Gesundheits Magazin, 01/2010
Tummy Tuck - The reasons are varied
Multiple pregnancies or significant weight loss can lead to overstretching of the skin. The elastic fibers of the skin are destroyed, so that the skin does not return to its original level. The result is an excess of soft skin tissue, which can be so pronounced that it sags like a curtain over the pubic area. The overlapping skin frequently causes persistent inflammation and eczema in the lower abdominal fold. This represents a serious problem for many of those affected. After removal of the excess skin and fatty tissue as part of a tummy tuck, the inflammation usually heals spontaneously. The abdominal wall becomes smooth and taut, and even stretch marks are reduced.
What surgical techniques are available?
Various different techniques are available for the tummy tuck. They differ primarily in the incision approach and the surgical technique. The choice of procedure depends on many factors and must be determined individually. Criteria include, among others, the type and extent of the excess soft skin tissue or the presence of abdominal wall weakness. An essential component for a good surgical outcome is planning. With the patient standing, the incision lines are marked using a marking pen. Distances to important reference points, such as from hip to hip above the pubic area, are measured and marked. Various incision approaches are possible, such as an arched, a horizontal, a W-shaped, or an anchor-shaped incision. When planning the incision, care is taken to ensure that the resulting scars are not visible when wearing a bikini or underwear.
The following surgical treatment procedures are considered for the tummy tuck:
- The complete tummy tuck (abdominoplasty) with navel repositioning
- The lower tummy tuck (mini-abdominoplasty) without navel repositioning
Additionally, corrective liposuction may be performed depending on the findings.
Occasionally, in addition to abdominal wall laxity, a rectus diastasis (abdominal wall weakness) may also be present. This involves a widening of the connective tissue plate between the straight abdominal muscles. The cause is overstretching of the connective tissue plate due to obesity or during pregnancy. If the tissue plate does not return to its original size after pregnancy or after weight loss, this leads to the separation of the straight abdominal muscles. The result is that the intestine pushes forward and is visible as a protrusion. In individual cases, an abdominal wall hernia may also be present, which would need to be treated at the same time.
In 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. The skin of the upper abdomen is detached from the abdominal muscles up to the level of the costal arches. If a rectus diastasis is present, the connective tissue plate between the straight abdominal muscles can be gathered simultaneously (fascial doubling). Through targeted gathering sutures at waist level, the waist can be accentuated. The detached skin of the upper abdomen is pulled down to the lower abdominal fold, tightened, and sutured there tension-free to the skin. A new navel opening is then precisely placed, and the excised navel is drawn through the new skin and sutured in. The procedure is performed under general anesthesia and takes between 2–4 hours depending on the extent.
If only a small excess of soft skin tissue needs to be removed from the lower abdomen, a so-called "mini-abdominoplasty" (mini tummy tuck) is suitable in these cases. Here, only an arched incision is made in the lower abdominal fold with removal of the excess skin, without the need to reposition the navel. This procedure is only suitable for cases where the excess skin is limited to the lower abdomen.
In all procedures, a special suturing technique is used to keep the scar as short as possible. As a result of the scar-sparing suturing technique, the skin scar frequently gathers at the transition to the flanks. During the first few months after the operation, the scar smooths out. Unfortunately, sometimes an excess of skin (dog ear) remains at the outer pole of the scar in the area of the flanks. This can be corrected half a year after the operation under local anesthesia.
A good surgical outcome requires adequate experience on the part of the surgeon. Particularly noteworthy are the aftercare and one's own behavior. The abdomen increasingly takes on its shape over the course of the first three months after the swelling subsides. During this natural modeling phase, it should be "protected." In the first two weeks, the abdominal wall should be relieved by bending the legs and elevating the upper body. The reduced tension and strain on the wound lead to better scar formation. After the tummy tuck, a compression garment should be worn for up to three months after the operation, particularly after correction of a rectus diastasis. This is very important so that the gathering sutures that have been placed do not tear out.
The following aftercare measures also have a positive effect on the healing process:
- Cooling measures promise relief for postoperative swelling.
- Gentle manual lymphatic drainage is highly recommended after the wounds have healed.
- Good moisturizing creams optimize postoperative scar formation.
- Direct sunlight, sauna visits, and solarium visits should be avoided.
The scars are initially red and fade during the first 12–18 months.
> Further information on the tummy tuck
