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Abdominoplasty (Tummy Tuck) At the Chicagoland Center for Cosmetic Surgery, we perform abdominoplasty alone, abdominoplasty with liposuction, abdominoplasty with liposculpting and abdominoplasty with fat transfer (to the face, cheeks, buttock, breasts, lips, etc.). We may also perform abdominoplasty with other surgeries such as sterilization procedures (tubal ligation), hysterectomies, hernia repairs, breast augmentation, etc. The abdominal wall consists of the skin, fat, muscle and a fibrous fascia. The fascia (not muscle) is the internal girdle (foundation) of the abdomen wall which is responsible for tightness of the abdomen. During pregnancy (or abdominal obesity), extra skin must be made to cover the extra volume of the baby (or fat). In addition, the body's internal girdle (fascia) is permanetly streched and loosened by pregnancy and abdominal obesity. No amount of diet, exercise or liposuction can remove extra (flabby) skin or restore tightness to the abdomen. Only a tummy tuck can do this. Abdominoplasty removes excess skin and fat. Liposuction only removes fat. However, the most important portion of the abdominoplasty is how it tightens the abdomen like a girdle. In the before (4A) picture, this patient is NOT fat. Instead, the patient shown before surgery has very loose fascia (internal girdle) which needs to be tightened with a tummy btuck. In the after picture (4B) below, the fascia is tightened (tummy tuck) so asa to give a more natural hour-glass shape. Pregnancy streches and distorts the abdominal wall permanently! In the cases shown here, pregnancy: 1) Overstreched the abdominal wall, resulting in loose skin, excess fat and loose fascia (foundation). 2) Distorted the abdomen. Notice how the umbilicus is no longer midline, but moved to the patient's right. 3) The patient has a small panus (overhang of fat) because her fascia is loose. 4) This patient's "love handles" are not excess fat, they are the result of loose fascia (foundation) which is bulging at the sides. As may be seen, this patient is actually in excellent aerobic fitness. In fact, she has very little body fat and her abdominal muscles are strong from all the abdominal crunches she does. However her muscles are not midline, assymetric and are resting in a loose fascia (foundation). No amount of exercise or liposuction can restore the post-partum abdomen to its original tightness Abdominoplasty Tightens the Abdomen
During this patient's abdominoplasty, all the excess skin and fat from the umbilicus and below was removed. The umbilicus is moved higher and realligned to the midline. Most importantly, the patient's fascia is tightened (imbricated) several times. In her case,her fascia was imbricated twice horizontally, and twice vertically. This reduced her waistline by about 3 inches, and gave her abdomen a "tight" look. Her rectus abdominus muscles were then sutured to each other in the midline. The drains are kept in for 3-7 days. This patient elected to also have liposuction of the flanks and upper abdomen during this procedure. Liposuction is a contouring procedure which may be performed before, during or after abdominoplasty. Patients are usually sent home the same day. Short stays at a local hospital or hotel are available, but most patients prefer to be sent home with their families or home nursing. Home nursing is available for all our patients. Out-of-town patients receive home nursing and free transportation service to a local hotel or hospital.
Abdominoplasty May Relieve Back Pain  Excess abdominal fat is more dangerous than fat of the thighs because it puts additional strain on the heart, lumbar spine, abdominal organs, etc. This fat may cause shortness of breath, heartburn and will increase cardiac load. This patient has chronic neck and back pain. She is not a candidate for back surgery and has been optimized on a variety of pain relief programs. She has lost a lot of weight on her own, but her lack of mobility makes it hard for her to exercise. She is a candidate for gastric bypass or stapling, but is scared of the complications. She has a moderate sized abdominal (incisional) hernia which also gives her problems. In this case, abdominoplasty with repair of her hernia was performed so as to reduce the strain on her back and increase her mobility.  In our view, abdominoplasty is not merely a cosmetic procedure but a procedure that restores the original architecture of the abdominal wall. In so doing, it reduces the strain on the back, reduces the cardiac load, reduces abdominal pressure (thereby reducing heartburn) and improves the exercise tolerance of these patients. Removal of excess weight also reduces the weight on the hips and knees. It takes about 1 week to remove the drain and about 1-2 weeks before the patient can be fully erect. In figure 4B, one week after surgery, the patient is still not able to stand straight because of excessive tension on the skin. But, in another week, enough new skin will be made, which will allow this patient to stand fully erect. At about 2-3 weeks, the patient may return to non physical work (housework, office work, swimming, sit-down work, power walking, aerobics). More strenuous work, involving professional dancing, crawling, blue collar work, heavy lifting, may need to wait 3-4 weeks after surgery. Fellow of the American Academy of Cosmetic Surgeons |
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