Body

Abdominoplasty

This procedure is often referred to as a “tummy-tuck” and helps to address problems men or women may have with loose or sagging abdominal wall skin and relaxation of the abdominal wall muscles. These conditions often result from pregnancy, massive weight loss, or both.

Good candidates for this procedure are in general good health, don’t smoke cigarettes, and don’t plan to have more children. Patients who are considering getting pregnant or losing a significant amount of weight are advised to defer surgery until their weight is stable, if possible, as pregnancy or substantial weight loss after surgery will result in some recurrent laxity.

In patients who have had previous abdominal surgery, particularly those with long oblique or transverse scars, the incisions used in abdominoplasty may need to be altered to reduce the risk of wound healing problems.

Many women desiring abdominoplasty have experienced abdominal striae (stretch marks) with prior pregnancies. Abdominoplasty surgery often allows for removal of the majority, if not all such abdominal stretch marks, particularly those which lie between the umbilicus and the pubic region.

In patients who have had previous surgery, have had pregnancies, or who were previously obese and have experienced marked weight loss, incisional hernias or umbilical hernias may be encountered during abdominoplasty surgery. It is often possible to repair these hernias if they are encountered.

Some patients who have experienced pregnancies or significant weight loss develop separation of the midline muscles of the abdomen (diastasis recti). This can be detected when a recumbent patient lifts both of his/her legs off the bed or table; a visible bulge occurs in the midline of the abdomen. While not a true hernia, this fascial weakness may be repaired with a muscle plication, which is typically performed in abdominoplasty surgery.

Many patients, particularly those who have undergone bariatric surgery and have lost a substantial amount of weight, have laxity which extends to the hips, flanks, and buttocks. In those patients, Dr. Casso recommends a circumferential body lift, which includes an abdominoplasty, but also involves removal of skin and fat in the hip and upper buttock, and which serves to slim the waistline and lift the buttocks. In this procedure, Dr. Casso typically removes excess tissue in the abdomen first, and then the patient is turned prone to complete the procedure, or, in some cases, is turned first to one side and then to the other to complete the tissue removal and closure. Lifting of the buttocks can be supplemented with fat injections to improve contour, if desired.

Dr. Casso performs abdominoplasty under general anesthesia at Houston Methodist St. John Hospital. While this procedure is sometimes performed in outpatient facilities, Dr. Casso recommends an overnight hospital stay, which provides the patient with close, expert nursing attention, the availability of intravenous pain control, treatment of postoperative nausea, if present, and immediate medical attention in the event of any unforeseen emergency. The option for surgery in a full-service, state-of-the-art facility such as Houston Methodist St. John provides patients with a measure of safety and security which is unmatched.

In this operation, Dr. Casso carefully removes the excess skin and fat in the lower abdomen with an incision low in the abdomen. Loose abdominal muscles are tightened with sutures. The wounds are carefully closed in layers with sutures, leaving a scar which typically lies very low, within the bikini line, and which is readily concealed in swimwear. This procedure is commonly combined with liposuction, which can further contour the abdomen and pubic region, if necessary. It may be performed in conjunction with other surgery, such as breast reduction or hysterectomy.

Typically, patients are seen in the hospital the day after surgery, and transitioned to oral pain medication and discharged when comfortable. Patients are typically seen in Dr. Casso’s office 2-3 days thereafter, and at regular intervals, until healing is complete. Patients may shower beginning 2-3 days after surgery. All sutures are removed within 10 days.

Walking is encouraged as soon as possible after surgery, and light activity is permitted three to four days after the surgery. An abdominal binder may be applied postoperatively to assist with management of surgical swelling. Most patients may return to sedentary work in about 1 week, but physical exertion is not allowed for 6 weeks.

Initially, scars are pink, but generally fade well as the months and years go by. Occasional patients who develop thicker scars may benefit from cortisone injections into the scars, or use of topical products for scarring, but generally, scarring from this procedure is well-tolerated by patients, particularly in view of the improvement in abdominal contour.

Pregnancy or marked weight gain after surgery, while not dangerous, will undo many of the benefits of the procedure.

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