Belly Up to the Operating Room Table

I don’t know about you but sometimes I feel like the Michelin Man – a big ol’ tire around my midsection.  Fortunately (or unfortunately!) I know what to do about it – feel the pain of hunger and exercise. And that should always be everyone’s first remedy.  There are, however, some situations where diet and exercise are futile.

First, multiple pregnancies and/or large swings in weight (“yo-yo” dieting) can lead to loose skin that can form an abdominal apron.  This condition may be cured with a “mini” tummy tuck. This removes the apron of fat and skin and leaves a scar in the bikini line. Because it is a “mini”, surgery time is only two hours.  Recovery time is only a few days and the cost is about half the cost of a full tummy tuck. For large “aprons”, drains may be needed for up to two weeks.

Often the abdominal wall has stretched out from childbearing or obesity, resulting in a “pseudo” hernia.  To create a “washboard” abdomen, a full tummy tuck is required. This requires the suturing of the cover of the abdominal muscles (called fascia) like a corset.  All the skin and fat are lifted off the fascia from the pubic area to below the ribs, cutting around the belly button which is left attached to the abdominal wall.  This tissue is then stretched down and all of the excess is trimmed away. Usually all the skin with stretch marks from the pubis to the belly button can be removed. Therefore, the skin that used to be near the belly button is now sutured to the pubic and hip areas with a bikini line scar.  A new hole is made in the skin and subcutaneous tissue for the belly button to pop through. I use pain pumps to numb the deep nerves for four to five days. Two drains are needed for up to a month, occasionally longer. This procedure is up to six hours long and requires a three week recovery.  This procedure should be performed in patients who are within 10 to 20lb of their ideal weight and committed to no further pregnancies or major weight gains. This procedure is becoming more commonplace in gastric bypass patients, many of whom have lost 150 to 200lb.

One last category of patients I want to discuss – those with a hereditary mal-distribution of fat. These people are usually close to their ideal weight but always carry several excess inches of fat in their abdomen and flanks.  Their skin tone is good with minimal laxity. These lucky folks can just get liposuction. A much quicker and easier procedure, liposuction of the abdomen and flanks takes less than 2 hours under general anesthesia. I use the tumescent technique for less pain and less blood loss. This involves pumping up the fat with fluid containing Lidocaine (for numbing) and epinephrine (to constrict the blood vessels).  I suction until I pinch less than ½ inch of fat. The tiny quarter inch incisions are mostly hidden in the belly button and pubic hair. Post operatively, patients look and feel bruised but are ready to go to the mall in two to three days. I recommend a girdle like abdominal binder for six weeks to get the best result.

The million dollar question is “will insurance pay for my tummy tuck?”  The answer is “yes and no”. Yes, if you have a heavy hanging apron of abdominal tissue that causes rashes, limits walking and causes back pain.  Insurance may pay for ONLY the removal of the apron.  Unfortunately, this often results in a dissatisfied patient.  The complete tummy tuck and liposuction are not covered by insurance.

Yes, a tummy tuck is a significant investment in your time and money, but nothing beats a great set of abs.

From my H-ART,

Yale M. Kadesky, M.D.

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