A tummy tuck, also known as an abdominoplasty, is a popular procedure all over the world. This procedure when properly done will restore the aesthetics look of your abdomen. The typical patient that is a candidate for this procedure is the post partum patient. During pregnancy, the changes that occur due to the slowly expanding uterus can in many ways compromise your figure. The changes that are associated with pregnancy are:
Laxity of the abdominal muscle
Distortion of the belly bottom with possible umbilical hernias
Stretch marks of various forms and shapes
Increase in the waist size
The excessive skin is the result of complete disruption of the internal structures of the skin. There is a loss of elasticity and skin tone. Some of this will improve after pregnancy but for the most part that will not be the case. The excessive skin can be located in various areas and its location will in many ways determine how long the tummy tuck scar will be, the final location of the scar, and the technique that will be most appropriate for each case.
The laxity of the muscles is improved with this technique. Although the laxity of the muscles can occur due to other causes, pregnancy is the most frequent cause. There is connective tissue in the middle of the pair rectus muscle (the six pack muscle). This tissue relaxes during pregnancy to accommodate the expanding uterus. This tissue does not completely return to its previous form after pregnancy, thus causing the muscle to “sag” and resulting in an increase in the width and enlargement of a protuberant abdomen. You are more likely to have this problem if:
You have multiple pregnancies
Give birth to a baby with a large weight
With a tummy tuck, the muscles are brought back to the midline restoring the abdominal wall, improving its shape, and creating a flatter appearance.
Fat distribution is also improved during this procedure. Weight gain is common during pregnancy and although some of it is the result of fluid retention and the baby’s weight, a significant cause is an increase in fat. Fat distribution will occur in different locations. A tummy tuck will remove any fat that lies below the belly bottom. Now, a tummy tuck does not necessarily sculpt the body. This will depend on how much fat you have and the location of the fat. It is crucial to determine the location of the fat during consultation because it will determine the final results. There are two different types of fat that compromise the abdominal aesthetics. When you gain weight, the fat is accumulated in the subcutaneous layer of the abdomen and also around the internal organs. The subcutaneous fat is the fat that is close to the skin.
The fat that is typically removed with a tummy tuck and or liposuction is the subcutaneous fat. It is the fat that you can grab with your hands. This fat layer varies in thickness as your body weight changes.
On the other hand, there is the visceral fat. This is the fat around the liver, guts, and spleen, which is essentially the fat that is in the peritoneal cavity. This fat lies under the abdominal wall muscles and cannot be removed with liposuction. Your genetics determines the location of your fat and the ratio of visceral fat to subcutaneous fat. I often notice that some patients have a significant amount of visceral fat compared to subcutaneous fat and, unfortunately, these are the patients that are not typically good candidates for surgery and the only way to remove and decrease the fat is by losing weight.
On the other hand, if you have mainly subcutaneous fat, which is the fat that you can grab with your own hand, it can be removed with liposuction, thus allowing me to sculpt your body.
If your main problem is the visceral fat even the maneuvers that I typically use to suture your abdominal wall and decrease the size of your waist will not work as effectively.
The belly button also needs to be effectively restored for a good tummy tuck result. Due to the excessive fat that accumulates above the belly button, the upper part of it gets obscure and distorted giving what I call “the sad smile” to the belly button. In certain patients, you will have an umbilical hernia that needs to be repaired. Fixing the belly button is one of the most underestimated aspects of a tummy tuck. A belly button has the following characteristics:
Hooded configuration on the top
A well-designed belly can make your belly look sexier and can avoid the tummy tuck look with an external scar. I pay a lot of attention to the belly button because of its central location and importance in the overall aesthetics of the abdomen. The belly button is to the belly as important as the areola is to the breast. If it does not look right, then, the overall aesthetics will not be good.
Improving the look of your abdomen with a tummy tuck also allows me to surgically excise the stretch marks that you hate. There is catch when assessing the abdomen and the limitation that the surgery will be able to do. The main factor that will determine if you will have residual stretch marks after a tummy tuck is mainly the location of the stretch marks.
Because a tummy tuck removes the skin that is below the belly button, any stretch mark in this location will be surgically removed. If your stretch marks extend way above the belly button, then this will not be possible. Remember that I need to have a certain amount of excess tissue left to close the abdomen. Regardless, even if some stretch marks are left behind, once the skin is excised and the remaining skin closed, these stretch marks will be located in the lower abdomen and will look much improved.
There are different patterns of stretch marks; for example, the stretch marks can be located in a radial distribution. In some patients, they can be located just below the belly button. This is the only situation when all the stretch marks will be completely removed and your abdomen will have no stretch marks after surgery. Finally, the stretch marks can extend all the way to the flanks. In this case, again I will not be able to remove all the stretch marks on her abdomen but the results will be very good.
Now, the changes in your body secondary to an increase in subcutaneous fat and stretching of the muscle result in the female body and proportions that divert from the normal hip to waist proportions that make a beautiful female body. Your waist gets bigger in width and depth. Suturing the abdominal wall in the midline, not only will recreate the abdominal wall to its previous form, but also will decrease the size of your abdomen improving your proportions tremendously.
Types of Tummy Tuck Techniques
There are different types of tummy tuck techniques with different names and descriptions. Each one has its own indications. The following are the different types of tummy tucks:
Traditional tummy tuck also known as standard tummy tuck
Mini tummy tuck
Modified mini tummy tuck
Extended tummy tuck
Dr Cortes’s technique – The Hourglass Tummy Tuck
So what is the difference? We need to go back to the main components of a tummy tuck. A tummy tuck addresses the excessive skin, the abdominal muscle, and the excessive fat. Depending on the severity of each one of these components individually, the best technique will be used to accomplish the best results. For example, if the muscle’s weakness is concentrated in the lower aspect of the abdomen and you have minor excess skin, you might be a good candidate for a mini tummy tuck. On the other hand, if your muscle’s weakness is more extensive, then, you will need either a modified mini tummy tuck or a traditional or full tummy tuck.
A tummy tuck by definition does not include liposuction. In my practice regardless of which tummy tuck technique I do, liposuction is always done. Liposuction dramatically increases your overall results and satisfaction. It allows me to sculpt the body in ways that a tummy tuck cannot.
The recovery of a tummy tuck takes about 7 – 10 days. I always tell my patients that pain after a tummy tuck is more significant than breast surgery. During a tummy tuck the abdominal wall is suture to recreate the abdominal musculature. The muscle is not cut like during a c-section where the lower abdominal muscle is cut to deliver the baby. Cutting the muscle is very painful. This is why I always tell my patients that the pain of a tummy tuck will be much less than a c-section. Now, the pain will be controlled with medications. You can expect some level of pain for about 2-3 days. After this, the pain gets much better.
You will be able to walk within 3 to 4 hours after surgery once the anesthesia is cleared. Most plastic surgeons recommend walking with the hip flex forward to diminish the stress on the incision. I have discovered that with my tummy tuck technique patients can start walking straight within 24hrs. This is because I set tension of the abdominal closure to minimize aesthetics complications that occur due to the removal of excessive skin.
I recommend my patients to walk and get out of bed. Bed is for sick people and you are not sick. Walking decreases the complications that can occur with immobility. Immobility causes your blood to pool in your legs increasing the chances of having a blood clot. I recommend to walk a few times even the days of surgery. Get out of bed for 5 – 10 minutes. This will help mobilize the blood in your leg significantly decreasing the chances of having this type of complication.
Activities that require straining, bending, and lifting must be avoided since these activities increase the likelihood of disrupting the muscle layer stitches. Sleeping with a pillow under your knees and a few behind your back is recommended. You should not resume any heavy lifting for about 5-6 weeks.
Going back to work will depend on the type of work you do. For example, deskwork can be resume within 10–14 days. Remember: If you have to lift a significant amount of weight, it will take longer to resume full duties. You will be able to return to work with weight restrictions.