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Preoperative Evaluation
During your preoperative evaluation you must speak candidly about your expectations from the procedure. You should be able to express why you want undergoing abdominoplasty and what you would like to accomplish with the procedure. Your physician will listen carefully to your requirements, and will discuss the possibilities according to your physical characteristics. The surgeon will ask for your medical history and will perform a thorough physical examination, evaluating the following factors:
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Skin quality. |
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Abdominal wall defects. |
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Excess of adipose tissue. |
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Location of the belly button. |
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Situación del ombligo. |
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If the excess of skin is focused on the abdomen or includes other areas of the body. |
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Presence of scars (cesarean scars). |
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Position of the scar. |
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Presence of stretch marks (striae). |
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The surgeon will evaluate the anatomic characteristics of the patient, which are different for men and women, as well as the fat deposits. Men have thicker skin than women. Women skin tends to develop laxity and stretch marks (striae). In the same manner, the physician should evaluate the possibility of performing abdominoplasty in conjunction with other procedures, in order to achieve better results. Abdominoplasty can be combined with liposuction of the abdomen to contour this area.
The physical examination should include anatomic measurements with the patient in both upright and supine position. The presence of adipose tissue in the abdomen, fat deposits in the inframammary region, lower thorax, and contour of the abdomen, waist, flanks and fat deposits should be evaluated. The physician will establish according to her criteria the fat deposits location. The treatment is viable for subcutaneous fat deposits. When the adipose tissue is located within the organs of the abdominal area, -intraperitoneal-, the treatment is not recommended. Dr. Nieto may take photos of different angles of your body to analyze them through the computer, document the procedure and evaluate the postoperative results.
Your whole body will be evaluated, torso, hips, breasts, and knees. It would be wrong to focus only on the abdomen area. Abdominoplasty preoperative evaluation should consider the entire body in order to achieve a well-proportioned result. Therefore, your physician may recommend treatments for other areas of your body.
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Abdominoplasty considerations
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Abdominoplasty is a major procedure that involves the portion of the body between the chest and the pelvis. This procedure may require a brief hospital stay and a more extended convalescence. |
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The complexity of your procedure , as well as any health issues specific to your case (your age, pregnancy, etc.), will be consider when determining the type of abdominoplasty technique for your surgery. |
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The patient must understand that abdominoplasty involves the presence of a scar. Your surgeon will make every effort to make your scar as inconspicuous as possible. However, you should understand that abdominoplasty will leave a significant scar. |
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Abdominoplasty may improve significantly the appearance of your abdomen. In the same manner, the appearance of stretch marks (striae) and cellulite may be improved through the procedure. However, these conditions may persist after abdominoplasty. |
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Abdominoplasty is not a procedure to treat obesity. |
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The appendectomy scar does not represent a problem for abdominoplasty. |
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Abdominoplasty involves separation of the abdominal skin and fat tissue from the underlying fascia and repair of the weakened abdominal muscle fascia. This maneuver will help to improve the skin tone. |
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The scars resulting from abdominoplasty may take some months to a year to become softer and more natural in colour and texture. |
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As time passes, you may begin to notice an improvement to your abdominal shape. |
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Abdominoplasty produces excellent and long-lasting results. |
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The procedure
What are the most common abdominoplasty techniques performed?
The condition of the abdominal area determines which technique to perform. There are different types of abdominoplasty procedures which vary according to the incision shapes and placement. The different abdominoplasty techniques can be combined to treat the skin and subcutaneous tissue laxity, presence of scars, and location of the fat deposits. The most commonly performed techniques include:
Minimal access abdominoplasty
It is recommended for patients with mild excess skin, and subcutaneous tissue, and fat deposits that can be treated with liposuction. Traditional liposuction or ultrasound liposuction can be used. Incisions of about 5-10 cm long are made on the inferior abdominal crease. Once the surgery has been performed, the site is wrapped in bandages which will be changed to an elastic compressive garment that the patient should wear for 2-6 weeks.
Mini-abdominoplasty
Mini-abdominoplasty is reserved for patients with mild excess skin, moderate laxity, and flat superior abdomen. This type of procedure is not recommended for those patients with moderate supraumbilical laxity. Liposuction may be performed depending on the amount of fat accumulation. The length of the incision depends largely on the amount of skin to be removed. Unlike other abdominoplasty techniques, in the mini-abdominoplasty there is no umbilical transposition. Through the incision the abdominal fascia is tightened at the midline above and below the umbilicus depending on the degree of laxity.
The excess skin is excised and drainage tubes are placed. This technique may vary depending on the patient´s needs. Usually, hospitalization is not required and shorter recovery time is needed.
Endoscopic assisted abdominoplasty
The endoscopic assisted abdominoplasty is a procedure indicated in patients with mild skin laxity and good elasticity of the skin. The incisions are hidden in or around the umbilicus and on the pubic bone, in such a way that incisions are inconspicuous. Through these tiny incisions, repair of the muscles and abdominal fascia is made. This maneuver restores skin tonicity. The surgeon may determine if liposuction is required. Once the desired reduction has been performed, incisions are closed and compressive bandages are placed. This technique may vary depending on the patient´s needs.
Extended abdominoplasty
Extended abdominoplasty is addressed to patients following large weight loss. Frequently these patients present skin excesses in abdomen, hips and back. Liposuction may be used to improve the results.
During surgery, the inferior incisions are made on the pubic hair line to the inguinal fold.
The excess skin and fat tissue are excised and the sutures are closed. This technique may vary depending on the patient´s needs.
Classic transverse abdominoplasty
The transverse abdominoplasty removes excess skin and fat accumulations located between the umbilical and the pubis. This type of abdominoplasty characterized by two incisions: a transverse incision at the pubic hair line up to the inguinal folds, and a second vertical midline incision with umbilical transposition. The umbilical scar around the navel, usually remains hidden in the natural depression of this part of the abdomen. When the patient presents excess skin around the umbilical region, the periumbilical area is defatted and umbilical transposition (very common) or de-epithelization is performed.
The plication of the abdominal muscles is made through the incision of the abdominoplasty by approaching the muscles to the abdominal wall. In this way the abdomen acquires a flat appearance. The surgeon will select the most convenient technique according to the condition of the abdominal tissues. The umbilicus transposition is a very frequent practice in the transverse abdominoplasty. This means that the skin of the umbilicus region becomes the skin of the pubic area.
The surgeon will determine if the old umbilicus is fixed to its new place or if a different one will be made.
The upper transverse supraumbilical abdominoplasty is a different way of approaching, in which the incision line is extended to the level of the inframammary crease. This technique may vary depending on the patient´s needs.
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