Tummy Tuck is the common word for abdominoplasty. Abdominoplasty is a procedure that is normally performed on women after one or more pregnancies. The abdominoplasty procedure almost always includes a correction of the muscle separation known as rectus diastasis. This muscle separation leads to several problems. First, sit ups do not work for correcting a bulging stomach because the muscles are not in their normal position, and therefore all the sit ups in the world will not give you a flat stomach. Second, abdominal muscles that do not work correctly leads to too much strain on the lower back muscles that leads to chronic low back pain which is correctible with a well-done tummy tuck.
Muscles: How the surgeon repairs your muscles is as important as the fact that they are repaired at all. They need to be repaired with permanent suture so that the repair does not fall apart a month or two after the procedure because dissolvable sutures were used inappropriately. The technique I use for correction of a rectus diastasis is a two-layer closure with permanent sutures. The first layer is figure 8 permanent sutures which are individually placed, followed by a running locking suture over the top of the figure 8 sutures to give extra strength and a tighter repair.
Belly Button: In a well done tummy tuck or abdominoplasty, a new belly button is created. The belly button, known technically as an umbilicus, has two veins and one artery that go to its base. They come from the liver and that is how your mother fed you when you were inside her. The new belly button created in an abdominoplasty is really your old belly button brought out through a new opening with few or no stretch marks around it, leading to a more attractive belly button.
Stretch Marks: The majority of stretch marks are present between the pubic hair and one inch over the belly button. Most of these are surgically removed during the abdominoplasty procedure, therefore not only leaving a flatter abdomen, but also one with much more youthful appearing skin.
Length of Abdominoplasty Closure: If you lie down in bed, bring your knees up, and pinch the skin of your lower abdomen following it with your fingers out to the side, you will know exactly the length of the abdominoplasty incision necessary to get rid of the excess skin and to leave no dog ears (excess skin that was not removed). The only way to shorten the abdominoplasty scar is to liposuction the hip or love handle fat from behind, which can lead to a slightly shorter abdominoplasty scar.
Pubic Hair: The pubic hair is located on an area known as the Mons Pubis. When the baby was inside you, the pubic hair or Mons Pubis was stretched out just like the rest of the abdominoplasty skin, therefore a portion of this hair bearing skin needs to be removed so that you do not end up with hair above the bikini line. I normally remove approximately 1” of hair bearing skin along with the rest of the tissue excised during a tummy tuck.
Tummy tuck surgeons bend the operating table to an angle of about 30 degrees up from neutral to allow for excess stretched out skin to be removed, not only when the patient is in a standing position but also in the seated position. Because of this extra tightness, I keep my patients in what is known as the lawn chair position, i.e. pillows behind the back and pillows behind the knees, for the first three days after surgery. This prevents tearing apart of newly-placed sutures and allows for a permanent closure not under tension.
Anterior Thigh Skin: This excess pull with extra skin removed pulls the loose skin on the anterior thighs up as well.
Stress Incontinence: Depends (adult diapers) were basically invented for older women who have had multiple pregnancies. Stress incontinence means you laugh, you pee, you cough, you pee. The anatomic reason behind this unfortunate post-pregnancy problem is that the female urethra has only one sphincter where the male urethra has two. The value of this sphincter is lost when the female vulva falls between women’s legs due to the stretching out of all the skin of the lower abdomen. A tummy tuck or abdominoplasty often repositions this and corrects this problem.
Clitoral Stimulation: A side benefit of a tummy tuck is to pull up the female vulva, leading to a better positioning of the clitoris that often leads to improved stimulation during intercourse.
As you can see, the abdominoplasty, if done correctly, not only leads to several cosmetic improvements on the abdomen, but also potentially several functional improvements as well.
