A common request at our Center comes from patients who seek help with bulging tummies. It was only a few years ago that our approach to these patients was limited to one operation -- a tummy tuck. While tummy tuck, or abdominoplasty, is still a common operation, we have many options to choose from. We will consider some of them here.
"TOO MUCH FAT IN THE TUMMY. I WORK OUT ALL THE TIME AND HAVE GOOD MUSCLE CONTROL. I'VE LOST AS MUCH WEIGHT AS I CAN, AND IF I LOOSE MORE, MY BREASTS AND REAR BEGIN TO SAG."
It seems like only yesterday that we first began practicing liposuction.
Actually it has been almost 15 years since it was first introduced. Now that the technique has been refined, it has become perhaps the most common procedure performed at our Center. Liposuction is ideal for fat removal when skin and muscle are firm. Even if there is some laxity, it may be the best choice. Most women fell into that category, but many men with bulging abdomens have excess fat that is deep to the muscle and surrounding the intestine. This type of fat is too deep to remove with liposuction.
Sometimes the choice for liposuction is a compromise. Patients may have to accept the fact that there will still be some loose skin or muscle bulge. We sometimes tell patients that liposuction will make them look good in a one piece bathing suit, but not necessarily in a bikini.
Example 1 shows an example of a patient who at first glance
might not be considered an ideal candidate for liposuction. In
fact, we initially recommended a tummy tuck, but she felt it
was more surgery than she was prepared for. The result shows
that her decision was certainly a reasonable one.
"I HAVE A TUMMY BULGE THAT JUST WON'T GO AWAY. I'M AT MY IDEAL WEIGHT AND THE REST OF MY FIGURE IS OK. SINCE MY LAST CHILD, I JUST CAN'T SEEM TO HOLD IN MY STOMACH.
When bulging stomach muscle are a primary problem, the new endoscopic abdominoplasty offers an excellent opportunity for correction without the wide incisions that are required for the full tummy tuck procedure. The incision is entirely in the belly button and all the work is done endoscopically through that incision. While there is more post operative discomfort than from liposuction alone, must patients are back to reasonable activity within a few days. A drain tube is required for several days, but it is attached to a small rubber bulb that is easily hidden.
Example 2 shows a patient following and endoscopic abdominoplasty with limited liposuction surgery.
One problem: some patients continue to drain for much longer periods. The reason is still unknown and subject to current study, but may be related to the amount of liposuction that is combined with the procedure. Currently, we are limiting the amount of liposuction done with the endoscopic abdominoplasty and going back later for some additional touch up. this seems to be working better.
"MY WHOLE TUMMY IS SAGGING. I KNOW I'M OVERWEIGHT, BUT EVEN IF I LOOSE ANOTHER 15 POUNDS, IT HARDLY MAKES A DIFFERENCE. I CAN'T FIND CLOTHES THAT FIT AND I ALWAYS FEEL UNCOMFORTABLE. MY BACK ACHES AND I HAVE A CONSTANT RASH UNDER THE TOP OF MY PANTIES. WHAT CAN I DO?"
With all the progress we have made in the development of conservative alternatives to abdominoplasty, the classic tummy tuck remains a popular operation. No other procedure allows correction of all aspects of the bulging stomach: skin, muscle and fat. Granted it is a major procedure, it still lends itself to outpatient surgery in most cases, and while full recovery takes several weeks, most patients are back to normal light activity within a week or so. Not only are the results impressive, they are generally long lasting as shown in example 3. This patient is seen before tummy tuck and five years after.
This patient had a full, or classic abdominoplasty. In some cases, the operation can be modified allowing for less extensive surgery with shorter incisions and quicker recovery.
The above examples show some of the choices that are available for patients in need of abdominal contouring. Of course, every patient is different, and only a personal consultation will give you all the answers you are seeking.
We hope that this will at least serve as a valuable introduction.
Table of Contents / Next Chapter
Updated April 2009
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