Tummy Tuck

The traditional tummy tuck involves tightening the abdominal muscles which are most painful to the patient in the postoperative period. In contrast, the mini tummy tuck avoids tightening of the muscle, instead of focusing on optimizing the contouring of the overlying skin and soft tissues.  The benefit of the standard mini tummy tuck is that you can recuperate within 1 to 2 weeks.

Separation of the abdominal skin and underlying fat from the abdominal muscles is limited during mini tummy tuck surgery. As such, prior abdominal surgeries are typically not a contraindication to mini tummy tuck surgery. A physician evaluation can determine if a mini tummy tuck procedure would be jeopardized by prior abdominal scars.

Temporary sensory loss of the abdominal skin is a consequence of surgery requiring elevation of the skin and underlying fat from the abdominal muscles. This is because sensory nerves of the abdominal skin which travel around the torso within the muscle layers prior to penetrating the skin from beneath are disrupted during the skin elevation. Since undermining of the abdominal skin is limited during mini tummy tuck surgery, sensory loss is limited.

Liposuction of the lateral flanks is routinely performed during a mini tummy tuck procedure. Although the mini tummy tuck procedure results in narrowing of the mid waist due to the direction of skin redraping, the lower waist (love handles) are also liposuctioned to improve the silhouette of the torso.

The mini tummy tuck abdominal incision is placed over the pubic area (or below previous C-section  incisions) and extends laterally following the bikini line. The placement of the incision may be altered by the presence of prior abdominal scars. Typically, patients are asked to wear their favorite underwear/bikini so that the incisions can be designed to be camouflaged underneath the garment. Scarring is avoided by minimizing the tension on the incision line; this is done by repairing  the incision line in multiple layers, including repair of the superficial fascial system. This fascia refers to a thin, yet tough layer that is found beneath the underlying skin which when reattached during the skin closure will reduce the tension on the skin incision. Reducing the tension on the skin incision will ultimately result in an aesthetically pleasing scar line.

In order to determine if you are a good candidate, your mini tummy tuck consultation will require evaluation of several items. First, the surgeon must assess degree of skin redundancy or flaccidity. This will determined the extent of the lateral skin incisions and degree of skin and underlying fat undermining. Next, attention must be given to extent of stretch marks. When limited to below the belly button, then the patient is considered an ideal candidate for a mini tummy tuck. When the stretch marks extend above the belly button, then a standard tummy tuck is needed so that the belly button can be released so that the skin above it may be removed. Finally, the abdominal muscle must be evaluated to gauge not only the tone of the muscle but also to rule out any hernias (holes or defects in the muscle).  If the patient demonstrates poor abdominal tone or presence of a hernia, then a standard tummy tuck is needed to gain access to the muscles in order to repair/tighten the muscles.

The mini tummy tuck procedure involves accurate marking of the abdominal area. While waiting in the preoperative area, the patient is asked to stand so that skin redundancy or flaccidity and areas of adiposity can be evaluated and the patient’s incision line can be marked. After induction of anesthesia, the entire abdomen is infiltrated with tumescent solution and liposuction performed; then, an abdominal incision is made down to the muscle, and the abdominal skin and underlying fat separated from the muscle all the way up to the belly button. The redundant skin is then redraped, trimmed, and repaired. A small drain is placed to remove any oozing of blood during the first week following surgery. Contour garments are fitted to the patient following surgery so that the new abdomen can mold to the desired aesthetic shape.

On your initial visit, the surgeon will evaluate your health status, determine the amount of skin redundancy and excess adiposity, and check your blood work. If you are a smoker, then you should quit for 1 month prior to mini tummy tuck surgery in order to allow your body adequate time to rid itself of any residual nicotine. Nicotine in your system results in shutting off of small blood vessels which carry nutrients to the skin; this event could be detrimental to your mini tummy tuck surgery resulting in an abdominal wound requiring weeks to heal.

Since your surgery will require general anesthesia, you must take several precautions prior to surgery. First, you will have to avoid eating and drinking after midnight on the day before surgery. This precaution ensures that your stomach is clear of digested foods that could potentially be aspirated and contaminate your lungs during induction of anesthesia. Since you will have anesthetic medications administered throughout the case, you will remain groggy for some time and will require a ride to and from the surgery center if you decide not to commit to an overnight stay on the premises. You should choose a caretaker who is conscientious and can spend the first few nights with you. As an alternative, patients may choose to have their mini tummy tuck performed with an epidural which will minimize grogginess but still require caretaker supervision.

Following mini tummy tuck surgery, patients can expect an improved abdominal contour, a more curvaceous silhouette, and a flat and firm abdomen. As your swelling resolves and when you stop wearing your girdle, you will find yourself buying a whole new wardrobe to fit your trim figure.

Since your surgery will require general anesthesia and/or epidural anesthesia, it must be performed in an operating room that is part of a hospital institution or outpatient surgery center. Patients may also be operated on in an in-house office based operating room, but it is of utmost importance for patients to make sure that the office facility has been accredited by a surgical accreditation body such as AAAASF.

Since your surgery involves removal of significant amounts of skin, you will require general and/or epidural anesthesia. This is because skin possesses a large number of sensory nerves (pain fibers) that would be triggered during trimming of the redundant skin; general anesthesia ensures that you do not sense firing of pain fibers. Infrequently, an epidural anesthesia may be administered to provide numbness to the lower abdomen. This will minimize the general anesthesia administered and help you have a smoother postoperative recovery with lower propensity for nausea and vomiting.

When you wake up from anesthesia, expect to find a tight garment around your abdomen. Expect to wear this girdle for approximately 1 to 2 weeks! Although you will feel significant tightness, you are encouraged to walk as soon as possible in order to minimize risk of developing blood clots in your legs. Your caretaker will show you how to take care of your single drain which will remove any blood/lymphatic fluid collection in the early postoperative period. These drains are removed usually by one week following surgery. After the first week, you will feel more energetic and desire to return to your routine daily activities.

For patients who undergo a standard mini tummy tuck, expect to return to work as early as 1 to 2 weeks following surgery. As opposed to the standard tummy tuck surgery, the mini tummy tuck uses a shorter incision, less undermining, and avoids detaching the belly button, all of which result in a shorter recovery period.

There are several side effects that have been associated with mini tummy tuck surgery and these include:

• Numbness: Numbness is inevitable due to separation of the skin and underlying fat off of the abdominal muscles. Since the sensory nerves to the skin travel in the muscle layer prior to crossing over into the skin, they are unavoidably disrupted when elevating the skin and underlying fat off of the muscle. However, numbness following mini tummy tuck surgery is minimized as the undermining is limited to below the belly button.
• Hypertrophic scar: Hypertrophic scar refers to the development of a thick scar in the skin. Degree of scarring is dependent on the tightness or tension along the incision line closure. Since degree of undermining and amount of tissue removal is limited during mini tummy tuck surgery, patients do not typically experience poor scarring.  In the even that scarring is observed several postoperative scar management treatments are available and these include: steroid injection, laser therapy, and silicone pressure therapy.

• Deep vein thrombosis (DVT) may occur in the legs immediately following any surgery. DVT refers to the clotting off of leg veins which may result in compromised blood flow return from the legs; a more critical consequence may develop from this clot if it is dislodged and travels to the lungs causing a pulmonary emboli. Although rare, pulmonary emboli are the leading cause of death following surgery. DVT’s are avoided with routine use of pneumatic compression boots during surgery and encouraging patients to walk as soon as possible following surgery.
• Hematoma: Hematoma refers to the accumulation of blood in the early postoperative period which pools into a pocket. Hematomas provide a perfect medium for harboring growth of bacteria. So if you have an infection anywhere in your body, the bacteria will travel through the blood stream and grow in the hematoma; this can lead to an infection as well as an open wound. In order to avoid a hematoma, a single drain is placed in surgery so that any fluid accumulation can be removed. Drains are usually kept in place for 1 week.
• Seroma: Seroma formation refers to the accumulation of plasma fluid in pockets created by surgical elevation of the soft tissue and disruption of lymphatic vessels. This fluid accumulates due to a low blood count and protein deficiency both of which may be present in mini tummy tuck patients. This fluid can be a nuisance to patients requiring several aspirations in the office prior to their resolution. More importantly, these plasma fluid pockets may harbor bacterial growth and result in a clinical infection. A single drain which is placed in surgery is very effective in preventing seroma formation.
• Infection: An infection can occur after mini tummy tuck surgery. The infection will disrupt the incision line and may leave the patient with an open wound. Prolonged antibiotics are required to fight the infection and to prevent further extension of the infection. Infections are usually avoided by using a single drain which will prevent hematoma formation. In addition, infections are less likely in patients who don’t smoke cigarettes or in patients who quit smoking for at least 1 month prior to surgery.
• Skin edge death/open wound: The skin incision can be disrupted if the skin edge dies or if there is local infection. This complication is best avoided by counseling patients on the terrible consequences of nicotine in cigarettes. Nicotine will literally clog all the small vessels found in the skin which are critical for the healing of the skin edge. Mini tummy tuck patients are usually mandated to quit smoking for 1 month prior to surgery. In addition, uncontrolled diabetes can lead to the undesired sloughing of the skin. Diabetic patients are urged to be vigilant about controlling their blood sugar levels prior to surgery. If patients develop an open wound, they will require prolonged local wound care with frequent dressing changes. Unfortunately, any delays in healing of the skin edges will compromise your aesthetic outcome.
• Asymmetry in abdominal contour can occur and is secondary to several factors including: 1)Uneven skin redundancy that is hopefully improved following redraping, trimming, and repair; 2)Stretch marks are areas of the skin which have lost their elasticity and are prone to re-stretching. The surgeon attempts to remove as much of the stretch marks as possible below the belly button. However, if there are stretch marks extend above the belly button, then a standard tummy tuck surgery is a better alternative for you. If stretch marks are left and they are uneven (more on one side than the other), this will result in asymmetric restretching of the skin and a resultant asymmetric contour. Asymmetry in contour can usually be repaired with a revision in the office.