ABC News in San Francisco reports that an ob-gyn and a plastic surgeon have teamed up to perform a pelvic sling procedure to correct bladder issues that arise after pregnancy and a tummy tuck to remove excess skin and fat from the abdomen and tighten the abdominal muscles.

ABC interviewed one mom who said her two pregnancies took an embarrassing toll on her body. “Every day you have to wear these thick pads so that you stay dry. Going down the steps, picking up your child from the car seat, a little bit of exertion you get wet,” she explained.

Rather than having her bladder issue fixed with conventional surgery, she decided on the combination procedure. “I know I’ll never be the same as before I had the children, but I think it will be spirit lifting,” she said.

Dr. Carolyn Chang, who has performed tummy tucks after the pelvic sling procedure at California Pacific Medical Center in San Francisco, said, “I like to call this the ultimate mommy makeover.”

The bladder procedure takes about a half hour, after which Dr. Chang performs the abdominoplasty.

Risks & Benefits

There are always risks to surgery, and one of the downsides of combining procedures is a longer time in the operating room and a potentially more complicated recovery if there are problems with either surgery.

However, there are some possible benefits to combining the procedures. The costs could be lower, because while the tummy tuck isn’t covered by insurance, some shared expenses — such as anesthesia and the recovery room — may be. Another possible advantage is that the patient will have a single recovery time for the two procedures.

Psychologically it could make going under the knife easier as well. “You’re doing a surgery that you want with a surgery that you medically need and that makes having surgery in general much more palatable,” said Dr. Chang.

Dr. Lu-Jean Feng, the study’s author and a microvascular plastic and reconstructive surgeon, looked at the charts of patients who underwent an abdominoplasty over a ten year period. The treatment group was made up of 77 patients who received the numbing solution, which blocks pain impulses between the abdomen and brain, and the control group included 20 patients who did not receive nerve blocks.

A comparison between the two groups revealed that the treatment group:

• Had significantly less pain following surgery
• Required significantly less pain medication during recovery
• Spent less time in the recovery room

Using recovery room data and patient questionnaires, the study also found that the those who received nerve blocks had significantly less pain at home after surgery and were able to  resume normal activities, such as driving, significantly faster than the control group.

“Today prospective patients are not only looking at the aesthetic quality of results of an elective surgical procedure,” said Dr. Feng. “They are also looking at ease of recovery and shorter downtimes.”  Dr. Feng presented her study at Plastic Surgery 2010, the American Society of Plastic Surgeons’ annual scientific meeting that was held October 1-5 in Toronto.

The study may also lead doctors to look at using the technique for other cosmetic surgical procedures, such as breast augmentation. Another possible use would be for patients getting a combination of procedures at one time.

Learn more by reading the study’s abstract: “Painless Abdominoplasty: The Efficacy of Combined Intercostal and Pararectus Blocks in Reducing Post-Op Pain and Recovery.”

 

A tummy tuck or abdominoplasty is a procedure for patients that have loose skin, stretch marks and loose abdominal muscles.   This may be due previous pregnancies, weight loss and aging.  A full abdominoplasty involves a long incision, removal of excess skin and fat, tightening of abdominal muscles and re-implantation of belly button in new skin.  This is fairly extensive procedure and requires a 3-6 week recovery.  The closer the patient to their ideal body weight the easier it is to accomplish the desired look and the easier the recovery.

The modified tummy tuck or the mini-tuck is not quite as extensive as the full tummy tuck.  It involves a shorter incision, less skin removal, some liposuction, muscle tightening in the lower abdomen only (below the belly button), with or without transposition of the belly button.  This is more suitable for patients who have laxity of skin and muscle mostly in the lower abdomen and a fairly tight upper abdomen.

For patients that tend to store most of their fat in the abdomen and excess bulk with some skin laxity is the main problem, liposuction with a dermolipectomy (excess skin removal) is the treatment of choice.  This frequently occurs in women after multiple births with weight gain and sagging skin.  The liposuction is performed with the standard tumescent technique of liposuction in the entire abdomen and waist region and then some of the loose skin between the belly button to pubic area is removed.  This usually results in a smaller scar and a faster recovery. 

 It is generally not recommended to combine a full tummy tuck and extensive liposuction.  This may result in a higher rate of complications and even longer recovery.  Therefore, patients that require both procedures extensively, may choose to have liposuction first then followed by a tummy tuck 6-12 months later.  In a small number of cases it is possible to perform the tummy tuck, followed by a touch up liposuction session.

Patients that have retained fairly good skin elasticity and have minimal skin laxity with some excess fat may achieve their goal of a flatter stomach with liposuction only.  Liposuction removes the excess fat cells but not the overlying skin, but it does stimulate skin contraction over time.  Even in older patients it is quite surprising how well the skin will contract.

Liposuction surgery is mainly considered a contouring procedure and is not a method of weight reduction.  It can be useful, as an adjunct to diet and physical conditioning in the management of contour problems.  The success of liposuction depends on patient’s post op weight management and care as well as his/her skin elasticity.

To find out which option is suitable for you, please schedule a personal consultation with myself 1-800-6-COSMETIC, 909-987-0899.   oYou can view our photogallery of Tummy Tucks at http://www.inlandcosmetic.com/before-after-photos/Body-Contouring/Tummy-Tuck/. 

Sincerely–

Dr. Haiavy

Today, I want to talk about the mini abdominoplasty (often referred to as the “scarless tummy tuck” or the mini tummy tuck).

Mini abdominoplasty

The mini abdominoplasty is a variation on the traditional abdominoplasty, suitable for those who have excess fat and/or loose skin only below the navel. Mini abdominoplasty calls for a smaller horizontal incision than the traditional full abdominoplasty, and it’s made near the top of the pubic hair line, enabling you to wear two piece bathing suits and other types of clothing that reveal the mid-body. Excess skin and fat are removed and slightly loosened muscles tightened. Then the skin is pulled downward and sculpted into place. Sometimes the procedure is combined with liposuction to remove excess fatty tissue.

7 possible indicators for a mini-tummy tuck

1. You are within 10% of the ideal weight for your age and height and have good skin elasticity and tone.

2. You have only a small amount of excess fat and loose skin and it’s localized below the navel line (lower abdomen).

3. You are not planning to get pregnant again.

4. You don’t have significant stretch marks that extend over your entire belly & abdomen. Stretch marks are not addressed by a mini-abdominoplasty. However, a full tummy tuck may be able to hide stretch marks.

5. You have a firm upper abdomen with no separation of the muscles, but have some weakness or protrusion between your navel and the top of the pubic mound.

6. Subcutaneous fat (fat that is situated just under the skin) is limited above and below the belly.

7. You have a disciplined diet and exercise regimen. You’ll want to avoid future weight gain to maintain your new shape.

• Read more about the mini-tummy tuck at Inland Cosmetic Surgery