common complaint is that the abdomen has been stretched to a point where dieting and exercise have no effect on improving its appearance. Some patients also have stretch marks in the lower abdomen that they would like removed with the procedure. Prior surgical scars, especially from gynecologic surgery, can also be removed in some cases. Abdominoplasty surgery can greatly improve self-confidence and self-esteem.

How long does it take for a patient to recover from an abdominoplasty?

The vast majority of patients go through the recovery and healing process without any complications after a tummy tuck. Dr. Miles follows patients very closely after any surgical procedure and he is always available to answer any questions or address any concerns. After surgery, patients will have surgical dressings over the incisions and the lower abdomen will be covered with an abdominal binder. This supportive garment is typically worn for several weeks. Patients will generally have surgical drains placed during the procedure, which are small tubes placed under the skin to drain any excess blood and fluid that may collect. The drains are painlessly removed in the office after 7-10 days. There are no sutures to remove after surgery. The wound care instructions and drain management is very simple. All patients are given specific written instructions for abdominoplasty recovery during their preoperative appointment. These instructions cover incision and drain care, medications, and how to monitor the surgical site.

The amount of time it takes to recover after a tummy tuck procedure varies between patients, depending on the extent of the surgery and the patient’s general physical condition. Early after the procedure, there can be visible swelling and bruising. Postoperative discomfort is usually mild and managed well with prescription pain medication in the first few weeks. Patients will generally take 2-3 weeks off from their regular activities. The office can provide excuse notes for work or school if needed. Following the surgery, patients are encouraged to get out of bed to promote blood circulation. Most patients will not be able to stand up completely straight immediately after the surgery due to the tightness of their abdomen. Straining, bending and lifting can cause complications such as increased swelling, bleeding, or incision breakdown. Most patients can resume non-strenuous work after 2-3 weeks, however exercise should be avoided for about 6 weeks after surgery. Abdominal muscle specific exercises, such as sit ups, should be avoided for approximately 3 months. Complete healing generally takes 6-8 weeks, but it may be months before swelling and induration fully subsides and the final results are evident. Many patients will notice some numbness over portions of the lower abdomen which may persist for several months. The incisions will initially be red or pink in color. Sometimes there are small areas of scabs that will need to heal. The incisions can remain dark for many months following surgery and may even appear to worsen before they finally begin to fade.

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