Abdominoplasty (or Tummy Tuck)
is a surgical procedure that not only addresses removal of fat but also the
tightening of skin excesses and the repair of muscle separation often associated
with pregnancies or weight loss. Patients are evaluated and there are a variety
of procedures to address individual needs. The procedure should be individualized
to patient. For
instance, an excess of skin and/or muscle separation limited to below the belly
button can be addressed with a limited or mini- tummy tuck. When the skin and
muscle issues involve the entire front of the abdomen, a full abdominoplasty
is needed. Liposuction is often carried out at the same time to further enhance
the final result.
Unfortunately, all surgical procedures have potential risks.
The most common complication of tummy tuck is persistent fluid collections
called seromas.
This occurs because a large space is left behind by the procedure in a very
mobile part of the body. As you move your abdomen to sit up, walk or even
breath, these tissue that are trying to heal may be disrupted causing the
formation of seromas. In an attempt to prevent this complication., most surgeons
place tubes called drains to try to remove the fluid produced.
Typically, 2-3 drains are placed into the surgical site and they remain until
a minimal fluid output is seen. This can be anywhere from one to four weeks.
And even with the proper use of drains, seroma formation may be as common
as 20% or greater. We have developed a “no drain abdominoplasty”
which involves a simple suturing technique to secure the abdominal tissues
so that they can heal without disruption. This unique method speeds and eases
patient recovery, while reducing seromas as well as other potential risk.
Our approach differs from standard techniques by the addition of a simple
suturing technique that allows us to secure healing preventing fluid
accumulation without the use of drains, it allows more rapid return
to upright posture and normal activities.
OUR APPROACH TO TUMMY TUCK (Easier recovery, less risk)
During the initial consultation, an individualized
evaluation and treatment plan to address patients' specific needs, is carried
out by the surgeon. During this visit the surgeon will explain the
technique, expected convalescence, and anticipated results.
The surgical technique that we use is the progressive
tension suture technique, which was originated and published
by our surgeons, Drs. Harlan Pollock and Todd Pollock. Our
experience of over 30 years using this technique in Dallas and Allen,
TX, has produced a high percentage of excellent results and the following
advantages:
NO DRAINS required, which minimizes post-operative care.
EARLY RESUMPTION OF UPRIGHT POSTURE AND PHYSICAL ACTIVITY is an improvement
over traditional methods that require a severe limitation of activity
and ambulation in a bent posture for several weeks.
Complications are dramatically reduced by the use of Progressive Tension
Sutures (PTS).
The Progressive Tension Suture Abdominoplasty (Tummy
Tuck)
We originated the progressive
tension sutures (PTS) » procedure that greatly
simplifies our abdominoplasties (tummy tucks), significantly reduces surgical
complications, improves our patients' results, and shortens our patients' convalescence.
We have been using this technique over the past 30 years and
have found it to be reliable and long-lasting.
Above: Illustration of PTS placement under the skin to advance
and anchor the skin flap
Following the appropriate management of the deeper tissues of the abdomen
including muscle repair, the skin redraping and tightening is
accomplished by the use of PTS. These are sutures that advance and anchor the
skin to the underlying tissues. This is a very simple, yet effective technique
that has the advantage of:
The distribution of pull over the entire skin surface (instead of only
at the skin closure!) improving the skin redraping
No tension on the skin closure -- resulting in less obtrusive
scarring
Direct suture of the bellybutton from the underneath
surface of the flap -- enhancing the appearance of the bellybutton
Elimination of the space under the skin flap and
secure anchoring of the skin flap to the underlying tissues -- eliminates
the most common complication of the procedure seroma formation (fluid collection)
Secure anchoring of the flap permits early return to the
upright posture and improves and speeds the convalescence
Modified Abdominoplasty (Tummy Tuck): Liposuction can be
utilized in both the upper and lower abdomen. The surgery then consists of
making a relatively short transverse incision, elevating the skin and fat of
the lower abdomen (called a flap) and repairing the muscle separation or diastasis
rectus. The incision is then closed after removing excess skin. This procedure
is usually done as an outpatient.
This is an illustration
of a full abdominoplasty (tummy tuck);
modified abdominoplasty is only below the belly button.
Full abdominoplasty (tummy tuck), illustrated above, is similar
but more extensive as it involves elevating the skin flap over the entire abdomen
and repairing the muscle separation. This procedure may be done as an outpatient,
but an overnight stay may be required.
Important techniques we utilize in our practice for Abdominoplasties
(Tummy Tucks):
Power-Assisted Liposuction (PAL) is a relatively new
adjunct to traditional liposuction. It is a device that reciprocates or moves
the cannula in and out at a very high rate of speed. This vibrating effect
cuts through the fatty tissues, facilitating the fat removal. The device
is particularly helpful for fibrous areas, can be done through small incisions
and adds no increase in risk or expense. PAL is surpassing ultrasonic-assisted
liposuction (UAL) in use among plastic surgeons, with safety concerns and
expense being the major considerations. We use PAL exclusively in our practice.
Tumescent Liposuction or Super-Wet Fluid Infiltration refers
to injection of the area to be suctioned with saline (salt water solution),
local anesthetic, and epinephrine. This solution plumps up the tissues, making
fat removal easier, constricts blood vessels, which reduces bleeding, and
block nerves, providing painless surgery. The super-wet technique uses less
volume of fluid than the tumescent technique.
Progressive Tension Sutures (PTS) is a surgical technique
used in abdominoplasty (tummy tuck) that our practice has developed and reported
in the Journal of Plastic and Reconstructive Surgery, June 2000. The basic
concept is that of a controlled redraping and advancement of the abdominal
skin flap by the placement of multiple sutures from the skin flap to the
deep tissue. Read more about PTS » above on this page.
The progressive tension sutures are placed from the skin
flap to the deep fascia as the abdominal flap is advanced. This downward
advancement is maintained as each suture is placed and tied, hence the name, "progressive tension
sutures." In this manner, tension is redistributed over a broad area of
the abdominal flap, as opposed to the conventional procedure in which all the
tension is concentrated on the incision. The PTS technique allows closure of
the incision with virtually no tension. This improves the quality of resulting
scars and prevents healing problems.
However, the most important benefit of PTS is the secure
anchoring of the skin flap to the underlying tissues. The attachment
of these tissues allows the entire abdominal wall to immediately move as
a unit, which prevents disruption of early healing. It is our opinion
that this is the primary reason that this technique prevents seroma
formation (fluid collection) – the
most frequent complication of abdominoplasty (tummy tuck).
Complications, such as excess scarring, healing delay and fluid
accumulation are usually prevented by this technique. As with any surgery
procedure, we have seen complications after abdominoplasty (tummy tuck);
however, they have been uncommon and usually minor. THIS
TECHIQUE IS AS SIMPLE AND LOGICAL AS IT SEEMS.
Abdominoplasty
(tummy tuck)
Cosmetic Surgery: Promises and Pitfalls™
PROMISES
Abdominal
deformities, such as abdominal fullness, excess skin, excess fat, etc.,
most of which are related to pregnancy or genetics, can be corrected
with liposuction and/or abdominoplasty (tummy tuck). Most patients are
pleased with the end results of this surgery, when it is appropriate,
well implemented, and successful.
PITFALLS
An accurate diagnosis by a surgeon trained
to do ALL types of body contouring surgery is important (see Promises
and Pitfalls: Credentials). Partially
trained physicians are offering liposuction in general practice, gynecology,
dermatology and other medical practices. The doctors may offer liposuction,
but most are not trained or interested in the more complex abdominoplasty
(tummy tuck). Results
following liposuction in a patient who is actually an abdominoplasty (tummy
tuck) candidate are usually disappointing.
There are many variations in techniques of performing abdominoplasty
(tummy tuck) and there is considerable variation in results,
rate of complications and length of severity of convalescence.
To assume all techniques are the same would be a mistake. Before having
surgery understand the basics of the technique, average length of convalescence
(especially restrictions after surgery) and the surgeon's rate of complications.
Abdominoplasty
(tummy tuck)
