Tummy Tuck - extended
The circumferential abdominoplasty, also known as a ‘belt lipectomy’, is a procedure designed to remove excess skin and fat from the entire circumference of the lower abdomen and waist line to achieve a firmer and smoother torso contour. The procedure is suitable for both males and females.
Sample Procedure
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|  | Case 3 - before and after circumferential abdominoplasty and gynaecomastia treatment. | | | More Images Back to Top |
Indications
The circumferential abdominoplasty is a more extensive version of the standard tummy tuck and is best suited to patients with either an excess of lower abdominal and waist line skin, with or without a degree of excess fat.
The best candidates are people who have reached a steady state in terms of their weight and size, and are no longer gaining or losing weight/size. Although the operation can be performed on people who still have some weight to lose, the best results are always seen in people who are already at their best sustainable weight. That is, the weight at which their body gravitates towards when they are performing realistically sustainable (long-term) amounts of exercise and are not actively pursuing a weight-loss diet.
Although it is possible to have a successful pregnancy following an abdominoplasty, this is not advised, as much of the post-operative improvement is likely to be lost when the abdomen is enlarged with pregnancy.
People who are not in generally good health should not contemplate this procedure. Diabetes is not a contraindication to having a circumferential abdominoplasty tummy tuck, although the surgical procedure is altered slightly to make the recovery simpler.
Benefits
A firmer, smoother and tighter torso brings many benefits for most patients. These include: -
- A return to a more youthful and balanced physique.
- A decrease in physical symptoms attributable to the excess and skin and fat around the abdomen.
- Improved self-confidence in social settings.
- A change in body image allowing a wider range of clothing possibilities.
Relevant Anatomy
The abdominal wall is composed of many layers including the skin, the fat below the skin and, finally, the abdominal muscles. The fatty layer is subdivided into two layers: a superficial and a deep layer, which are separated by a thin but very strong layer of tissue called a fascia. The two rectus abdominis muscles (the ‘six-pack’ muscles) run vertically, side-by-side down the midline. The ‘tummy button’ (umbilicus) can be traced back from the skin surface down to the midline between the two rectus abdominis muscles.
With pregnancy and/or excessive weight gain, a number of anatomical changes can occur. The two midline abdominal muscles begin to separate from each other. This separation reduces the efficiency of the abdominal muscular system, and also causes a decrease in the definition of the abdomen. Furthermore, in extreme cases, the abdominal contents can cause a bulge between these two muscles through the stretched region. The skin, which is also stretched with weight gain, has a limited ability to retract back again to its original size, once it has been over-stretched. ‘Stretch marks’ are an indication that the skin has been either over-stretched or stretched too rapidly. The presence of extensive stretch marks indicates the skin in unlikely to ever retract back to its normal shape and size.
Anaesthetic Used
This surgery is performed under a general anaesthetic (you are asleep). As a routine part of the procedure, Mr Masters infiltrates a large amount of long-acting local anaesthetic both through the abdominal tissues and also around the margins of the surgical site. This long-acting local anaesthetic means that most of the stimulation due to the procedure is numbed out when you awaken. This means the anaesthetist can help you have a far smoother transition from anaesthetic to recovery. Furthermore, post-operative pain is vastly diminished with the extensive use of local anaesthetic.
Where is the Surgery Performed
This is a significant surgical procedure, as such Mr Masters performs them in a fully equipped and appropriately expertly-staffed operating room.
Pre-operative Preparation
Mr Masters will provide you with precise instructions well in advance of your surgery to allow you a smooth and stress-free preparation for the procedure. Take the time to read your consent form thoroughly, along with any other written information Mr Masters has provided for you with regard to your surgery. This will allow you to have all of your questions answered prior to the procedure, and ensure there are no unexpected surprises during the post-operative period.
If you are the main domestic executive in your home, or you live alone, you should plan ahead with regard to housework and meal preparation. Do your grocery shopping, cleaning, etc the day before your surgery and plan to have meals that require minimal preparation and/or cooking time.
If you are a smoker, stop smoking at least one month pre-operatively (see the “Disclaimer� page). Do not take any aspirin or aspirin-containing products for at least one week prior to the surgery. If you are on any other medications, ensure that Mr Masters is aware of the medications (including homoeopathic remedies) so that any other medications that require cessation during the pre-operative period can be discontinued
The Procedure
With you face down on the operating table, the excess skin and fat from the lower back is removed down as far as the muscles of the back. Some times this tissue is used to return fullness to the buttocks that has been lost by large weight losses. This stage takes approximately 2.5 hours.
Then the patient is turned face up and an incision is made around the tummy button so that it remains in its current position fixed to the underlying abdominal muscles. The lower incision is completed across the abdomen either within or close to the natural skin fold; this incision meets up with the one from back. Through this the skin and the layers of abdominal fat are lifted off the muscle layers. The two midline rectus abdominis muscles are sutured together in the midline. The excess skin and fatty tissue are then pulled downwards towards the patient’s feet and the redundant skin and fat are removed.
Strong sutures are placed deeply within the strengthening fascia layer. The sutures take all of the tension of the closure of the wound so that there is minimal pull at the skin surface. This means that the scar is unlikely to broaden and will remain thin and pleasing.
A small hole is made in the abdominal skin and the tummy button is returned to the surface and stitched in place. The tissues involved in the operation tend to ooze fluid afterwards, for this reason two drains are placed in the wound at the time of closure to prevent a fluid build up under the surface.
Post-operative Recovery
The 2 -3 nights after the operation are spent at the surgical facility. The drains that were put in as part of the procedure will remain in for 5 -15 days, and you will be thoroughly instructed on how to care for these drains prior to going home. Most patients require 2 weeks to recover sufficiently from the surgery to return to work. There are usually no sutures to be removed following the procedure. You will wear a post-operative garment for approximately 3 weeks. This garment helps to reduce swelling and offers support to the tissues which makes you feel more comfortable. A series of follow up appointments will ensure you have no problems during this vital post-operative phase.
Initially, you will feel that you are unable to stand straight and will feel significantly stooped over. This feeling will disappear as your natural posture returns over the first week to ten days post-operatively. You will notice diminished feeling in the skin of your stomach and possibly upper legs. Usually this sensation makes a full and complete recovery; however, occasionally you are left with permanent numb spots in these areas.
Mr Masters encourages patients to resume gentle cardiovascular exercise as soon as they feel able. You should not contemplate higher impact exercise (eg running, aerobics classes, etc) for at least three to four weeks. Swimming may be recommenced as soon as your wound is fully healed (usually around 2 - 3 weeks). If you have a membership at a gymnasium, it is recommended that you suspend the membership for 6 weeks to allow sufficient time for complete healing. Should you be ready to return to the gymnasium prior to this, you will be able to reinstate your membership sooner.
Results
Once you have fully recovered from your tummy tuck procedure, you can expect a smoother, flatter and firmer abdomen and narrower waist line. Usually the buttocks are also less saggy as well. The umbilicus (tummy button) changes shape and is left in a more vertically orientated shape resembling that of a youthful abdomen. Your surgeon will aim to have the scar from your tummy tuck to be both as short as possible and ideally located low on the abdomen, so that it is easily covered by your underwear or a bathing suit.
Risks and Complications
A tummy tuck is a relatively major operation. Although every precaution is taken to help avoid a complication, surgery by its very nature has inherent risks. Some of the complications that can occur are detailed below:
- Numbness – as described above.
- Seroma (fluid accumulation under the skin) – this can develop occasionally after the drains have been removed. It will need to be drained on a regular basis or even require an insertion of a new drainage tube, but it will resolve with time.
- Unfavourable scarring – occasionally scars may widen despite the surgical manoeuvres performed to avoid this. Similarly, the location of the scar can sometimes be visible beyond the confines of underwear.
- Lumpiness – usually in the lower abdomen and resolves with time.
- Bleeding – it is unusual to require a blood transfusion for this surgery.
- Bruising – particularly if there has been liposuction performed. This resolves with time.
- Blood clots – you will need to wear compressive stockings on your legs until you are fully mobilising. These clots, which are not common, can be very serious if they move to your lungs, occasionally fatal.
Approximate Costs
Including the theatre charges, consumable items used, post-operative garment, anaesthetist and surgeon’s fees, the cost of an circumferential abdominoplasty starts from $19,500. This price can change depending on your medical history, the complexity of the case and whether additional procedures such as liposuction are done at the same time.
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