The ABC's of plastic and cosmetic surgery: Abdominoplasty.
By Dr. Mathew C. Mosher

From Spring 2002 Issue

Plastic surgery can profoundly affect the lives of people of all ages, and this is one of the reasons I love what I do. Plastic surgery is a specialized segment of surgery that focuses on restoring natural form and function to the body. Restoring shape may be something as common as improving on a disfiguring scar or as specialized as improving the appearance of a child born with a birth defect. Many of the amazing functions of our body depend on nerves, blood vessels, muscles, and tendons. If these become injured, plastic surgeons are often called upon to restore function, ideally to pre-injury levels. Cosmetic surgery is a commonly used term for surgery done to improve our appearance. These procedures are an integral part of the training for plastic surgeons, and some of us focus our entire practice on this aspect of plastic surgery.

Every year I perform hundreds of surgeries. These operations range from the removal of small moles and cysts to complex rejuvenation procedures on the face and body. While these procedures have many things in common, every surgical procedure and every patient is unique. You are unique even if the procedure you desire is done many, many times a year. Your surgeon must be able to work with you to tailor a solution that accounts for your uniqueness.

My goal in this column is to give you the information that you need to help you decide if cosmetic surgery is right for you. The more information and knowledge you have, the better you are able to communicate with your surgeon and improve your chances of achieving your goals.

All About Abdominoplasty
Abdominoplasty, commonly called a tummy tuck, is surgery to improve the appearance of the abdomen. The goal of abdominoplasty surgery is to have a smoother and flatter tummy, and most patients considering this procedure want to regain their abdominal shape. Weight gain followed by weight loss can lead to a loose and sagging tummy. Many women who have experienced one or more pregnancies are familiar with these changes to their abdomen after giving birth. Sometimes surgery on the abdomen has also aggravated the problem. A scar from a Caesarean section can leave a permanent indentation or can cause damage to the underlying muscle tone. The problem that many patients complain of is they have a rounded tummy that only looks okay when they are consciously holding in their tummy and preferably wearing loose and layered clothing.

"The ultimate goal of abdominoplasty surgery is to have a smoother and flatter tummy. A better shape to the torso means your clothes will fit differently and you will feel more confident about your shape in and out of clothing."

There is a range of techniques to improve the appearance of the abdomen and the approach is unique to each circumstance. The first place to start is with a healthy diet and regular exercise. With hard work and discipline, you can often improve the appearance and shape of the abdomen without surgery. However, many people struggle to achieve worthwhile results on their own. Also, if the skin has been permanently stretched and the tissue that surrounds the muscle has been damaged, getting your shape back on your own is unlikely. Let's look at these critical components and see how I develop a surgical plan for abdominoplasty surgery.

The factors that determine the shape of your tummy start from the inside out: your inner body fat that surrounds your organs, your abdominal wall made up of muscles and supportive tissue (called fascia), your outer body fat, and finally your skin.

You can improve many of these on your own. Improving your weight, lowering your percentage of body fat, and strengthening your muscles will help you look better. When you decrease your inner fat layer, your tummy will flatten and there will be less stretch on your abdominal wall and skin. Shrinking your outer fat layer will improve your shape and allow the skin to contract further. Strengthening your muscles will flatten your tummy even further, as long as you are contracting your muscles. If you want the best results from abdominoplasty, your stomach muscles should be in the best shape possible before you have surgery. Therefore, good nutrition and aerobic exercise are essential, and the guidance of a qualified personal trainer might be very helpful.

Unfortunately, you cannot "train" loose skin or stretched fascia. If you lose weight your skin and fascia will tighten to a certain degree. The amount of tone that your skin and fascia achieve is not directly under your control. If your fascia has been damaged and stretched, your tummy will bulge as soon as you stop contracting your muscles (that is, holding your tummy in).

An abdominoplasty is designed to tighten damaged fascia and remove excess stretched skin and fat from the lower abdomen. An incision tailored to the needs of the surgery is usually placed above the pubic hairline and extends upward and outward toward the pelvic bones. The length of the incision depends on how far out the loose skin and fat extends. A mini-tummy tuck has a shorter incision and is for those who just need tightening of the central and lower abdominal skin or who need some tightening of the lower tummy fascia. A standard tummy tuck tightens the skin in the upper and lower abdomen as well as tightening the fascia from the pubic area to the breastbone, if needed. If the loose skin and fat extends towards the flank and hip area, an extended tummy tuck with a longer incision is required. Regardless of the length of the incision required, it can be discreetly located and will not interfere with clothing or bathing suits.

One final consideration is contouring the adjacent areas to further improve the shape of the waistline and torso. Excess fat in the lower back, hips, buttocks, and thighs is frequently improved with liposuction at the same time as the abdominoplasty is performed. Liposuction is really the only way to spot reduce an area of fat. However, not everyone needs liposuction, and it is something you should discuss with your plastic surgeon during your consultation. You can learn more about liposuction on our web site.

The ultimate goal of abdominoplasty surgery is to have a smoother and flatter tummy. A better shape to the torso means your clothes will fit differently and you will feel more confident about your shape in and out of clothing. The best results are achieved in healthy patients who do not smoke, have a healthy diet, and who are already involved in a regular exercise program.

Come back to our site on June 15, 2002 when we will discuss breast augmentation, breast reduction, and breast lifts.

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