KOSMETIK International, 01/2010
Many people struggle with their own body shape. When the abdominal skin has sagged so severely that even targeted dietary or exercise measures can no longer counteract it, a tummy tuck is the only remaining option.
Multiple pregnancies or significant weight loss can cause the skin to become overstretched. The elastic fibres of the skin are destroyed and the skin does not return to its original level. The result is an excess of soft skin tissue, which can be so pronounced that the abdomen sags like a curtain over the pubic area. Because the skin overlaps, stubborn inflammations or eczema frequently develop in the lower abdominal fold – a distressing problem for many of those affected. When the excess skin and fatty tissue is removed as part of a tummy tuck, the inflammations usually heal spontaneously. The abdominal wall becomes smooth and firm. Stretch marks can even be reduced. What surgical techniques are available?
Various methods are available for a tummy tuck. The standard procedures are often individually modified by the respective surgeon – particularly with regard to incision technique. The choice of procedure depends on many factors, e.g. the type and extent of the excess soft skin tissue. It must also be clarified whether abdominal wall weakness is present. Good planning is an essential component of the operation and is decisive for the outcome. This also includes marking the incision lines, which is carried out on the standing patient using a marking pen. Distances to important reference points are measured and marked, e.g. from hip to hip across the pubic area.
Various incision patterns are possible during the operation, e.g. an arc-shaped, horizontal, W-shaped or anchor-shaped incision. Care is always taken to ensure that the resulting scars are not visible when wearing underwear or a bikini.
Based on individual findings
The following surgical treatment procedures are options for a tummy tuck:
- Complete tummy tuck (abdominoplasty) with navel repositioning.
- Lower tummy tuck (mini-abdominoplasty) without navel repositioning.
- Depending on the findings, an additional corrective liposuction may be performed.
- Occasionally, in addition to abdominal wall laxity, a rectus diastasis (abdominal wall weakness) may also need to be corrected.
In the case of abdominal wall weakness, the connective tissue plate between the straight abdominal muscles is widened. The cause is overstretching of the connective tissue plate, which can occur due to excess weight or pregnancy. If the tissue plate does not return to its original size after pregnancy or weight loss, the straight abdominal muscles drift apart. The result is that the intestine protrudes and is visible as a bulge. In individual cases, an abdominal wall hernia may also be present, which must be treated at the same time.
The complete procedure
In a complete abdominoplasty, the skin and subcutaneous fatty tissue between the upper pubic hairline and the navel are incised and removed. The navel is also incised and remains on the abdominal wall. In the upper abdomen, the skin is detached from the abdominal muscles up to the level of the rib arches. If abdominal wall weakness is present, the connective tissue plate between the straight abdominal muscles can be tightened at the same time (fascia plication). The waist can be accentuated by targeted gathering sutures at waist level. The elevated skin of the upper abdomen is pulled down to the lower abdominal fold, tightened and sutured there without tension. A new navel opening is then precisely positioned. The excised navel is pulled through the new skin and sutured in place. The procedure is performed under general anaesthesia and can take between two and four hours depending on the case.
If only a small amount of excess soft skin tissue needs to be removed from the lower abdomen, the so-called mini-abdominoplasty (mini tummy tuck) is suitable. Here, an arc-shaped incision is made in the lower abdominal fold and excess skin is removed without the need to reposition the navel. However, this procedure is only suitable for cases where the excess skin is confined to the lower abdomen. In all procedures, an attempt is made to keep the scar as short as possible using a special suturing technique. Due to the scar-sparing suturing technique, the scar often gathers at the transition to the flanks. However, it frequently smooths out in the first few months after the operation. Sometimes an excess of skin (dog ear) remains at the outer pole of the scar in the flank area. This can be corrected under local anaesthesia six months after the operation.
A matter of experience
A good outcome requires sufficient experience on the part of the surgeon. Complications are rare but cannot be ruled out. As with any surgical procedure, bruising, swelling and pain may occur. Rare post-operative bleeding can prolong the healing process and may sometimes need to be corrected surgically depending on its extent. Circulatory disorders of the skin can lead to wound healing problems.
However, the outcome is not only influenced by the procedure itself. Important factors also include aftercare and one's own behaviour. Over the course of the first three months after the procedure, the swelling subsides. The abdomen gradually takes on its shape and should be "protected" during this natural modelling phase: In the first two weeks, the abdominal wall should be relieved by bending the legs and elevating the upper body. Tension and strain are thus reduced, which promotes good scar formation. In particular after correction of abdominal wall weakness, a compression girdle should be worn for up to three months. This is very important to prevent the placed gathering sutures from tearing out.
