Case of the Week: Tummy Tuck [PHOTO]
Case #1 Weak abdominal wall muscles with no excess abdominal skin or fat Recently, I had a patient come to my plastic surgery clinic for evaluation regarding her abdomen. She was middle aged and had seen several other plastic surgeons. She presented to me quite distressed. The plastic surgeons she had consulted with said that "she did not need anything" and that "there was nothing they could do". She came to me quite anxious about her protuberant abdomen. Her history revealed that she ate very healthy and exercised one to two hours every day. She had never been pregnant. She had no history of massive weight loss and had never lost more than 10 pounds. Previously, she had been a very slim, athletic gymnast. However, on physical examination, her stomach looked like she was six months pregnant! Further examination revealed that her abdomen was quite distended and she had no excess abdominal skin and fat.
Usually, a tummy tuck has three primary objectives: to remove excess abdominal skin, remove excess abdominal fat, and tighten the muscles of the abdominal wall. Typically, the target of an abdominoplasty is to remove excess skin and fat from the belly button to the pubic region. Most tummy tucks should involve muscle tightening. In this case, even though she did not have excess abdominal skin and fat, I still recommended a tummy tuck. However, the objective of her tummy tuck was not the removal of excess abdominal skin and fat--for there was none. The goal of this patient's tummy tuck was muscle tightening. She did not need the removal of abdominal skin and fat; she just needed muscle tightening from the sternum to the pubis. [accordion_shortcode class="myClass" title=""] [accordion_content title="Warning: The following pictures are graphic in nature. Click here to view" open="true" el_id="1476221504859-16730298-6563"]
BEFORE RECTUS ABDOMINUS TIGHTENING
A: Before Rectus Abdominis Plication. The Vertical Lines Along The Lateral Borders Of The Rectus Abdominis Muscles Will Be Brought Together With Two Layers Of Permanent Sutures. This Will Flatten Her Abdomen And Bring In Her Waist Line By 3 Inches. B: This Patient’s Abdomen Is Now Flat And Her Waist Has Been Reduced By 3 Inches. C: This Shows The Minimal Amount Of Excess Skin. D: This Shows The Skin To Be Removed.
AFTER RECTUS ABDOMINUS TIGHTENING
[/accordion_content] [/accordion_shortcode] During this patient's surgery, once she was asleep, an incision was made in her lower abdomen. Tissue dissection was carried to the belly button and then to the sternum and rib cage. The rectus abdominis muscles were identified. The rectus muscles were brought in by about three inches. The rectus muscles were imbricated in two layers from the sternum to the belly button and then, from the belly button to the pubic region. This rectus abdominis muscle tightening flattened her distended abdominal. Since her defect was mostly weak abdominal muscles and not excess abdominal skin, only a minimal amount of skin was removed. Approximately about two inches of lower abdominal skin and fat was removed. Thus, just by tightening her abdominal wall muscles, she achieved a very sexy, washboard stomach. The patient was exceedingly happy and now proudly shows off her flat abdomen in a bikini. Case #2 Weak abdominal wall muscles after rectus tightening The “X” tummy muscle tightening technique to tighten the oblique muscles Sometimes additional work needs to be performed on the abdominal wall muscles. Usually, during a tummy tuck, the rectus abdominis muscles are tightened from the sternum to the pubis with permanent suture. However, sometimes there is additional laxity in the lower abdomen. This requires further repair of the anterior abdominal wall. Further tightening is achieved with permanent sutures placed in the external and internal oblique muscles of the lower abdomen. Typically, these sutures are placed perpendicular to the aforementioned rectus abdominis plication sutures. This line of permanent sutures is usually just inferior and lateral to the belly button. This row of sutures serves to tighten further the lower abdomen. Case #3 Complete laxity of the anterior abdominal wall muscles Sometimes patients have a very weak abdominal wall due to extreme abdominal wall muscle laxity. Extreme muscle laxity can be genetic or can be due to multiple pregnancies or massive weight loss. If the entire abdominal muscle wall is still weak even after rectus abdominis muscle plication and perpendicular oblique muscle plication, sometimes a piece of permanent mesh is placed. The mesh can be quite large and can sometimes measure 8” x 10". Mesh insertion serves to buttress the abdominal wall. Regardless of what type of abdominal wall repair you need, the tummy tuck or abdominoplasty takes approximately 3 to 4 hours to perform under general anesthesia. The recovery from a tummy tuck is usually about two weeks. Therefore, if you have a distended abdomen, you may need abdominal wall muscle tightening. So, if you are stressing about your abdomen, please consider consulting with celebrity plastic surgeon Dr. Katzen. Dr. Katzen has lectured and operated throughout the world and is considered an international expert in abdominoplasties. Dr. Katzen has performed thousands of abdominoplasties. Please call one of Dr. Katzen's offices today to book your appointment for a sexier, flatter abdomen.