Mid-section Makeovers…Redefine Your Midline

By: Beth Phillips, RPAC

As the winter months start to fade away, and the daylight hours become longer, many of us start to look forward to the summer months ahead. With this in mind, we become more aware of what has been hiding underneath our bulkier winter clothing and realize that summer clothing and swimsuit season are almost here. As I look at my schedule at our plastic surgery practice, I am struck by the seasonal increase in abdominoplasty consultations that occurs each spring.

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Abdominoplasty, commonly called a “tummy tuck,” is an excellent procedure to restore abdominal contour in the right candidate. While the standard abdominoplasty is likely the most well known procedure, there are many variations and considerations that need to be investigated prior to scheduling a surgery. I frequently have patients come in for a consultation in hopes of having a tummy tuck as a way to lose weight. The procedure is best for people that are at a stable weight and have excess skin and loose fatty tissue. It is not a replacement for the gym, but a way to get rid of tissue that will not likely go away with diet and exercise.

As weight loss surgeries such as gastric bypass and gastric sleeves have become more commonplace, the number of abdominoplasties has increased dramatically. Skin that has been “overstretched” will lose its ability to contract. Following childbirth, some women have an amazing recovery of their skin, while others are left with stretch marks and saggy skin. Much of this is due to genetics.

The standard abdominoplasty removes the skin and fatty tissue from approximately the level of the navel down to the superior aspect of the pubic region. An incision is made in the bikini line extending from hip to hip. The tissue from the navel extending up to the rib cage and sternum is then elevated from the upper abdomen and stretched down to the pubic area to fill in the created defect. The belly button is left connected to the underlying abdominal wall, and a new hole is made in the skin where it is brought to the surface and sutured in place.

Often following significant weight loss or childbirth, the rectus muscles of the abdomen do not return to their original position and have a gap between them. This is termed a rectus diastasis. Sometimes, the muscles are sutured back together to act as somewhat of an “internal corset.” The decision as to whether this is necessary is usually made intra-operatively based on each patient’s current anatomy.

A “mini-abdominoplasty” is a procedure that removes less tissue and mainly addresses the area below the belly button. Instead of removing all the tissue from the belly button to the pubic area, about half of that tissue is removed. The belly button is often left attached and in its original position. This avoids a scar around the belly button. Sometimes the belly button is detached from the abdominal wall and re-sutured slightly lower to allow for the tissue to stretch more freely. Rectus plication can be performed during a “mini-abdominoplasty” as well.

In cases of massive weight loss, a more extensive procedure is often required. A “body lift,” also called a belt lipectomy, combines an abdominoplasty and a buttock lift. In essence, tissue in a “belt” distribution is removed circumferentially allowing for better contour of the abdomen, hips and buttocks.

Abdominal and flank liposuction can be performed in patients who have good skin elasticity and isolated areas of fat deposits that are out of proportion to the remainder of the body. Procedures such as Sculpsure and CoolSculpt are noninvasive techniques that can help to redefine your mid-section without surgery.

Recovery varies. For standard and mini-abdominoplasties, as well as liposuction, most patients go home the same day. Patients typically will need a few days to a few weeks off of work depending on the extent of the procedure. By 6-8 weeks, most patients are back to full activity.

Clearly, there are many options available for mid-section improvement. These range from non-invasive techniques to more aggressive surgical procedures. Consulting with an experienced health care provider will help you to decide which procedure, if any, is best for you. Remember, beauty is so much more than skin deep! If you want to learn more or schedule a consultation, contact us at 315-663-0112 or www.plasticsurgeryofsyracuse.com