Tummy Tuck

Plastic surgery after major weight loss.

Scottsdale – After major weight loss many people experience notable skin excess in almost all the areas of the body. For many, the anterior abdominal wall becomes a priority. For most, a comprehensive circumferential body contouring procedure, such as, a body lift offers the best overall improvement. However, many patients believe the bodylift is too aggressive or they do not want an incision that goes all the way around their body for other reasons. Those patients may present themselves requesting a traditional tummy tuck. Unfortunately, the standard tummy tuck does not address all the excess skin that is usually present after major weight loss.

A Modified Vertical Abdominoplasty, on the other hand, has been shown to compensate for most of the excess skin and can help patients achieve a better result. Other options might include an extended tummy tuck (will be covered in a forthcoming issue of the blog).  While for others the only option may still be the bodylift.  An exam by a plastic surgeon will be necessary to see which procedure might ultimately be better for you.

The modified vertical abdominoplasty has been around for a long time. It was, however, seldom used until the popularity of weight loss surgery exploded a few years back. An article published in Plastic and Reconstructive Surgery,  presents a significant experience using this technique out of Harvard Medical School. The authors present a 2 year experience, in 64 consecutive patients and noted the outcome and complications. The average patient in the series was 44 years old, had lost 59 kilograms, and had surgery done 22 months after bariatric surgery. Some of the patients had hernia repair performed at the same time as modified vertical abdominoplasty. Seven other patients had brachioplasty (arm tuck) or breast surgery.

The procedure involves creating a horizontal abdominoplasty excision combined with vertical triangular excision of the tissues above the belly button. It is an ideal design for patients that already have an open bariatric surgery scar. The design of the skin excision compensates better than the traditional tummy tuck for the amount of excess skin seen in major weight loss patients.  Final closure of the incision leaves an upside-down T design on the abdomen.

The results of the study demonstrate that the procedure can be carried out efficiently, with an average time of 2.5 hours by itself and 3.6 hours with hernia repair. The weight of the tissue removed, on average, was 3.8 kilograms. The most common complication was wound breakdown at the T junction, experienced in 17 patients, seroma formation (trapped fluid) in 3 patients, hernia recurrence, and minor wound separation.

Importantly, the authors only identify one potential risk factor for wound healing complications at the T junction- and that was a Body Mass Index (BMI) of 35 and above. In fact, they no longer offer the procedure to patients with a BMI greater than 35, instead they encourage those patients to loose weight until they can have surgery. Abdominal scars, diabetes and smoking were not independent risk factors for wound healing complications.

Patients should realize that Modified Vertical Abdominoplasty is an option after weight loss surgery that “partially compensates” for all the excess skin. Bodylift is still considered the best operation. However, the MV Abdominoplasty may be associated with less risk than body lift. Wound healing complications at the T junction are common as this article shows, but most wounds healed efficiently with treatment. The authors of the article stated that all wounds healed by an average of 4 months. This is not unusual since bariatric patients suffer from profound malnutrition and it takes a long time for most wounds to heal completely (model used in illustration).