An abdominoplasty may be performed in select cases with a smaller incision
Commonly called “Tummy Tuck,” the colloquial term makes it sound cute and rather trivial; an abdominoplasty is in fact in geographic if not anesthetic terms a sizeable procedure.
It is performed to rid the patient of excess skin over the abdomen. As such it is not performed while the patient is losing weight, nor after bariatric surgery until the weight has stabilised. It comes in degrees, the smallest changes are open to liposuction, the largest require excision of kilos of skin.
The so-called “mini” abdominoplasty is better called “partial.” A skin pencil is used to draw lines for correct closure later. The incision is across the abdomen, suprapubic or “bikini” where it will be least noticeable wearing minimal (beach) clothing. The subcutaneous tissues of the upper margin of the wound are separated from their attachment to the deep muscular fascia, an electro-cautery speeds the work by minimizing bleeding. Tension is applied to draw distally the margin of freed skin to determine the quantity to remove. The umbilicus is in general left attached to the underlying abdomen, on a “stalk.” The new position for the umbilicus is determined and an incision made for it to be drawn through. The excess skin is cut off and the wound firmly closed in layers.
The larger or “full” abdominoplasty calls for a wider incision, almost margin to margin of the iliac crests, swinging down to the pubis. Liposuction removes the fat at the sides, re-establishing a waist contour. With preservation of the umbilicus the skin flap is peeled back to the chest margin. The central abdominal rectus muscles and the expanded linea alba are exposed, correction of the separation of the abdominal muscles is completed by suturing the margins together.
It is not uncommon for other procedures to be carried out under the same anesthetic. Surgeon and patient need to be cautious in how many of the numerous procedures of the “Mummy Makeover” are performed at the same operative session.