Abdominoplasty Consultation

Abdominoplasty Consultation

We had an extensive discussion about abdominoplasty, commonly known as a tummy tuck. This procedure addresses excess skin and lax abdominal wall musculature that typically results from pregnancy, significant weight loss, or aging. Unlike liposuction, which primarily removes fat, abdominoplasty focuses on removing excess skin and tightening the underlying muscle layer.

Limited Liposuction Approach

Unlike thigh lift surgery where extensive liposuction precedes skin excision, abdominoplasty requires a much more conservative approach to fat removal because I would not want to compromise the vasculature of the abdominal wall.

My technique involves:

1. Tumescent infiltration across the treatment area using a solution containing saline, epinephrine (to minimize bleeding), and local anesthetic. This enhances patient safety, reduces blood loss, and facilitates the subsequent dissection
2. Selective lateral liposuction as needed on the sides of the abdomen region, using power-assisted liposuction (PAL) with its mechanically oscillating cannula for precise, controlled fat removal with minimal trauma

Aggressive liposuction of the abdomen itself would compromise the vascularity of the overlying skin. I do not use ultrasound-assisted (UAL), laser-assisted (LAL), or cryolipolysis-assisted (CAL) techniques due to concerns about thermal injury to the overlying skin from the heat or cold generated by these devices.

Full Abdominoplasty

A full abdominoplasty involves a horizontal incision typically extending from hip to hip, positioned low enough to be concealed beneath most underwear and swimwear. I outlined the incision pattern on the anatomical diagram. The dissection extends upward to the costal margins (lower ribs), which necessitates relocating the umbilicus to its natural-appearing position on the tightened abdominal wall. The umbilicus remains attached to its blood supply throughout the procedure and is brought out through a new opening created in the repositioned skin.

A critical component of full abdominoplasty is plication (tightening) of the rectus abdominis muscles, which often separate during pregnancy or with weight gain — a condition called diastasis recti. I repair this muscular separation with permanent sutures from the xiphoid process (lower breastbone) down to the pubic bone, recreating a firm, flat abdominal wall. After muscle repair with individual sutures, excess skin and fat are removed, and the remaining skin is re-draped and sutured into position. Sometimes there is additional skin laterally, which needs to be excised, extending the length of that incisions onto the hips.

Drains are placed beneath the skin to prevent fluid accumulation during the initial healing phase. These typically remain in place for one to two weeks. Some surgeons use internal sutures to avoid the drains. However, at times these sutures fail, and fluid accumulates, which can result in infection. In addition, the sutures do not allow complete removal of all loose skin. Compression garments should be worn for comfort only, typically for six weeks to minimize swelling and support the healing tissues. Most patients require a couple of weeks off from work, with longer recovery needed for physically demanding occupations. Full activity, including vigorous exercise, is typically resumed at six to eight weeks.

Mini-Abdominoplasty

A mini abdominoplasty is appropriate for patients with excess skin and muscle laxity limited to the lower abdomen below the umbilicus. The incision is similar but usually shorter than a full abdominoplasty. Dissection extends only to the umbilicus rather than to the costal margins, and the umbilicus is not relocated. Muscle plication is performed only in the lower abdominal region below the umbilicus. Less skin is excised compared to a full abdominoplasty.

A drain is still typically placed, and compression garments are worn for approximately two weeks. Recovery is somewhat faster, with most patients requiring two to three weeks off from work.

Important Technical Considerations

I want to emphasize certain techniques that I specifically avoid because they compromise aesthetic outcomes or patient safety:

Umbilical Preservation: Some surgeons advocate removing the umbilicus entirely to facilitate more aggressive rectus muscle plication or to avoid the technical challenge of umbilical translocation. I find this approach unacceptable. Removing the umbilicus creates an unnatural appearance that is immediately recognizable as surgical and cannot be corrected later. This is analogous to removing the nasal tip to improve breathing during rhinoplasty — it sacrifices form for a questionable functional benefit. Proper surgical technique allows for excellent muscle repair while preserving the umbilicus.

Incision Pattern: Traditional abdominoplasty uses a horizontal incision. Some techniques, such as the Fleur-de-Lis pattern, add a vertical midline incision to address severe lateral skin laxity. While this may remove more skin, it creates a visible vertical scar on the central abdomen that is often conspicuous and problematic. In my experience, proper undermining, strategic liposuction, and tension distribution along the horizontal closure can address lateral laxity without resorting to vertical scarring. The aesthetic trade-off of a central vertical scar is rarely justified.

Setting Realistic Expectations

Abdominoplasty creates a permanent improvement in abdominal contour, but maintaining results requires stable weight and healthy lifestyle habits. Subsequent pregnancy will compromise the results and is not recommended after abdominoplasty. Significant weight fluctuations can also alter outcomes.

The procedure leaves a permanent scar, which I position as low as possible and design to be concealed by most clothing. While scars fade significantly over 12-18 months, they never disappear entirely. Scar quality varies based on individual healing characteristics, tension on the closure, and adherence to post-operative instructions.

Potential Complications

As with any major surgical procedure, abdominoplasty carries risks that include:

• Seroma or hematoma formation requiring drainage
• Wound healing complications, including wound separation or delayed healing
• Infection
• Unfavorable scarring, including widened, raised, or thickened scars
• Asymmetry or contour irregularities
• Changes in skin sensation, which may be temporary or permanent
• Umbilical complications including poor blood supply or unsatisfactory appearance
• Blood clots (deep vein thrombosis) or pulmonary embolism
• Need for revision surgery

I take multiple precautions to minimize these risks, including meticulous surgical technique, appropriate patient selection, prophylaxis against blood clots, and careful post-operative monitoring. Following all pre-operative and post-operative instructions significantly reduces complication rates and optimizes results.

Making the Decision

Abdominoplasty is a significant decision. We discussed your specific concerns, anatomy, and goals. Please take time to consider all the information we reviewed, and please contact me with any questions that arise. My goal is to help you make an informed decision and, if you proceed, to achieve a result that addresses your concerns and meets your aesthetic goals safely and effectively.

 

Michael H. Freedland, M.D.

MHF / EUH.PPU

D: 10/21/2025

T: 10/21/2025