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Tummy Tuck

Abdominoplasty or "tummy tuck" is a cosmetic surgery procedure used to make the abdomen more firm. Sometimes the skin of the abdomen gets very loose with pregnancies and gaining of weight. When you lose the weight skin remains and gets looser. The surgery involves the removal of excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fascia of the abdominal wall. Prior to a complete tummy tuck it is required that the patient has finished all the pregnancies and has come down in weight close to her ideal weight. If the weight is not close to the ideal weight after losing further weight reconstruction might be needed again.

Traditional technique involves general anesthesia and has a risk of mortality of about 1 in 3000. In published experience with body lift procedures, the average hospital stay is up to 5 days, with multiple patients requiring at least 1 unit of blood, and the length of drain placement ranges from 2 to 5 weeks.57 This report highlights the important advantages of applying the lipo-abdominoplasty concept to the circumferential body lift. With this new technique, advantages include short operative times, the ability to perform the procedure safely in an outpatient setting, elimination of drains, and reduced recovery time. With the liposuction abdominoplasty done under local anesthesia there has not been any mortalities up to now. Only the fat of the abdomen is numbed initially and the patient undergoes a liposuction using power assisted liposuction. At the end of this, the patient's skin is partially numb and can be easily anesthetized completely with local injection of Lidocaine. The excessive skin can be removed and stitched cosmetically. The new technique is ideal for patients who do not require relocation of the umbilicus. Patients do not require drains and are able to get back to work in two days. With the traditional tummy tuck patients had drains and were not able to go to work for about two to three weeks.

In addition to the above the traditional tummy tuck has these disadvantages

1.Usually at the upper abdomen extensive dissection is done to loosen the upper abdominal flap. During this large perforator blood vessels are sacrificed and therefore blood supply to the skin is diminished. With liposuctionabdominoplasty all the blood vessels are remaining and there is no compromise to the blood flow to the skin.

2. Tumescent liposuction always leaves a rich layer of blood vessels and lymphatics minimizing the complications. Similarly during the tumescent liposuction patient can take breaks and walk about preventing the dreaded complications of deep vein thrombosis and pulmonary embolism.

3. After tumescent liposuction patients can go home right after surgery. There is a few days of hospital stay following a traditional tummy tuck.

4. Drains are routinely placed after traditional tummy tuck.

 

2. Only a limited liposuction is performed with traditional liposuction. With the new technique a more complete liposuction is always performed with better final result.

UIf the patient has loose skin on the sides of the abdomen then further skin removal can be done by extending the same incision to the side. This is called a body lift. In some patients the procedure is done in stages to minimize the risk to the patient.


     Before                                         After


       Before                                             After

Above patient had tummy tuck as well as a bodylift performed under local anesthesia.

 

Here is another example of a tummy tuck where a large amount of skin was removed and skin suture extended laterally to eliminate loose skin from the sides.

 

The above patient had lose skin due to excessive obesity. Patient regains her shape following liposuction with tummy tuck. In this patient the tummy tuck scar had been extended to the sides of the body to provide a body lift.

The scar of the tummy tuck is kept at the bottom of the abdomen and could be well hidden by the clothing. The stitches are plaed subcuticularly for better cosmetic result. A small percentage of patients are known to make ugly scars after wounds or surgery. These patients are at high risk for keloid or hypertrophic scars. These are ugly overgrown scars. They can be treated with new techniques yet the results cannot be guaranteed. If a person is known to make ugly scars then it is better to avoid this surgery. It would be better to remove the fat with a liposuction and use a laser technique such as refirme to tighten skin. Sometimes the liposuction can be done in stages to obtain better skin tightening.

This patient already had a tummy tuck performed with the traditional technique but did not like the scar since it was not in a straight line. In addition to that she had collected a little fat over that ten years. A liposuction and a mini tuck was performed and the results are seen following two months.

Above is a mini tummy tuck with very satisfactory results. It is done together with the liposuction of the abdomen.

Above patient also underwent a mini tummituck and a good result was obtained four weeks following the procedure.

With the evolution of new techniques more and more patients are now benefited from gradual reduction of their abdominal fat with Power Assisted tumescent liposuction followed by laser liposuction. After all the fat is removed and skin tightened a minituck can be done and the scar can be placed at the bottom of the stomach which can look similar to a transverse C section. This way the natural belle button can be preserved. Most patients in sri lanka are likely to get ugly pigmentation of the reconstructed belle button scar as well as carry a higher risk of keloid formation of their scars. Traditional form of tummy tuck is therefore not the best procedure for them although some patients might be good candidates due to extreme laxity of the abdominal skin. The proper procedure can only be determined after a detailed consultation with your physician.

Typical Tummy Tuck performed under general anesthesia has a risk of dying about 1 in 617. About 10% to 20% of patients undergoing a tummy tuck would need blood transfusion, a hospital stay of about 12.4 days, and a complication rate of between 24% to 65%. The data reported in Journal of Plastic and Reconstructive Surgery showed that on the average, only about 55% of patients got good or excellent result and about forty-five percent did not achieve positive results.

This is the only currently available tummy tuck in Sri Lanka, except at Dr. Nimal Gamage's Medical Center. Dr. Nimal Gamage has perfected a Tummy Tuck under local anesthesia only which does not carry a life risk. There is no need for blood transfusions and patients are able to go home right after the procedure. The tummy tuck scar can be placed at the pubic hair line or where a patient might have a C section scar already. No drains are required and patients can even return to work in a day. He has performed about 300 of these in USA and quite a few have been performed in Sri Lanka already. If the patient has a large fat collection with inner abdominal fat he recommends to perform a liposuction to remove the external fat first. Patient should follow a diet and exercise programs to lose the inner fat prior to final tummy tuck so the best results can be obtained from it. Patient must have completed all the pregnancies prior to contemplating a tummy tuck procedure.

Data from the American Association for Accreditation of Ambulatory Surgery Facilities indicate that the highest mortality associated with cosmetic procedures is pulmonary embolism secondary to abdominoplasty. When we do Abdominoplasty ( Tummy Tuck) under local anesthesia patients are mobilized very quickly and they go home right away. Most patients can even return to work in two days. I have seen patients going shopping right after we had completed a Tummytuck.  Again in an attempt to reduce the risks a very large abdomen should always be liposuctioned prior to subjecting the patient to a tummy tuck. Many reports of side effects such as seromas have occurred when combining a large volume liposuction with tummy tuck.

Kanya Wests mother died due to general anesthesia when undergoing tummy-tuck.
Everybody should be aware of risks of General Anesthesia

For Doctors only.

The advantages of tumescent anesthesia include immediate ambulation postsurgery, shorter recovery time, and lack of general anesthesia, thereby reducing the incidence of deep vein thrombosis, pulmonary embolism, and respiratory depression.8,9 In addition to its anesthetic action, lidocaine exhibits antimicrobial properties10 (and epinephrine decreases the extent of bleeding, bruising, edema,8,11,12 hematomas, and seromas10).

References

References
1. Bozola AR , Psillakis JM. Abdominoplasty: a new concept and classification for treatment. Plast Reconstr Surg.1988;82:983993.
2. Matarasso A. Abdominoplasty: a system of classification and treatment for combined abdominoplasty and suction-assisted lipectomy. Aesthetic Plast Surg. 1991;15:111121.
3. Nguyen TT , Kim KA , Young RB. Tumescent mini-abdominoplasty. Ann Plast Surg. 1997;38:209212.
4. Sozer SO , Agullo FJ. Triple plication in mini-abdominoplasty. Aesthetic Plast Surg. 2006;30:263268.
5. Sozer SO , Agullo FJ , Santillan AA , Wolf C. Decision making in abdominoplasty. Aesthetic Plast Surg. 2007;31:117127.
6. Cervelli V , Grimaldi M , Gentile P , Araco A , Colicchia GM , Gravante G. Miniabdominoplasty for the treatment of aesthetic defects after Pfannenstiel incisions. Scand J Plast Reconstr Surg Hand Surg. 2008;42:96100.
7. Klein JA. Tumescent Technique: Tumescent Anesthesia & Microcannular Liposuction. St Louis, Mo: Mosby; 2000.
8. Klein JA. Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg.1993;92:10851098.
9. Klein JA. Deaths related to liposuction. N Engl J Med. 1999;341:1001.
10. Klein JA. Antibacterial effects of tumescent lidocaine. Plast Reconstr Surg. 1999;104:19341936.
11. Klein JA. Anesthesia for liposuction in dermatologic surgery. J Dermatol Surg Oncol. 1988;14:11241132.
12. Flynn TC , Coleman WP II , Field LM , Klein JA , Hanke CW. History of liposuction. Dermatol Surg. 2000;26:515520.
13. Abramson DL. Tumescent abdominoplasty: an ambulatory office procedure. Aesthetic Plast Surg. 1998;22:404407.