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Common Questions on Bariatric Plastic Surgery (Body Contouring after Massive Weight Loss)
Author: barryeppley
1. How soon after my weight loss can I get plastic surgery done?
Large amounts of weight loss, generally 75 to 100 lbs or greater, will cause significant loose skin on multiple areas of the body. It does not matter whether that amount of weight loss is from dieting, gastric bypass, or lapband surgery, the skin can not shrink back done in most people.
Because body contouring surgery is about removing as much excess skin as possible, one should have maximized their weight loss and proven that this new weight is stable. For some patients, that may be 9 to 12 months. For others, it could be much longer than a year.
The other benefit to waiting until your weight loss is stable is to make sure you are in a good nutritional state. Weight loss, no matter how it is done, depletes one’s body of vital nutrients and other stores that are needed for the healing of long surgical incisions and extensive wounded tissues.
2. At what weight should I before I can have body contouring surgery?
Many extreme weight loss patients have a specific target weight in mind. Whether they make it or not depends on a lot of factors and one of those is certainly time. Whether any patient will hit their weight target is unknown. But at some point one will realize a point when their weight will not get any lower. Once one has bounced around at a low weight for awhile, then you can be certain this is where your body will live. Once you are comfortable that you have found this weight, and can keep it, then you are ready for surgery.
3. What’s the difference between a tummy tuck and a circumferential body lift?
The one body area that bothers all extreme weight loss patients is the abdomen or waistline area. Loose skin is always present in front of, over, and behind the hips. For some patients, a skin overhang is only present in the front. For many others, the skin excess extends around the waistline and across the back, resulting in sagging of the buttocks and posterior thighs as well. These concerns are almost always addressed first in most bariatric plastic surgery treatment plans.
When the excess skin overhang is primarily in the abdominal area, a tummy tuck or abdominoplasty is all that is needed. While it can be a conventional horizontal elliptical excisional pattern, the amount and stretched out quality of the skin may need a modified pattern to provide optimal tightening. This may require the horizontal cutout to go further back along the waistline or to include a vertical skin wedge resulting in an invert T or anchor closure pattern. (fleur-de-lis tummy ruck)
When the loose skin incorporates the entire waistline, a circumferential or 360 degree cutout is needed. This is known as a circumferential body lift. It is a lot like ‘pulling up your pants’. The scar will run completely around your waistline. In some cases, the front side of the circumferential body lift may include the fleur-de-lis cutout pattern as well.
4. How can I reshape my saggy breasts…or my manboobs?
One of the most challenging of all body parts to reshape after extreme weight loss is the female breast and the male chest. The female becomes essentially a deflated bag of skin with severe sagging and the nipple often pointed downwards. The male chest also loses volume, although less so than the female, but the chest skin shifts and sags downward with a lower than normal nipple position.
The breast often requires a combination of an implant, for volume replacement, and a lift (mastopexy)to reduce the amount of sagging skin and bring the nipple back up to a more central position of the breast mound. This is a difficult operation, from an artistic standpoint, and it often requires two separate surgeries to get the best result.
The sagging chest in the male, while not trying to make a mound like in the female, is complicated by trying to limit scarring. There are no natural creases or folds to hide scars in the flat male chest. Getting the nipple back up on the chest and tightening the skin requires a compromise between the result and the amount of scarring. The chest lift in a man is done differently than a breast lift in a woman.
5. I hate my ‘batwing’ arms, what can I do about them?
Loose skin in the arms is another common extreme weight loss problem. In the back of the upper arms (triceps area), loose skin and fat hang off and below the humerus bone. This creates a large fold of hanging skin. It often extends into and past the armpit and down into the side of the chest. In some cases, I have seen the skin excess goes past the elbow into the forearm.
The good news is that arm recontouring, known as brachioplasty, is the ‘simplest’ of all body contouring procedures. The arm’s circumferential measurement can be measurably reduced. Skin and fat is removed longitudinally along the arm and the cut out often takes a right turn into and past the armpit. The bad news is that it does result in a long scar in an unnatural area on the inside of the arm. Scar healing problems are not uncommon in the moist and moveable armpit area.
6. How bad are the scars from bariatric plastic surgery?
Body contouring after extreme weight loss is about making a trade-off…scars for improved contours. Depending upon the body area, scars tend to turn out somewhat different. Breast and abdominal scars generally look best while arm and thigh scars tend to become wider. Most of these scars are more than just fine or pencil-line in width and some of them will end up becoming hypertrophic or wide due to the tension placed on the wound closure.
Regardless of how the scars may look, there can be a lot of them if multiple body areas are treated. Despite the plethora of this new skin ‘problem’, weight loss patients universally prefer them to their prior ‘sharpee’ body look.
7. Will insurance cover my skin removal surgeries?
While third-party payors often pay for surgical and non-surgical weight loss treatments, such widespread coverage for body contouring is not so generous. The line between cosmetic and reconstructive procedures for removal of excess skin is a judgment call that does vary amongst different insurers. Ultimately they are looking for functional problems that this skin causes, such as infections, to determine medical necessity for the operation. In general, the most commonly covered procedure is the abdominal panniculectomy or frontal abdominoplasty. The procedures never covered are breast and chest reshaping.
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from 12:00 to 1:00PM on Saturday afternoon, hosted by Dr. Barry Eppley Indianapolis plastic surgeon, the topic of body contouring in men was discussed. Male body reshaping generally includes liposuction, modified forms of tummy tucks, gynecomastia reduction, and chest reshaping. Interviewing several patients, both before and after their surgical procedures, was done to listen to their concerns, apprehensions, experiences, and the results afterwards.
Each year, plastic surgery in men becomes more popular. As Americans live longer and healthier lives, the expectation of looking and being vital is important even into one’s sixties and seventies.
One of the most popular surgical procedures among men is liposuction. As with women, men are genetically designed to accumulate fat in certain areas. While women tend to accumulate fat in the hips and thighs, in men fat generally goes straight to the waistline. And for some patients, once this excess fat has accumulated, no amount of diet or exercise may be able to make it disappear. Such individuals are often excellent candidates for liposuction. I typically perform circumferential liposuction of the trunk for male patients, to improve the aesthetics of the torso not only anteriorly but also in profile and when viewed from behind. Another area where liposuction is commonly performed in men is the area below the jaw, where removal of fat can significantly improve the male facial profile. Liposuction of the anterior neck and the area below the jawline is frequently performed at the same time.
Many of my liposuction patients are very active individuals who have essentially ‘hit a wall’ in terms of improving their body contours through dietary modification and exercise. The boost they get from liposuction in recontouring their ’stubborn fat’ areas quite often motivates them to be even more intensive in their exercise and nutrition regimens. I have many patients who at one year post-op have a result that is perhaps 75-80% the direct result of body contouring surgery, and 20-25% is the result of their own efforts at maximizing the result of surgery through diet and exercise.
In men that lose a significant amount of weight, the abdominal skin may be left loose and sagging. In such patients a tummy tuck (abdominoplasty) or mini-tummy tuck can instantly restore a more appealing abdominal contour. While women undergoing abdominoplasty usually require abdominal wall repair (from prior pregnancy), in some male patients the tummy tuck consists of only skin and fat removal, which has a much faster recovery time.
Male tummy tucks are usually combined with liposuction of the abdomen, waist and chest. Depending on the degree of abdominal skin laxity, a male abdominoplasty may be performed with or without umbilicoplasty (the surgical creation of a new umbilicus or belly button. The surgical approach is always individualized to the particular needs (and goals) of each abdominoplasty patient.
Enlargement of the male breast is referred to as gynecomastia which can occur in response to certain medications or hormonal conditions but most often has no clearly identifiable cause. Gynecomastia may develop at any age, and may occur on one or both sides. In most patients it can be corrected with liposuction or with a combination of liposuction and direct excision (removal) of breast tissue and/or skin.
Surgical correction of gynecomastia produces a dramatic, positive change for patients with this troublesome problem, as it is usually a source of significant self-consciousness and embarrassment. For most patients the results are quite liberating, especially in terms of participating in athletic endeavors and relaxing at the beach or pool.
Whenever possible, my strong preference is to avoid skin excision and thereby limit the surgical scar to the inferior border of the areola. When a patient with gynecomastia has breast enlargement to an extent where too much liposuction is likely to produce a ‘deflated’ appearance, I often will stage the procedure, which allows time for the skin to retract to some extent between the two liposuction surgeries. In many cases this completely eliminates the need for skin excision, and in some it reduces the need for skin excision to that which can be accomplished with a peri-areolar scar only (instead of standard ‘inverted-T’ breast reduction scars).
Men interested in body contouring can arrange a consultation with Dr. Eppley by calling his Indianapolis suburban area facilities at Clarian North office at 317-814-4100 or his Clarian West office at 317-217-2200.
Self-Image, Psychology, and Bariatric Plastic Surgery (Body Contouring)
Author: barryeppley
The road from the beginning of the decision to make weight loss happen…to bariatric surgery…to the final steps of body contouring plastic surgery is a difficult and long journey. Often, this is a process that has evolved over years. Not only has pounds and inches been lost but your lifestyle has hopefully changed forever. For many, this process may have been the most difficult commitment of their lives. Many start this journey, but only some will make it all the way.
Not that you have done your best to look and be healthy, now what? For some patients, there will remain a disconnect between how they look and how they still see themselves. Changes in the shape of the body, clothing options, scars, relationships with others, and memories of the ordeal may leave one on a rollercoaster of emotions for some time after. This is not abnormal and you may need support as you go through this ‘final phase’. Support groups, counseling, and sharing your experience with others are all good ways to work through these emotions as you remodel your self-image.
As a plastic surgeon, my biggest observation and words of advice are that body contouring is not the cure for a poor self-image or any form of depression. It is designed to be helpful, and often is greatly so, but persistent down feelings after the euphoria of plastic surgery passes may require some form of treatment or professional help. I do know based on my own patient experiences that many body contouring patients go on to have very normal and quite productive lives.
Body contouring surgery can be quite liberating, removing a lot of physical limitations. These physical changes will result in other changes as well, particularly in relationships and in how people interact and deal with you. And for the most part, these are quite positive changes. But expect a few bumps along the road and not every change that you make will make everyone happy. Not everyone around you can adapt and change with you. That is just one of the conundrums of life.
Embrace your new body and your new self. What you do from this point on will now be determined by what lies between your ears, not by what surrounds them.
Dr. Barry Eppley
http://www.epplyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
The treatment of obesity with bariatric surgery is a commonly done and highly effective procedure for generating large amounts of weight loss. (> 100 pounds) This has led to a large population of such weight loss patients seeking body contouring surgery to deal with their hanging skin issues. Many of the body contouring surgery options (e.g., circumferential body lift, breast lifts, arm lifts, thigh lifts) involve large amounts of skin removal with resultant long incisions and a lot of wound surface area to heal.
Such wound healing needs require a patient to have good nutrition to provide all the necessary nutrients to make new tissue and mend the wound edges. Unfortunately, many bariatric patients have chronic nutritional deficiences secondary to their gastric bypass procedure with altered absorptive capabilities. Such poorly nourished patients can be hard to detect prior to surgery unless they are part of an ongoing program of management from their original bariatric center or family physician. Body contouring surgery has a significant incidence of wound problems including minor to more significant wound separations, seromas (fluid collections), and incisional problems secondary to suture reactions. These problems are undoubtably magnified and more severe when the patient’s nutritional status is not ideal.
Because of the nutritional issues during the period of weight loss, bariatric patients should not consider body contouring surgery for at least 12 to 18 months after their gastric bypass procedure. Even when maximal weight loss is achieved, many bariatric patients will have nutritional issues. Most prevalent among them are protein-calorie, vitamin (A, B, C and folate), and mineral (iron and zinc) deficiencies. Ideal daily requirements for good healing after body contouring surgery include protein (70 - 75 grams), vitamin A (25,000 units), vitamin B12 (500 ug), folate (400ug), vitamin C (2 grams), iron (100mg), and zinc. (20mg) A wonderful article on the nutritional needs of the postbariatric patient undergoing body contouring surgery is available in the December 2008 issue of the Journal of Plastic and Reconstructivhe Surgery by Drs. Agha-Mohammadi and Hurwitz which provides in-depth nutritional information.
To achieve this level of supplentation, multivitamins and protein drinks and bars may be adequate in some cases. For many patients, however, this oral approach may not be sufficient. Fot this reason, there are available formulated supplements unique to the needs of the bariatric patient including ProMend (Bariatric Advantage, Irvine, CA) and ProCare Surgical Formula (NutrEssential, Wilmington, CA) These formulas bring to the table the necessary vitamins as well as protein, free amino acids, arginine, and glutamine which are essential building blocks for new tissue formation. ProCare is preferred as it comes in a powder form which is better absorbed in the gastric bypass patient as opposed to pills.
The postbariatric patient is a unique surgical patient because of the magnitude of the procedures and their often compromised nutritional situation. Oral vitamin and protein supplementation should be started one month before most body contouring surgeries and continue for one month after. While this will not eliminate all wound complications, it will decrease the number that occur and the length of time that any wound complications will take to heal.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
The sagging skin that results from extreme weight loss does not spare the upper body, particularly the arms. Flabby upper arm skin, often referred to as ‘bat wings’, is a very troubling problem that makes many affected women wear long sleeves, even in warmer weather. It limits their clothing options and is a frequent source of embarrassment. In my experience it is always in the top two concerns of most extreme weight female patients.
Such an arm problem is a good candidate for an arm contouring procedure known as an arm lift or brachioplasty.This operation removes a large amount of excessive skin and fat from the upper arm. This is a fairly simple operation that causes little to no pain afterwards. The biggest decision for any one considering this procedure is whether they can handle the scar that results from the procedure. Unlike most body contouring plastic surgery procedures where the scars may be fairly well-hidden under clothes, this is a scar which will be visible. For this reason, the decision for some patients can be a difficult one. Is it better to have a flabby arm with no scar or a more tightened arm with a scar? While the temptation is to always assume that the scar may be better, it is important to know that the scars in the arm (in my opinion) are never great. They frequently end up after healing and time to be wider and more raised than we like. While some arm scars can look quite good, many will be simply acceptable in the vast majority of patients. Scars are the arm simply do not do as well, for example, as scars from a tummy tuck or a breast lift. Scar revisions after an arm lift can really make a big difference is problematic arm scars…but that is another operation as well.
There are two types of arm lifts or brachioplasties. A full (extended) and a limited (short scar) arm lift. The difference is in the amount of skin removed and the resultant length of the final scar. In every extreme weight loss patient that I have seen, they all need an extended or the full arm lift due to the amount of skin. While I usually never cross the scar past the elbow, it is almost always necessary to carry the upper part down into the armpit if not further down into the chest wall and back. The arm lift scar can be placed either on the inside of the arm or on the back of the arm. There are arguments to be made for either scar placement,. neither approach is necessarily better than the other. Both locations of skin and fat removal will do the job. I leave the scar location decision up to the patient since they are the one who has to live with the final result.
While arm lifts cause very little pain afterwards, they do create some temporary swelling in the hands and forearms. The combination of upper arm skin tightening and circumferential dressings (loosely applied) causes some temporary lymphatic obstruction which resolves in less than a week after surgery. Healing of the incision is sometimes slow in the armpit area and it is not rare to have to drain a seroma in the elbow in the few few weeks after surgery. Beyond these short-term troublesome issues, arm lifts produce good results with a relatively uncomplicated postoperative course.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Currently, men make up a minority of patients presenting for body contouring surgery after weight loss. However, their numbers are increasing and they have several different body concerns that women. One of these is that of the chest area. The skin sag and the presence of excess fat under the nipple creates a relatively new type of problem. Some call this chest problem gynecomastia but that is inaccurate. It is really pseudogynecomastia as it has more skin and less actual fat.
Most male chest deformities after weight loss require dealing with the extra skin. Some patients may need liposuction only but this is not common in my experience. When a male patient is motivated to undergo chest reconstruction, they almost always have a significant problem. It usually requires removal of skin and then what to do with the the sagging and often stretched out nipple. The skin part is relatively easy. The overhanging skin (that which sags below the lower chest crease) is horizontally removed with the goal of making the chest flat and keeping the final scar low enough so that it hopefully lies in the natural skin crease at the lower end of the chest muscle.
The more difficult choice is how to manage the sagging nipple. Choosing a new location is based on standard measurements but how to get there is another. The nipple can be removed and replaced like a skin graft or the nipple can be moved while attached to some underlying breast tissue. (similar to how it is done in a female breast reduction. Both methods are reasonable but they have slightly different outcomes. Free nipple grafting gives one the flexibility to place it anywhere on the chest but the nipple will not have sensation and make look a little artificial and stuck-on. (plus there is no guarantee it will survive and it may lose some color after it is healed. ) Pedicled nipple grafts are harder to perform and are more limited in where they can be placed. But they usually look more natural and have better color. In some cases, the amount of sagging chest skin dictates which nipple technique can be used. But in others, it is a matter of the patient’s choice and their level of concern about the look of the nipple.
For male extreme weight loss patients, the chest deformity is right up there in concern just behind the abdominal and waistline areas. Men are most interested in how their chest looks in clothes and want a relatively flat appearance in shirts.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
The excess skin and fat from extreme weight loss often creates a circumferential hanging effect at many levels of the body. While many think of the body lift as only one contouring procedure, they are only thinking of the lower body lift or circumferential body lift procedure. There is another body lift procedure for the upper body, not surprisingly called the upper body lift.
Like the lower body lift, the upper body lift is a combination of three body contouring procedures. A frontal breast procedure (for both women and men), a side chest wall lift, and an upper back lift. In some cases, the cut out of loose skin may extend into the arms as well. This combined operation leaves long scars around the upper body but are usually a worthwhile trade-off for the dramatic improvement in the shape of the upper body. The resultant scars across the back and on the side of the chest are horizontal, much like the lower body lift. The change is in what occurs across the chest/breast area. Usually I like to keep it in the lower chest/breast crease and make it horizontal also. It can certainly be combined with a breast lift or a gynecomastia reduction if needed. But the one thing you don’t want to do is cross the midline/lower sternal area with a scar if you can avoid it. The risk of scar widening is very likely in this area, not to mention being very noticeable particularly in women. Therefore an upper body lift is not always completely circumferential as a lower body lift would be.
Upper body lifts are not as common as lower body lifts because it takes a very extreme amount of weight loss to create enough skin to justify the operation. Usually the patients must have lost 150 to 200 lbs after their bariatric surgery. The upper body lift has its greatest effect in the problematic area of the side of the chest wall and upper back. As a result, it would not be uncommon to just do a partial upper body lift stopping short of the chest/breast area and not crossing the exact middle of the back. Upper body lifts have the same riska and postoperative issues as lower body lifts including poor scarring, small areas of wound separation, and fluid build-up after the drains are removed.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
The Circumferential Body Lift Procedure For the Bariatric Patient
Author: barryeppley
In some weight loss patients, enough loose skin results that it feels like a suit is hanging off your body. The excess skin exists in a 360 degree fashion from the chest down to the knees. You could call this the ‘sharpee’ syndrome or one that looks like ‘wax melting off a candle’ but , either way, it is uncomfortable living in your skin suit. With this much skin excess, drastic and non-traditional methods of plastic surgery are required.
To achieve a balanced body look, no one plastic surgery operation is enough. It requires a combination of procedures at the core of the body to make a dramatic difference. Such a procedure is the body lift. It goes by many different names including the old term belt lipectomy, circumferential body lift or a lower body. Essentially, a body lift reshapes the entire midsection of the body in a circumferential manner. It combines three operations into one, a frontal tummy tuck, a side thigh lift, and a backside buttock lift. Such an approach produces a complete recontouring of the waistline in a 360 degree manner. The effect can only be described as dramatic for every body lift patient. The waistline is narrower, the abdomen is flatter, and the loose skin of the buttock and thighs is lifted. Some of the rolls, wrinkles and cellulite of the legs and buttocks is also improved. While a final scar goes all the way around, that is but a small price to pay for such dramatic improvement.
The body lift is, by far, the most difficult body contouring operation for patient and plastic surgeon alike. Body lifts take a lot of time to perform (4 to 6 hours) and require the patient to be repositioned multiple times throughout the surgery. It takes a lot of cutting and sewing to perform a body lift which is taxing for the plastic surgeon. Patients surprising do not have a lot of pain but they must endure the use of three or four drains after surgery for a few weeks. Patients will feel like they have had their ‘pants lifted’ (sometimes like having a wedgie) and it will feel tight for awhile. Because of the magnitude of a body lift, It is the only body contouring operation I will do in one setting and prefer most patients to spent their first night after surgery in the facility for monitoring, IV fluids, and pain control. One should allow a good three, and preferably four weeks after surgery for recovery before returning to work. I have not yet had a need to do a blood transfusion but it is always a remote possibility.
Because of the length of the scar and the amount of sutures used, every patient will end up with some temporary wound separation problems. This, surprisingly, does not occur until about three weeks after surgery. It is not a question of if it will happen…just when and how much. Most wound separations are allowed to heal on their own with the use of dressings.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Body contouring surgery usually involves the removal of large segments of excess skin and fat after considerable weight loss. Such radical resection usually occurs from tummy tucks, body lifts, and thigh lifts. Lesser segments of skin and fat are removed in breast lifts, arm lifts, and back lifts. No matter what the area of resection, the outcomes from these procedures is often dramatic. Such major body changes, however, come at a price…that of long scars.
Most extreme weight loss patients gladly accept this scar trade-off and are usually well aware of it. They typically consider the scars a far better alternative to loose hanging skin. Few would quibble with that approach given the medical and aesthetic problems that all that loose skin can cause.
But scarring is a process that takes time to get to its optimal appearance, often up to a year after surgery. Understanding the healing of these long incisions and the maturation of the resulting scar is helpful as the patient watches closely as this process evolves.
For a short time after surgery, incisions must heal before they can be truly called a scar. There are many dissolveable sutures used to hold these incisions together underneath the skin. While they will eventually dissolve, it takes a long time to do so. Many times some of these sutures will ’spit’ or come through the skin because they are so close to it. The body does this because it recognizes them as foreign and wants them out. This never occurs before three weeks after surgery but may occur for several months thereafter. This is not abnormal and most body contouring patients will experience this nuisance problem. It can be frustrating because the incision looks so great initially and then develops these problem areas. Many patients think this is an infection but it is nothing more than the body getting rid of these sutures. After about 6 to 8 weeks after surgery, this process is pretty much over.
Once the incision starts to heal, the resulting scar will change color. Up to about 3 weeks after surgery, the incision looks fantastic…basically because it hasn’t really started to heal yet. Once this healing process starts, blood vessels grow into the incision and it turns red. This is distressing to some patients as they think something is wrong. When in fact this is normal and is part of the process that allows the skin to knit back together and get as strong as it was before the surgery. (a process that takes up to 9 months or so after surgery) The scar will remain red until the strength of the skin from the healing process is normal. As a result, the red color of a scar may not have gone away for up to a year after surgery. This is called scar maturation and is a long process.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
The extra skin and fat around the waistline is usually the most common concern for most extreme weight loss patients. It is the most frequently requested procedure in this patient group and is usually done first in the priority of body contouring procedures. In cases of only moderate skin excess, a more simple and traditional tummy tuck (abdominoplasty) may suffice.
Like a more typical cosmetic patient, the tummy tuck in the weight loss patient is a frontal procedure that results in a hip to hip scar. An elliptical cutout of skin and fat is done that starts low at the level of the pubic hairline and stops just above the belly button. The excision patterm looks like a horizontally shaped football. The key is that the cutout goes above the belly button, which differentiates it from a limited or mini-tummy tuck in which the cutout goes below the belly button. It is very uncommon to do a limited tummy tuck in the extreme weight loss patient. This type pf cutout pattern in a full tummy tuck results in both a low horizontal scar that extends from one hip prominence to the other but a circular scar around the newly created belly button. (umbilicus)
As part of the tummy tuck, the abdominal muscles (vertical rectus muscles) are sewn closer together to help provide further flattening of the stomach area. There is a common misconception about this part of the procedure. The actual muscles are not really sewn together but the covering of the muscles are, known as the fascia. A running vertical row of sutures, from just below the breast bone down to the pubis, is placed to create a horizontal tightening effect across the stomach . In some patients, this effect is significant while in others this muscle tightening does not make a dramatic visual flattening effect. For this reason, not every tummy tuck patient needs this part of the procedure. If not done, the amount of pain after surgery is dramatically reduced.
Every tummy tuck patient gets drain tubes placed during surgery. These drainage tubes remain for an average of 10 to 14 days after surgery. They are critical to avoid a fluid collection over the stomach area after surgery.
This relatively simple tummy tuck in the extreme weight loss or bariatric patient represents about 1/3 of the types of tummy tucks that I do for this patient population. Whether this tummy tuck version, or a more extended one is necessary, depends on the amount of extra skin and fat that the patient has.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis