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ABDOMINOPLASTY (TUMMY TUCK)

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Tummy Tuck

Abdominoplasty (Tummy Tuck) Procedure

Abdominoplasty or ‘tummy tuck procedure’ or the common layman term of ‘stomach plastic surgery’ is a cosmetic surgery procedure used to make the abdomen thinner and more firm. 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. Tummy tuck and Lipoplasty may also include a tummy liposuction. This type of surgery is usually sought by patients with loose or sagging tissues after pregnancy or major weight loss.

Abdominoplasty operations vary in scope and are frequently subdivided into categories. Depending on the extent of the surgery, a complete abdominoplasty can take from 1 to 5 hours. A partial abdominoplasty (mini-tuck abdominoplasty) can be completed between 1 and 2 hours. The various tummy tuck options include the following. Dr. Vinay Jacob and Dr. Rajesh Gawai are rated as the best tummy tuck surgeons in Mumbai. Not only do they do this procedure well, they are teachers of this fine art to other plastic surgeons who regard them as best plastic surgeons in India.

Classic Abdominoplasty

In general, a classic abdominoplasty follows these steps:

  1. An incision is made from hip to hip just above the pubic area.
  2. Another incision is made to free the navel from the surrounding skin.
  3. The skin is detached from the abdominal wall to reveal the muscles and fascia to be tightened. The muscle fascia wall is tightened with sutures.
  4. Liposuction is often used to refine the transition zones of the abdominal sculpture.
  5. A dressing and sometimes a compression garment is applied and any excess fluid from the site is drained.
Abdominoplasty

Excess skin cause problems with the skin – including infection and dermatitis. This may be associated with people who have lost a large amount of weight or women who have had previous pregnancies. Any separation of the rectus abdominis muscles can be retightened and corrected. Abdominoplasty will result in an improved abdominal tone which may be resistant to usual toning techniques. This will also improve the weakness as well as enhancing the appearance of the muscles of the abdominal wall.

Repairing the separation of the rectus abdominis muscles will also lead to an increase in core strength. Many patients also feel that back pain may be improved. Furthermore, some stress and urge incontinence of urine may be reduced by having this muscle repair performed. The tummy tuck treatment also helps to create a more "normal" appearance to the abdomen by removing the excess apron of skin and fat.

Abdominoplasty

Any abdominal hernia or bulges that are present will also be repaired at the time of surgery. The operation may involve removal of the skin and adipose (fat) tissue that is excessive.

Classically the skin and fat are removed. The umbilicus is islanded and left in place and then the skin is mobilized around it to create a new hole for a relocation of the umbilicus. A new umbilical position may be relocated into an aesthetically ideal position.

All patients have the procedure performed as an inpatient and remain in a hospital for two to five days. Most patients are discharged home without drains which are removed during their inpatient stay.

Goals of Abdominoplasty (tummy tuck surgery procedure)

  1. To create a more normal appearance of the abdomen.
  2. Repair any an abdominal hernia that may be present.
  3. Removal of the apron of excess skin and fat.
  4. Improvement in abdominal muscle tone and shape.
  5. Revision of any existing scars.

The operation may involve approaching only the skin if this is the only element that is excessive. It may progress to performing excision of skin, fat as well as mobilization of the umbilicus. Usually, an incision is made in the lower half of the abdomen and abdominal skin is removed between this incision all the way up to the umbilicus. The skin above this is then elevated allowing it to be pulled down to meet lower incision. A new umbilical position will be created in an aesthetically sensitive manner. Before the skin is closed the underlying muscles are surgically tightened with stitches. Drains are then placed and the skin is stitched together using dissolvable stitches.

There are alternative options including a mini abdominoplasty and a vertical abdominoplasty.

Mini-Abdominoplasty

A mini abdominoplasty or a mini tummy tuck is indicated in patients who have a moderate degree of excess skin in the lower abdomen. It is also suited to women who have separation of their rectus abdominis muscles below the umbilicus.

A partial (or mini) abdominoplasty proceeds as follows:

  1. A smaller incision is made.
  2. The skin and fat of the lower abdomen are detached in a more limited fashion from the muscle fascia. The skin is stretched down and excess skin removed.
  3. Sometimes the belly button stalk is divided from the muscle below and the belly button slid down lower on the abdominal wall.
  4. Sometimes a portion of the abdominal muscle fascia wall is tightened.
  5. Liposuction is often used to contour the transition zone.
  6. The flap is stitched back into place

This procedure is also helpful in correcting the bulge which can be present above a lower horizontal scar, such is the case after a cesarean section. We will be able to advise you at the time of your consultation, if you are a suitable candidate for a mini abdominoplasty or, if the degree of skin you have is beyond the scope of this operation and/or your muscles require repair up to the ribcage (xiphisternum), then this technique may not be powerful enough in which case a Classic abdominoplasty would be a more effective procedure.

Vertical Abdominoplasty

In patients who already have a midline scar from previous surgery (e.g laparotomy), a vertical abdominoplasty may be an option to avoid the need for additional scarring. This technique may also be an option for patients with a large hernia or extremely thin skin.

Combined Abdominoplasty with Abdominal Liposuction

It is possible in selected cases to perform liposuction at the same time as an abdominoplasty.

It is generally recommended that patients obtain their goal weight prior to surgery and the surgery is generally performed after patients have lost weight and their weight is stable. However, there are situations where patients may still have some areas of excess Fat that have not responded to weight loss. These areas can be dealt with either a staged procedure having liposuction prior to an abdominoplasty or alternatively, can have the two surgeries performed at the same time.

The central upper abdomen is where the blood supply to the flap raised for an abdominoplasty obtains its blood supply. For this reason, it is generally not safe to perform liposuction to the upper part of the abdomen. Other areas of the abdomen and torso are safe areas to perform liposuction simultaneously with an abdominoplasty. The area that responds best is generally the outer part of the upper abdomen (flanks) extending onto the lower back.

We will be happy to advise if you are a suitable case to have the combined procedure.

High lateral tension tummy tuck

This is an advanced technique that takes a little more than four and half hours to perform. Conventional abdominoplasty tightens muscles in a vertical line. In this new method, known as high lateral tension abdominoplasty, in addition to vertical-line tightening, muscles are tightened horizontally. The final result with this technique is a dramatically flat abdomen with the significantly better-defined waistline.

Circumferential abdominoplasty

Recovery depends on the problem to be treated, surgical technique(s) and other factors. It can take one to four weeks and patients are advised to take at least a portion of this recovery time off from work.

  1. Heavy lifting is best avoided during this time.
  2. Initially, there may be bruising and discomfort.
  3. A supportive abdominal binder or compression garment can minimize swelling/bruising, and support the repaired tissues. This compression garment is also effective in helping the skin in the treated area conform to its new shape.
  4. Patients are advised to avoid all forms of nicotine for a month or longer prior to surgery and also during the recovery period.
  5. Full recovery takes 3–6 months, with further fading of scars thereafter. Scars may appear red and prominent at first, but with proper care, they heal into a thin, silvery line.

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