The tummy tuck, or abdominoplasty, operation is the most successful method of waistline contouring for many patients. It is an absolute must operation in three specific situations, in loose skin and muscle from multiple pregnancies, in the presence of an overhanging abdominal pannus, and after massive weight loss. While pregnancies is an exclusive female qualifier, the abdominal sequelae from significant weight loss in not gender specific.
Massive weight loss, as defined by a 75 lb or greater drop in body weight, can be the result of either bariatric surgery or tremendous motivation and diet and exercise. When someone loses this much weight,an inevitable amount of loose skin will develop along the waistline and into the hip area. Loose skin develops both above and below the bellybutton. But the amount of loose skin and how the abdominal area looks is somewhat different between men and women. Women usually have much more loose skin and a more protruding stomach after extreme weight loss due to muscle laxity from prior pregnancies and more stretched out skin to start with. Men, due to thicker skin that has not lost as much elasticity and an undisrupted abdominal muscle wall, do not usually end up with as much loose skin.
Because of these differences, the male tummy tuck after weight loss is done differently than that of a female in most cases. The amount of skin resection is less in extent and in design. As an elliptical horizontal cut out, it may stay below or go above the belly button depending on whether there is significant loose skin above the belly button. Skin hanging over the belly button calls for a supraumbilical resection pattern.
The most significant difference in the male tummy tuck is the lack of a need to do any muscle manipulation in most cases. Unless there is a hernia present from bariatric surgery, the muscle wall will be intact. In men that have lost weight through non-surgical means, the muscle wall will appear as if they had been slim and in shape all of their lives. This also means the patient will experience less pain after surgery that they initially envisioned. It is the suturing of the muscle (technically the overlying fascia) that causes the greatest amount of pain from a tummy tuck operation.
In many cases, the final scar does not need to extend much beyond the front part of the hips as the skin excess does not extend back that far. But it is important to avoid a dogear deformity, a common problem at the tail end of tummy tuck scars, so the cut out and scar may go back further into the back if need be. Liposuction of the flanks may also be needed, but in the extreme weight loss patient that is usually not necessary. The need in the male is primarily skin removal.
The male tummy tuck after weight loss is in many ways a scaled down version of that which is used in women. The need for less extensive skin removal and no muscle suturing makes most male abdominal contouring a more ‘simple’ tummy tuck.
Dr. Barry Eppley
Indianapolis Indiana