Surgical Procedures

 
 
   

Tummy Tuck

 

"I dieted, jogged and did a million sit-ups but nothing I did could help me get my figure back."

 

 

Every woman wants a smooth, firm abdomen. But few have one.

 

Pregnancy, weight gain and weight loss and weight gain again take a toll on a women's shape.

 

Repeatedly stretched, many women's abdomens are oversized and out of shape.

 

Abdominoplasty is a surgical body contouring procedure that corrects abdominal contour problems caused by a combination of skin laxity, stretch marks, fatty collections and muscle disruption. It involves all external layers of the body wall- not just the external fat.

Pregnancy is the commonest factor causing these problems. The skin becomes thin and stretch marked. Fat deposits increase around the lower abdominal wall and the lower abdomen is more rounded. Hidden beneath this is a diastasis (disruption) of the rectus abdominis muscles- the "Abs". Once pregnant, there is no way of preventing this from happening, and no amount of dieting or exercise can correct it afterwards.

 

Many women are embarrassed and ashamed about this.

 

The best candidates for this procedure are women who are in pretty good shape but have large fat deposits or loose abdominal skin that won't respond to diet or exercise. The surgery is particularly effective for women who, after multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where they can return to normal. Women who are planning future pregnancies should wait, as the vertical muscles in the abdomen that are tightened during surgery will separate again during pregnancy.

If there is only lax skin and little if any external fat located below the navel, a less complex procedure called a mini-tummy tuck (or partial abdominoplasty) may be recommended. This is performed on an outpatient basis.

Often, to improve the final result, liposuction is performed in conjunction with an abdominoplasty to remove fat deposits from the hips. And sometimes liposuction alone creates the best result. You and Dr. Weiglein will consider all of the options and decide what's best.

Men are generally not candidates for abdominoplasty because their fat deposits are usually inside the body wall and therefore surgically out of reach. Men also don't experience the pregnancy related alterations to skin and body fat distribution. Men who would benefit from abdominoplasty are those who have lost significant amount of weight (75-100 plus lbs.) and who have lax abdominal skin as a result of this.

 

Depending on the severity of the problems, a mini, standard or extended abdominoplasty may be required.

 

Mini, Standard or Extended: How To Decide

 

Mini and "Midi" Abdominoplasty
A Mini Abdominoplasty corrects only skin laxity that is present below the belly button. It is done through a "Bikini" type incision. Recovery is very fast as there is no muscle repair involved. The "mini" is a good procedure for thin individuals with moderate to marked skin laxity without fat and no significant muscle disruption. The "mini" is done using a general anesthetic or sometimes sedation only. It is done as a day surgery procedure. A variation of the "mini" allows treatment of the area above the belly button. This is called the "midi" and involves releasing the belly button to allow skin and fat excess above the belly button to also be treated. There is no muscle repair with a ‘midi" or "mini". Dr. Weiglein will discuss the benefits of this variation. Because there is no muscle repair required, the recovery time is usually a matter of days.

 

Patient satisfaction is extremely high.

 

 

Standard Abdominoplasty
A Standard Abdominoplasty corrects skin and fat excess of the entire abdominal wall as well as correcting the underlying muscle disruption. The incision is a longer version of a "Bikini" type scar and may extend well past the hipbones. Because the entire body wall is treated there is also a circular scar around the belly button in order to allow it to be brought forward on the new abdominal skin.

Excess fat of the hip rolls and upper abdominal areas is usually treated with liposuction. By removing the sagging excess skin and fat, you'll immediately enjoy a flatter, firmer abdomen and a thinner waist.

A general anesthetic is used and the procedure takes about two and one-half hours. (See Tummy Tuck Anesthesia Update- Below). This is by far the commonest type of abdominoplasty carried out. It is now done on a day surgery basis. Recovery time is at least two weeks.

 

Patient satisfaction is extremely high.

 

Extended Abdominoplasty

The Extended Abdominoplasty involves larger incisions as well as possible vertical incisions in order to treat larger quantities of excess skin and fat. This operation is commonest following a very large weight loss were the patient is literally a small person trapped in a large envelope of skin. Depending on the magnitude of the surgery involved with the extended abdominoplasty this procedure may not carried out at the Centre. If, after a suitable consultation, we feel you would benefit from this procedure we will refer you to a Hospital based Plastic Surgeon if necessary. The procedure may be covered by OHIP.

 

Circumferential Abdominoplasty, Belt Lipectomy or Body Lift

A circumferential "Body Lift" removes excess skin, usually due to marked weight loss, not only from the abdomen but from the hips and lower back as well. It results in a circumferential scar. It has the benefit of tightening the entire trunk and lateral thigh and buttock regions as well. Body lifts can be involved and extensive procedures that require hospital care. For safety reasons we limit the size of procedures done at the Centre.

 

 

Tummy Tuck Anesthesia Update
For the past two years we have carried out abdominoplasty procedures with a general anesthetic on a day surgery basis.

 

And our patients love it!

 

This change has resulted in increased patient comfort and satisfaction. We believe that recovery time is shortened as well.

 

What are we doing that is so different?
The discomfort associated with an abdominoplasty is the result of repairing the separated abdominal muscles- not the skin incision. Typically this is treated with narcotic analgesics. This can be very effective for pain relief but nausea and vomiting are common side effects of these types of medications. To avoid these problems we now use the On-Q Pain Pump. This device uses two very small catheters placed directly at the site of the muscle repair to continuously irrigate the area with a dilute local anesthetic solution for at least 72 hours post operatively.  This means you are far more comfortable after the procedure with far less use of narcotics or injections. Thus there is far less chance of nausea and vomiting. You are able to breathe more deeply and cough without discomfort. This improves your lung function and speeds recovery.

 

Abdominoplasty can benefit you if:

Note: if you have any of the above issues then liposuction alone- no matter what technology is used- cannot produce an adequate result as the skin will not shrink nor will the muscle gap be corrected.

Abdominoplasty: How it's done

Dr. Weiglein has found that abdominoplasty is best done under general anaesthesia. The Centre only uses fully trained and experienced certified anesthetists. All of our procedures are done in our private accredited and inspected operating facilities.  It takes about two hours to perform. Once you are asleep the abdominal area is suitably marked. The abdomen and hip roll areas are then infiltrated with "Tumescent" fluid. This fluid contains dilute local anesthetic and adrenalin. It significantly reduces blood loss. If liposuction is required it is now carried out. Areas commonly liposuctioned are the hip rolls, upper abdominal areas and mons (pubic area). The volumes of extracted fat / blood are carefully recorded. The lower fatty collection (pubic hairline to above the belly button and extending to the lateral hips) is then surgically removed. The remaining abdominal wall is then undermined to just under the lower ribs.  This allows exposure and of the repair of the space (diastasis) between rectus muscles. Permanent sutures are used. The On-Q Pain Pump catheters are then threaded between the repaired muscles and a drain is also placed. These catheters are secured externally to prevent inadvertent removal.  The new belly button location is marked and the upper and lower skin edges are then closed using dissolving sutures under the skin. The belly button is then brought out and sutured in place. All areas are then carefully cleansed and dress and finally a Velcro binder is applied. 

After the procedure you will recover for approximately two hours in our recovery room. A responsible adult must take you home. You may shower the day after your operation. Medications are prescribed for post operative discomfort. The On-Q Pain Pump continuously bathes the muscle repair site with a dilute local anesthetic solution for 72 hours following your procedure. It can be refilled if required. Follow up appointments are pre scheduled to allow monitoring of your progress and answer any concerns you may have. Our nurses will manage your drains and the ON-Q pain pump. You will take your prescribed medications as directed and wear a binder for three weeks post operatively. The final visit is usually at 5-6 weeks post surgery or as long as necessary to ensure that all is well. You will need to take about ten to fourteen days off work and limit physical activity for about four weeks. It is another "Happy but Sore" procedure.

Questions about:

General anesthesia is required for the 2 hour procedure. If you are not healthy enough for an anesthetic we will not proceed. Anesthesia standards require that you are seen by an appropriate medical doctor prior to the procedure. All of our anesthetists are fully trained and certified.

 Bleeding can occur after any operation. If it happens it will occur in the first 24 hrs. It is important to stop taking any medication (aspirin!) or supplements ( green tea!) at least 10 days prior to any surgical procedure as many of these products act as blood thinners. Bleeding is very rare following our abdominoplasties. There is no expectation of having a blood transfusion.

Infection can occur after any operation. A surgically clean environment, careful surgical technique, healthy patients and suitable antibiotic coverage will minimize the risk of infection. Infection is very rare following our abdominoplasties.

Seromas or fluid collections can occur after an abdominoplasty. Fluid always accumulates following an abdominoplasty. It will continue to accumulate until the space between the skin and fat and the body wall has healed together. This is painless. Normally this fluid is removed by the drain that is placed during the procedure. Sometimes this fluid may re accumulate after the drains have been removed. If this occurs it can easily be drained during one or more office visits. Excessive activity failure to wear the supplied binder in the immediate post operative period will cause seroma formation.

Scars are a necessary part of any abdominoplasty. The more tissue that needs to be removed the longer the scar will be. As a rule of thumb the final scar length will be three times as long as the distance from the pubic hair line to above the "belly button". My experience is that no one cares about the scar as long as all of the skin and fat is removed. We work hard to give you the very best outcome.

Delayed wound healing may occur following an abdominoplasty. This usually involves the loss of a variable (usually small) amount of skin and fat along the incision just above the pubic area. This is caused by poor or inadequate blood supply. Smoking is the single biggest preventable factor associated with this problem. If it occurs then time and suitable dressings will allow the area to heal. It should not delay your return to normal activities. This can produce a poor scar that may require a small revisional procedure when fully healed.

Blood clots can form in the deep (not varicose) veins of the legs and pelvis during any operation. This is called a deep vein thrombosis (DVT). It occurs 72-96 hours after the operation when you are at home and may be asymptomatic. This is rare with abdominoplasties. These clots may grow and a portion may break off and travel to the lungs (Pulmonary Embolus). This is a potentially serious problem that may require emergency treatment and hospitalization. Fortunately, there are a number of ways to minimize this risk. At the Centre we use all known methods to decrease this unusual problem to its absolute minimum. We use TED stockings, Sequential Compression Devices, adequate hydration Intraoperative Warming and early mobilization. At home you will continue with the TEDS, movement and use a medication called Lovenox® (a platelet inhibitor) for 10 days after your procedure.

 

From Initial Phone call to Post Op Visits: How it Works

Your initial contact with the office will be with Trish, our Patient Coordinator. She will guide you through the process. You will then meet with Dr. Weiglein to determine the best solution to your particular problem. This initial meeting is designed to be an information and educational meeting. It is actually a time when you "audition" us and we "audition" you. With your input a recommendation will be made and all questions answered. We have numerous pre and post operative photos for you to see. There are always former patients available to speak with you about their experience. We welcome friends / husbands/ others to this meeting.

You will then meet with Josie again to discuss costs, scheduling and logistics. If you require more time to consider your options, or wish another appointment, we will arrange it. If you wish to finance the procedure we will assist you.

We encourage you to see us as a second opinion.

If you elect to proceed you will then meet with one of our nurses for your pre operative visit. She will review the procedure and expectations. Any necessary lab reports will be reviewed. Anesthesia standards require a pre operative physical from a family doctor.

We will provide you with full written post operative care instructions, your prescriptions, follow-up appointment dates, contact telephone numbers and instructions for care-givers at your pre operative appointment. No question will be unanswered.
Need more information?
Please contact us if you have questions. 

We are one of the leading cosmetic surgery practices in Canada so you can rely on our expertise to give you what you want.

Dr. Weiglein has done over 3,000 abdominoplasties.