Contouring of the stomach and hip area is a common request. Many post-partum women long to get rid of that ‘babyroll’ and get particularly frustrated when, despite diet and exercise, fail to make any headway. At this point, they seek out a plastic surgeon. When seeing this kind of patient, I reassure them that no amount of effort on their part can get rid of excess skin, fat, or stretch marks over the lower abdominal area. And the type of surgical procedure that they should chose is based on an understanding of their problem.
The shape of the abdominal area is determined by three types of tissues; how much skin, how much fat, and how loose is the underlying abdominal muscles. Each woman’s stomach shape is determined by differing proportions of these three components. In the post-partum patient, the amount of loose skin and its residual elasticity provides the key to the right type of tummy tuck. (adominoplasty)
The classic or full tummy tuck removes the most skin and gives the tightest result. It results in a hip-to-hip low scar, the cut out is carried above the bellybutton (which remains attached to the muscles like a mushroom), the muscles are tightened in a midline vertical fashion, and the skin is then pulled down and sutured to form a low-lying scar. A new hole for the bellybutton is made and it is then pulled through. Liposuction to thin out the upper abdominal is not commonly done as it may interfere with the blood supply to the skin. While producing the best result for many patients, it is a big operation, requires 7 to 10 days of drains, and will take 3 to 4 weeks to fully recover. This operation is best used in women with a lot of skin excess.
The mini- or limited tummy tuck also leaves a low scar but it is shorter than for a full tummy tuck. This is because the cut out of skin stays below the belly button, also meaning that no scar will result around the belly button at the end. Liposuction is liberally used on the upper abdomen since no skin undermining is done. The muscle tightening is usually done only on the lower half from the bellybutton to the pubis. The skin is then pulled down and the bellybutton ‘floats’ downward so that is an inch or so lower than before. A drain is still used but only remains in 3 to 5 days.
Over the years, I have changed the ratio of full to mini-tummy tucks that I do. These days I do more mini-tummytucks than before. In many patients the results are not significantly less, I can more more aggressively use liposuction, and their recovery is quicker. My incidence of seroma formation is also less.
Dr Barry Eppley
Indianapolis, Indiana