This procedure is one of our best! It helps patients achieve their goal of a flat, attractive tummy. After having children, the muscles that support the front of the tummy are stretched apart. This is called a “diastasis”, or separation, of the rectus muscles. Unfortunately, no diet or exercise program will repair the laxity, which creates a “pooch” or protrusion in the front. Also, many women develop extra skin during pregnancy or with weight gain; this does not totally shrink back down after childbearing or weight loss. Excess skin tends to hang over the C-section scar or the waistband of clothing. The combination of the pooch in front and extra hanging skin usually tells the doctor that liposuction alone won’t cure the tummy problem; an abdominoplasty may be needed. A nice thing about this procedure is that it is a life-long repair; the abdomen won’t bulge out with age unless a significant amount of weight is gained or the muscle repair is damaged. Results vary as each person’s form is different. If you have a barrel type rounded chest, or if you are very short waisted, the results may not be as excellent as they would be for a person with a long torso or a thinner upper abdomen. However, dramatic improvement can be seen in all patients who qualify for an abdominoplasty. The result can be improved by adding liposuction, or radiofrequency assisted liposuction (this tightens skin even more), to the flank, waist and back region. The combination procedure will take longer and will cost more, but the outcome will be much more satisfactory for those who want the most improvement that is possible.
Most patients can have the surgery done in Dr. Duncan’s AAAASF in house surgery suite. Instead of needing an overnight stay, patients receive a pain pump that delivers a constant infusion of local anesthesia for about 4 days, thus greatly reducing the need for postop narcotic pain medication. The procedure takes between 2 and 4 hours; depending on the size of the patient, the amount of extra skin that needs to be removed, and the severity of the muscle separation.
A light general anesthetic is needed. Once the patient is asleep and ready for surgery, Dr. Duncan first removes the excess skin and fat in the lower abdomen. Additional liposuction may be performed. The remaining skin is lifted up to the base of the rib cage, so the central muscle repair can be performed. The pain pumps are placed. An extra step Dr. Duncan takes at this point is shaping of the tummy. She stitches the skin layer down in the middle of the upper abdomen in order to give some muscle definition. Extra fat in the deep layer is removed in critical regions. The waist is pulled in to create more definition, and lower bulges are corrected as well. At this point, skin if fully advanced down to the base of the lower incision and is closed. A drain is placed in the right corner. The belly button is brought through a buttonhole and is stitched underneath the skin to minimize scarring. The outer incisions are checked for dogears and these are corrected before the operation is completed.
The patient is then put into a postoperative compression garment and taken to the recovery area. She will stay there about 1 ½ hours before being sent home with a family member or caregiver.
Postoperative guidelines: for many patients, the need for a recovery period is a limiting factor in having this procedure done. At least a week’s recovery is recommended; this means no physical work, including picking up small children. The reason for restrictions is that with strain, the muscle repair may be damaged. It takes about 3 weeks for the skin that is redraped to stick back down to the fascia of the muscles. Too much movement before that time may create a fluid collection called a seroma that would need to be drained repeatedly. At one week, patients may drive, return to work that does not involve a lot of physical activity, and they may enjoy limited activities of daily living. We recommend not returning to the gym or heavy physical activity for 6 weeks, in order to allow all skin and muscle repairs to gain some strength. The final result will not be seen for 12-18 months, but a good indication of final outcome will be seen at 6-8 weeks, when we’ll take some early “after” photos.