Bradon J. Wilhelmi, M.D., F.A.C.S.
Leonard J. Weiner Professor and Chief of the Division of Plastic Surgery, University of Louisville
Plastic Surgeon, University Surgical Associates PSC
After pregnancy, some women find it difficult to lose unwanted fat, excess skin and stretch marks that resulted from carrying a baby in the womb. Also, the growing womb can stretch out the overlying fascia around the muscles of the abdominal wall. This weakening of the fascia is called a fascial diastasis.
This strong layer of fascia usually maintains the contour of the inner layer of the abdomen. With pregnancy, the fascia, especially in the midline, can be irreversibly stretched out. This fascial diastasis can be corrected with a standard or mini-abdominoplasty.
An abdominoplasty procedure is also known as a tummy tuck. The goal of an abdominoplasty procedure is to remove excess skin, excess fat, lower stretch marks or scars and to tighten the underlying fascial diastasis to improve the contour of the abdomen and midsection. The difference between a mini-abdominoplasty and standard abdominoplasty is the length of the scar required to remove the excess fat and skin.
Patients that are good candidates for a mini-abdominoplasty require only a minimal amount of skin and fat resection. When the fat and skin is removed with a mini-abdominoplasty, the fascial diastasis can be tightened by plication sutures through the lower abdominal opening created by the removal of the fat and skin. Typically, a mini-abdominoplasty requires only removal of 6-10 inches of fat and skin and therefore results in a 6-10 inch wide scar. A standard abdominoplasty is required in women that have more excess skin and fat, which therefore results in a much longer scar, such as from hip bone to hip bone.
Candidates for a tummy tuck include women that have unwanted excess skin and fat in the lower abdomen, lower abdominal stretch marks and scars, and loose fascia after one or several pregnancies. If a woman plans future pregnancies, the gains made with the abdominoplasty can be lost or reversed. The fascia can be stretched out again with the enlarged womb. Therefore, the best candidate for an abdominoplasty is one who plans no future pregnancies.
Liposuction is a procedure performed to remove excess fat with a suction tube connected to a medically specialized vacuum. Liposuction can be considered for women who may plan future pregnancy but would like to remove excess fat between pregnancies. Liposuction alone cannot be expected to tighten excess loose skin of the abdomen.
Women should have lost as much weight as they can or expect to prior to undergoing an abdominoplasty. If the patient looses much more weight after the abdominoplasty, the skin can be excessive again. The abdominoplasty procedure is not a weight-loss operation. It does, however, significantly improve the patient’s contour of the abdomen to a more youthful shape.
An abdominoplasty procedure is performed under general anesthesia and usually warrants an overnight stay in the hospital for pain control. Mini-abdominoplasty procedures may cause less pain and can sometimes be performed as a same-day surgery. The procedure usually takes two to four hours, depending on the severity of the excess skin, fat and fascia. Patients can expect to experience pain, swelling, and numbness after the procedure with a variable recovery of four to 12 weeks.
Most abdominoplasty procedures require postoperative drains to remove fluid that collects in the space under the abdominal skin for about two weeks. Usually, absorbable sutures are used on the abdomen and around the belly button. These don’t have to be removed. Scars can be supported with butterfly tapes for two to six weeks after surgery. Some patients find comfort in using abdominal binders for a while after surgery.
In summary, an abdominoplasty procedure is a very effective way to improve a women’s contour after pregnancy and can be considered after achieving maximum weight loss with diet and exercise. An abdominoplasty directly removes redundant skin, excess fat, lower stretch marks and scars and tightens the contour of the abdominal fascia to immediately provide women with a more youthful abdominal shape.
