Background: Tummy tucks are done for a wide variety of abdominal wall deformities. Whether it is a small lower pooch from pregnancies or a large overhanging pannus from a lifetime of weight gain (and some weight loss), tummy tucks are done in an almost customized fashion for each patient. The location and extent of the abdominal incisions must be casefully planned and executed for each type of abdominal wall problem.
Abdominal wall deformities can often be expressed in the number of rolls present. Most patients have just one roll present which is often spread out over the whole lower abdomen. When multiple abdominal rolls are present they often cascade or pile up on each other like a set of mountains of which some of it falls over the waistline.
Case Study: This 52 year-old woman had a large abdomen that she wanted to get rid of. It was hard to find clothes to fit and it was uncomfortable to carry it around. She had two large skin and fat rolls that hung over her waistline and gave her back pain as well. One interesting and potentially confounding issue was a very long and old gall bladder removal scar from over thirty years ago. This had potential compromise of the vascularity of the upper abdominal flap from the tummy tuck…although there was no way to avoid this potential issue short of not doing the procedure.
Under general anesthesia, the double roll was essentially incised at the top and at its base with minimal undermining of the upper abdominal skin flap. The upper and lower abdominal skin flaps were brought together after some muscle plication and a new hole made for the shortened old stalk of the belly button to be unmasked.
Her recovery was typical for most tummy tucks. The initial concern about the complete viability of the upper skin flap, even with a hole made for the belly button, was fortunately not realized and she had uneventful incision line healing. This was undoubtably due to the lack of any skin flap undermining. The improvement in her abdominal shape was remarkable although expected when both rolls are removed. She still has upper abdominal roundness and some suprapubic mound prominence which is expected.
Abdominal rolls are often the result of weight loss either from bariatric surgery or a dedicated diet and exercise program. But often these abdominal rolls are deflated or just loose rolls of skin. True abdominal rolls are usually seen in non-weight loss patients because it requires some fat content to have an observable roll. The large double abdominal roll is the result of years of aging and weight gain and can become impossible to get rid of short of bariatric surgery. But in the right patient an ‘amputating’ tummy tuck can provide a quick cure for most of the abdominal shape problem. The patient should must not expect to have a perfectly flat abdomen and will have some residual upper abdominal and suprapubic fullness.
Case Highlights:
1) Tummy tuck surgery is very effective at eliminating the ‘double roll’ abdominal wall deformity.
2) Removal of the abdominal double roll requires little undermining of the upper abdominal skin flap and thus is safe even when large oblique abdominal surgical scars are present.
3) The tightest part of the double roll tummy tuck is along the waistline, often leaving a bulge above and below the scar line.
Dr. Barry Eppley
Indianapolis, Indiana