Women often come to me for a consult and ask “What can you do about my stomach”. In short it depends on what the patient looks like.
I recommend this procedure for women who have excess lower abdominal tissue typically seen after child birth. I do recommend that these woman are done having children. There is no sense in having elective surgery if you are planning on having more children as the results will change post pregnancy. The patient should be in good health and at their optimal body weight. If you are planning to lose weight you should hold off on any elective cosmetic surgery. As you lose weight the skin may not contract as you would like it and this will leave you with lose or “flabby” skin.
The procedure takes about 2 hours. A horizontal incision is made across the lower abdomen, just above the pubic hair. The incision may be hip to hip depending on how much skin needs to be removed. I then dissect down through the fat to the anterior abdominal fascia. Dissection continues at this level up to the umbilicus otherwise known as the belly button. At this time I cut around the belly button preserving it so that I can continue the dissection up to the xiphoid in the middle and the rib cages on either side. By mobilizing this tissue I am able to pull the excess tissue down as far as it will go. After the dissection is complete I will then assess the anterior abdominal wall muscle. Most muscle will be separated in patients who have been heavy at one time or who have had children. I will then put multiple sutures to bring the two recti muscles closer. This maneuver will give a flatter appearance to the abdomen. The patient is then sat up to ensure that I will be cutting away as much tissue as possible. The excess skin is then removed and the wounds are closed. A new incision will have to be made to allow the belly button to pop through the skin that was mobilized downward. I try to make this incision in a v shape as this will allow superior hooding of the skin and give a more natural appearance to the new belly button. It is also important to try to get the scar round the new belly button to be hidden inside as any outside scars will be more evident.
I usually place drains to allow the extra fluid under the skin to be discarded. The drains are removed after a week or so. I will ask the patient to measure he drainage and when it is below 30cc/24 hours I will then remove it. I will place the patient in a loose binder to help avoid tape on the skin. It is imperative that the binder not be too tight. If a binder is too tight it can decrease blood supply to the wounds and cause delayed wound healing. Other factors that affect wound healing include smoking and diabetes. I ask the patients to refrain from working out for 6 weeks after the surgery as this will increase chance of fluid under the skin flap called a seroma. If a seroma does occur small needles are inserted to aspirate them and remove them which is usually done in the office. Normally this is not painful as he skin will be numb from the surgery performed in that area.
Patients are pleased wit their results as the extra tissue and stretch marks are removed from the lower abdomen giving a flatter and more toned look.
Sharon T McLaughlin MD is a board certofoed plastic surgeon in Syosset, NY. You can learn more about her practice at www.syossetplasticsurgery.com
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