Tummy Tuck Germany
The tummy tuck, or abdominal wall tightening, is also known as abdominal plastic surgery, abdominal wall plastic surgery or, medically, as abdominoplasty. The following types can be differentiated:
- Classical tummy tuck = abdominoplasty with mobilization to the costal arch (lower rib cage) and repositioning of the navel.
- Mini tummy tuck = mini abdominoplasty with mobilization only to a little above the navel, which is not repositioned.
- Inverted T-incision = large abdominoplasty with an additional vertical incision line. This incision is required in cases of massive skin excess.
- Upper tummy tuck with the incision in the area of the inframammary fold. This surgery is seldom performed because of problematic scar tissue build up.
- The circular incision line is used if there is also an excess of skin in the area of the lower back, or if a buttock lift must also be performed.
- Combinations of tummy tuck with liposuction are often offered. It may be desired that the hip pads match the abdomen, or for the abdominal fat to be somewhat thinned out.
- When women lose weight, the breasts usually sag as well, so in this case a tummy tuck can be done simultaneously with a breast lift.
The main reasons for getting a tummy tuck (abdominal wall tightening procedure) are changes as a result of pregnancies (often multiple pregnancies) and massive weight loss after being severely overweight (obesity = adiposity, or the extreme form = morbid obesity).
On the one hand, the abdominal skin can be massively stretched. On the other, the abdominal wall, which is composed of abdominal musculature and firm fibrous tissue, is often also enlarged. Even in slender women, the latter can lead to a small, round belly. A simple tummy tuck at the skin level would not suffice. Interior tightening of the abdominal wall is important as well.
A severe separation of the abdominal musculature in the midline, called diastasis recti, can be corrected with an abdominoplasty at the muscle level (see below: inner corset).
Excessive weight loss, which in principle involves similar changes, is often given as the indication for a tummy tuck, in which an enormous excess of skin and fat (panniculus) takes center stage.
Smoking must be stopped for 2 weeks before a tummy tuck to minimize the risk of disturbance to wound healing. After wound healing is complete, the danger is no longer present. About 2 hours need to be allowed for the surgery. It is performed under general anesthesia. The incision is dependent on the amount of the tissue to be reduced. Depending on the extent of the tummy tuck, a hospital stay of 1-2 days is recommended, or even longer if removal of excessive tissue is anticipated.
The basic principle of the tummy tuck consists of the removal of excess skin and fat tissue. This is accomplished by means of an incision that runs over the mons pubis and then laterally upward in the direction of the iliac wings. The line can be adjusted for bikini or panties. To mobilize as much skin as possible, the fat tissue must be detached from the abdominal wall - all the way to the lower margin of the breast bone, in fact. Only in this manner can the tummy tuck be extended to the upper abdominal area.
The navel is excised and sutured into its new location. Of course, one tries to produce as little scar tissue as possible and to avoid vertical scars in the midline from the mons pubis to the navel as far as possible.
However, there are conditions that necessitate a tummy tuck using the additional midline scar:
- Small tummy tuck: Sometimes it is not possible to remove enough skin to hide the previous naval position using the transverse scar. The defect is then closed with a small vertical seam.
- Large tummy tuck: Here the excess skin is so large, that skin must be removed in the vertical direction as well, resulting in a midline vertical scar. The pattern resembles a lily, hence this technique is called "fleur-de-lis."
To conserve tissue when a large amount of fat deposits are involved, it is preferable to remove the fat apron (see below) by means of a classical abdominoplasty.
Picture above: flabby abdomen after pregnancy.
In the following 4 pictures, the areas to be removed by the tummy tuck are highlighted. The white line represents the course of the resultant scar.
1. Mini tummy tuck (also mini abdominoplasty)
2. Classical tummy tuck
3. Small "fleur-de-lis" tummy tuck
4. Large "fleur-de-lis" tummy tuck
When a tummy tuck is performed, it should be kept in mind that over-stretching the tissues can affect the abdominal wall and abdominal muscles. If the two large vertical abdominal muscles (m. rectus abdominis) separate from each other, in addition to simple slackening of the abdominal skin, a so-called diastasis recti develops. One can solve such challenges that arise during a tummy tuck through the use of a so-called "inner corset." Inner tightening is possible using a particular suture technique in which the firm muscle sheaths, not the muscles themselves, are sutured. With this technique one achieves tightening in the horizontal as well as vertical direction.
The navel is repositioned.
In the classical tummy tuck / abdominoplasty, the navel is repositioned. The described techniques for re-implanting the navel are as numerous as grains of sand on the beach. The goal of all the techniques is that the new navel look as natural as possible. To that end, though, only a few methods are suitable.
The skillful formation of the navel is an important part of the tummy tuck, because it cannot be hidden by a bikini or bathing trunks. Effectively, a funnel is formed in the abdominal wall and the scar is, to a large extent, hidden within it.
What is the "champagne groove?"
In colloquial speech, a deepening between the vertical abdominal muscles is known as a "champagne groove" in Germany. Some people find it especially attractive. If desired by the patient, it is possible to form this during a tummy tuck procedure.
The tummy tuck / abdominoplasty can be sensibly combined with liposuction. In many cases, it's true, there is a slackening of the abdominal skin, but there is also clearly excess fat tissue. In such situations, liposuction can be performed first, followed by the tummy tuck. A plastic surgeon carries out both procedures, one directly after the other, to avoid another anesthesia and to prevent their patients from undergoing two postoperative recoveries. Others argue that the risk of disturbance to wound healing is greater because of the manipulation of the fat tissue during the liposuction and favor a second procedure, so as not to increase the risk of complications after the tummy tuck.
The upper tummy tuck is performed only rarely.
The upper tummy tuck is a seldom-employed technique. It offers a possibility for patients who wish to have, for example, a breast reduction or breast lift carried out simultaneously with the tummy tuck. The incision line in the inframammary fold used for the breast intervention is used for the tummy tuck as well. The skin of the upper abdomen, along with the underlying fat tissue, is pulled upward, and the excess is removed at the level of the inframammary fold. The disadvantage however, lies in that the two lower breast incisions must be joined in the middle in order to remove sufficient tissue in this area as well. Right here, in the area of the breast bone, ugly, bulging hypertrophic scars frequently occur, even when skillful suture technique is used.
If the tissue excess lies not only in the upper abdomen, this technique can be combined with a small lower abdominoplasty. In this instance, the naval does not need to be repositioned.
Taken as a whole, this type of tummy tuck is employed only in exceedingly rare cases.
A special form of tummy tuck is the panniculectomy (removal of the fat apron). In most cases, the patients who get this intervention are still overweight.
The complete classical tummy tuck is not recommended in this case. Because of the total mass of fat tissue, which tends to have a poor blood supply, complications occur at a significantly higher rate, including the following: disturbances of wound healing, infections, fat necrosis (dying off of fat tissue) and hematomas, among others. The tummy tuck is reduced to the minimum necessary in order to keep the resultant wound area as small as possible. The panniculectomy is performed through the horizontal incision described above. The wound is then sutured in multiple layers.
The navel is not repositioned, and the dissection of the abdominal wall is carried out only up to the navel, and not, as in the tummy tuck, to the breast bone. Consequently the wound area is smaller. Because of this, an improved blood supply reaches the wound margins, and the risk of disturbance of wound healing is minimized.
Meeting the costs of a tummy tuck
In Germany health insurance companies cover the costs of a tummy tuck less and less. A chance exists, however, in extreme cases that are clinically significant, similar to breast reduction.
It is not unusual for a tummy tuck to be combined with liposuction. Most frequently the hips are reduced to improve the contour of the waist.
Updated on 01.10.2015
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