If you have had Caesarean section deliveries, other abdominal surgery, pregnancy or other sources of weight gain and loss, an abdominoplasty or tummy tuck may offer a remarkable restoration of youthful contour as well as muscle tone.

Though so-called mini-operations are available for the abdomen that have become possible since the advent of liposuction. In the average patient, who comes with skin looseness and some fat accumulations in the abdomen, flanks and other regions after one or more pregnancies or previous surgical procedures, a full abdominoplasty with a lengthy incision is required.

Vancouver Tummy Tuck – Gallery #1

---

The Incisons: When less isn’t more

Some women may feel the incision is a deterrent to surgery and wish to have liposuction alone, under the mistaken impression the small incisions in liposuction will offer a reasonable tradeoff. This is usually not the case; as the fat layer is reduced skin becomes looser, and liposuction may worsen the situation rather than making an improvement.

In fact, the most common form of abdominoplasty in Vancouver which I use is not a lesser variation of a traditional procedure, but is, instead, more extensive, because so much more is now known about how to achieve best results safely.

---

History of the Tummy Tuck

Removal of a fold of skin plus the underlying fat dates back to the early part of the 20th century. In the 1960’s, the operation was refined considerably and popularized by a Brazilian surgeon, Pitanguy. He also did early thigh and buttock lifts. Many of his improvements are with us to this day. Further advances were made, particularly in incision design, by a Quebec surgeon, Paule Regnault, who also worked on innovations in breast lift and reduction surgery.

However, the two most significant advances in the last quarter century have been the advent of suction lipoplasty, which allowed for treatment of the abdomen fat, with or without skin removal, and the deep layer support techniques of Dr. T. Lockwood of Kansas City. He carefully looked at the anatomy of the abdominal wall, and decided that there was merit in using the superficial fascia, a layer of thin but strong tissue, part way down in the fat layer, as the main means of support, in repairing the skin incisions during both abdominoplasties and thigh lift procedures.This layer had been known to surgeons and anatomists for many years, but most plastic surgeons never felt it had enough strength to be of significant use in repairing the abdominal wall and it was often either ignored or only loosely stitched.

---

Assessment for Tummy Tucks

If you have stabilized your weight at a reasonably healthy level, and your general health is good, it may be time to consider moving forward with tummy tuck surgery. As a basic assessment of your weight status, we look to the which gives a relationship of height and weight. Normal is a BMI between 19 and 25, overweight between 26 and 30. If you have a BMI of 30 or over, for reasons of safety, I will not perform abdominoplasty, or, in , any other surgery. The risk of major complications of surgery or anaesthesia begins to rise quickly between BMI 30 and 35 (classified as obese) Over 35 is considered morbid obesity. The BC College of Physicians and Surgeons Non-Hospital Surgical Facilities Committee has well defined rules about this.

---

Should you wait until you reach your “ideal body weight” for a Tummy Tuck?

Experience has shown that for many people, this puts too much pressure on them to diet and the usual result is “yo-yo” dieting and never getting to a weight at which surgery can be done. Furthermore, sometimes the effects of the surgery can be so profound you will be motivated to lose from other areas. Nutrition and dietary health is of major concern to us, and, though I do not currently work with any particular nutritionist, I would be happy to help you get started on a healthy pathway.

The usual patient presenting for abdominoplasty has had previous pregnancies, and has usually decided not to have any more children. ( Future pregnancies will tend to re-stretch the skin and may cause recurrence of the shape the patient feels is unsatisfactory). She may or may not have had Caesarean sections, or other abdominal surgery. The low gynecologic and Caesarean scar (called a Pfannenstiel incision by gynecologists) is often adherent to the underlying muscle, and above the incision, the non-adherent abdominal skin and fat often droop, and fold over the site of the incision. In some cases, with skin lying against skin, there may be so much problem with moisture causing skin irritation, that the medical insurance will pay for a procedure to reduce the overhanging skin, but a formal, cosmetic abdominoplasty will usually require patient payment.

The vertical abdominal muscles (the rectus abdominis) have often been stretched, and they may be separated down the midline, giving bulging of the central abdomen. In more severe cases, there may even be a hernia of the belly button (umbilicus). In a hernia, not only does the abdomen bulge, but some of the contents of the abdominal cavity (internal organs, fat, etc.) may bulge through a weak part of the abdominal wall. Other old surgical scars may further distort the shape of the abdomen.

Occasionally, I also have male patients who want abdominoplasty surgery. Men often carry most of their trunk fat inside the abdominal cavity, rather than under the skin, and abdominoplasty is somewhat less effective at reducing and recontouring in men. Yet, they will usually have satisfying result.

In patients with less dramatic changes, a modified, or mini-abdominoplasty may be effective. In this procedure, there is less excess skin and a significant amount of fat, so the major procedure is liposuction with the addition of a smaller skin tightening procedure. At one time, about three quarters of my patients seemed to fall into this category; the reverse is now true. This is because I feel I must do a full abdominoplasty in most of my patients to give them the result they have envisaged for themselves; a lesser operation leaves them somewhat disappointed.

---

What you can expect after a Tummy Tuck:

Surgery can be done on a daycare basis with you going home the first night but usually we keep you until the next morning as it gets you started properly in terms of pain control, drinking and eating, voiding etc. Most patients will find getting around after tummy tucks to be a little trying in the first few days; and the first night I feel you are best watched by a nurse. For this reason we usually keep our tummy tucks ( and facelifts ) in the clinic till morning, watched by experienced staff. Within a few days walking around will become much easier.

You will be completely asleep ( general anaesthesia) for the operation, and will wake up in the recovery room with a nurse. There will be one , and sometimes two surgical drains which are soft silicone tubes used to remove fluid from under the skin and help the skin/fat layer to re-attach to the underlying muscle layer. The nurse will teach you how to manage with these; they are removed a few days later.

Most patients take about two weeks away from work although sometimes return to work earlier is possible. Exercise begins quite early at a gentle level and by six weeks nearly all exercises can be resumed.

---

Risks associated with Tummy Tucks

As with any surgery, certain risks must be accepted . With abdominoplasty, as with any surgery, infection and post operative bleeding can occur.

We take precautions to minimize the chances. You are asked to avoid medications and foods which may increase the risk of bleeding, and as complete a list as possible is provided to you in writing in advance. You should be aware that if you take medication which promotes bleeding such as aspirin or ibuprofen, your surgery will be cancelled.

Infections of a significant degree are rare. In over twenty years of performing abdominoplasty we have had only one patient admitted for treatment to hospital, and her treatment resulted in complete resolution with an excellent fonal result. You will be started on a low dose of antibiotics after surgery and intravenous antibiotics will be given during surgery.

The most common problem after tummy tucks is relatively less serious and is called a seroma. Because the skin and fat layer is separated from the underlying muscles, advanced, trimmed, and stitched to the lower edge of the incision, there is space under the layer which needs to heal by sticking down again. Usually this occurs without problem but on occasion this space begins to fill with fluid much like that seen in blisters, serum.

---

Combining the tummy tuck with other surgery:

Safety is always our primary consideration . but it is often possible to combine tummy tucks with other procedures. Closely related operations such as thigh lifts have been done simultaneously with abdominoplasty for many years. Recently there has been a trend to combining a breast procedure with abdominoplasty and this has become common enough that the Globe and Mail ran a feature entitled < “Mommy Makeover”>. So many women ( who had lost body shape from pregnancy and breast shape and volume as well) would come first for either breast augmentation or lift and later for tummy tuck surgery ( or the reverse) that they began to combine the two procedures, saving one recovery period and some costs. This has become quite commonplace in my practice and the surgical time required to achieve the desired results falls well within our limits for safety considerations.

---

Vancouver Tummy Tuck – Gallery #2

---

Vancouver Tummy Tuck – Gallery #3

---

Note that in this case,as in most patients, there is some difference between the right and left sides. This is present before surgery as asymmetry of not just breast size and position, but also pelvic and back posture, chest and shoulder size, etc. We try to recognize the presence of asymmetries before surgery, because almost inevitably, they will be present after.

---

Vancouver Tummy Tuck – Gallery #4

---

Occasionally we have also done abdominoplasty in combination with facelifts or other procedures as well. AS LONG AS THE EXPECTED SURGERY TIME is seven hours or less, we generally feel comfortable that the risks associated are not increased. The exception is when extensive lipoplasty/fat removal is planned.

Again, experience has shown risks begin to rise when liposuction in excess of one litre is combined with any major procedure. As a result, we restrict liposuction volume to one litre or less, unless suction is done as an isolated operation.