Abdominoplasty Archives - McMahan, James (jmcmahanmd.com)

Tummy Tucks: An Option for Every Patient

abet — Thu, 04 Oct 2018 23:55:35 +0000

There are so many different types of tummy tucks now there is an option for vitually every patient. Thirty years ago there were only a couple of abdominoplasty choices; now the possibilities include standard, mini's, extended, circumferential, reverse, fleur-de-lis, combinations and more.

Most women who have had a number of children resulting in loose abdominal muscles and excess skin are candidates for a standard tummy tuck where excess skin is removed from just above the belly button and the rectus muscle is tightened in the midline from the breast bone to the pubic bone to help flatten the abdomen.

A mini-abdominoplasty generally involves some liposuction of the abdomen, removing excess skin from the lower abdomen and rightening jus tthe lower abdominal muscles from the umbilicus to the pubic bone. The scar is tupically shorter and lower than with a full tuck and less skin is removed. This procedure mostly improves just the lower abdominal contour.

As the name implies, a circumferential abdominoplasty, also known as a lower body lift, removes skin from the lower abdomen, flanks and lower back. The abdominal muscles are generally tightened as is done with a full lift, however considerable more skin is removed. This procedure is typically in patients who have lost a considerable amount of weight.

The fleur-de-lis tuck is also performed in patients who have had massive weight loss. This procedure combines a standard tuck with removing an inverted "V" of skin from the abdomen to tighten the trunk both vertically as well as horizontally. The downside to this procedure is the long midline abdominal scar.

A reverse tummy tuck removes skin from the upper abdomen; pulling the skin upwards instead of down. Muscle repair is not normally done with a reverse tuck and most of the incision is hidden in the breast inframmary creases. The procedure is often done in patients who have already had a standard tuck or mini-tuck but have residual excess upper abdominal skin. A modified version removes less skin and leaves two separated scars under the breasts without combining them.

Almost all of the above procedures can be combined with one abother in the right patients.

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Smoking is Not Allowed with a Tummy Tuck

abet — Thu, 18 Aug 2016 21:06:36 +0000

In the process of performing a tummy tuck, the skin and fat on the stomach is elevated off of the underlying abdominal muscles. During this portion of the surgery, arteries and veins which pass from the muscles to the skin are removed, which reduces the blood supply to the abdominal skin significantly. Enough blood is able to get to this skin to keep it alive through small blood vessels, which travel from the back and sides as long as these vessels have not been damaged during previous surgeries.

For some unknown reason, our blood vessels have a natural receptor for the nicotine molecule. When nicotine is inhaled, ingested or absorbed through the skin, the nicotine molecule attaches to the blood vessels which stimulates them to constrict or narrow in size. This results in less blood traveling to their intended area such as the abdominal skin.

Under normal circumstances, this reduction in blood supply goes unnoticed because there is adequate blood traveling from multiple sources to the skin so that some decrease in perfusion does not threaten the viability of the skin. During a tummy tuck, however, the combination of reduced blood supply from surgery and nicotine blood vessel constriction often is too severe to keep the skin alive. Large areas of skin will often die requiring subsequent surgeries to remove the dead skin and replace it with skin grafts resulting in severe scarring and deformity.

All forms of nicotine including cigarette smoke, nicotine gum, nicotine patches and secondary smoke must be strictly avoided for at least three to four weeks before a tummy tuck and for one month after surgery. This is also true for other cosmetic surgeries where skin has been undermined and pulled tight such as facelifts, breast reductions, breast lifts, arm lifts and thigh lifts.

Even inhaling secondary smoke will cause a high enough concentration of nicotine in the bloodstream to cause blood vessel constriction and loss of skin. So, in addition to avoiding the use of tobacco in any form, you can’t be around anyone else who is smoking for at least three to four weeks before and after a tummy tuck.

Although no forms of nicotine to help you reduce or quit smoking is allowed at or around the time of surgery, there are other prescription medications that help patients quit smoking that do not contain any nicotine and can be used at the time of the procedure. It is not clear how these medications work to reduce the urge to smoke and there are potential side effects of any drug. Some of our patients who have successfully used Chantix to quit say that it made cigarettes taste bad so that their desire to smoke was dramatically reduced making it much easier to not smoke.

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It is Not an ‘Outie’

abet — Thu, 12 Nov 2015 20:27:02 +0000

Hernias of the abdominal wall are very common, especially in women who have had several children or in anyone who has had a previous surgical procedure. Umbilical hernias are particularly common as there is an inherent weakness in that area which does not tolerate a lot of pressure, such as from a growing pregnant uterus.

A hernia is a defect in the muscle fascia, which is the tough, white fibrous layer surrounding our muscles. When a hernia bulges outward, internal organs are pushing through the opening; most commonly the omentum but the bowel often comes through as well.

Plastic surgeons also often find unexpected hernias while performing tummy tucks on patients who have had previous laparoscopic procedures, as many surgeons don’t repair or poorly repair the fascia during these surgeries.

The problem is that, if the organs get stuck (incarcerated) in the hernia defect, their blood supply can be cut off creating a surgical emergency. This is why it is best to have hernias fixed before this happens. Having a hernia repaired as an elective procedure is typically a much easier surgery on both the patient and the surgeon than having it done when it is incarcerated and emergent.

The majority of hernias can be fixed at the time of a tummy tuck. Dr. McMahan became board certified in General Surgery before his plastic surgery training and has repaired hundreds of hernias while performing tummy tucks.

This simultaneous hernia repair and tummy tuck can cut the cosmetic cost of the operating facility and anesthesia. For this to happen, it is necessary to obtain prior authorization from your insurance company. Fortunately, repairing an umbilical or ventral hernia generally has no effect on the pain of surgery or change the period of recovery.

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Medical Benefits from a Tummy Tuck

abet — Fri, 30 Jan 2015 18:01:36 +0000

The major benefits of having an abdominoplasty are cosmetic in nature. These include flattening of the stomach, removal of excess skin and fat, tightening of the abdominal muscles and elimination of many unsightly stretch marks.

In a recent study by Dr. McMahan, et. al., many patients who have urinary stress incontinence will get significant if not complete relief of their symptoms after a tummy tuck; even if it is just a mini-tuck. Unfortunately, insurance companies will not cover the costs for this potential medical benefit.

In addition, it is not unusual to find small hernias when the skin is lifted off of the muscle, which can be repaired at that time as long as your surgeon is experience with hernia repair. Dr. McMahan is a fully trained general surgeon as well as plastic surgeon and is very experienced with hernia repair.

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