Tummy Tuck Denver,

Denver Tummy Tuck Surgery, Abdominoplasty Surgeon

The physical stresses of life including pregnancy, obesity, or just the passage of time cause the muscles of the abdominal wall to relax. While weight loss or regular focused exercise will strengthen the muscles, they cannot return the flat, buff abdominal wall of the past. For this, surgery is necessary The contour of the abdomen is determined by several factors: muscle wall tightness/looseness; amount/thickness of abdominal fat beneath the skin and inside the abdominal cavity; looseness of the skin. Abdominoplasty (tummy tuck) is designed to improve muscle wall weakness and remove skin excess. Fat within the abdominal cavity needs to be lost through weight loss. Fat on the outside will be removed where the skin with which it is associated is removed. Other fat on the abdominal wall requires liposuction. This liposuction is not done at the time of tummy tuck. It requires a separate (3 months or more after tummy tuck) relatively minor outpatient surgery.

The pregnancy, obesity, and aging can cause the strong central (6-pack or Rectus muscles) muscles to separate in the center of the abdomen allowing bulging and “pot belly” appearance and widening (loss of) the normal waist. In the Grossman "tummy tuck", the 6-pack muscles are tightened and rebuilt, defects are repaired and the skin tightened to the point of smoothness.

At the end of surgery, you will be in a “jack-knife" position, bent at the waist and knees to remove any tension on the incision. In the hospital, the bed will be positioned this way. At home, you will accomplish this position with 2-3 pillows behind your back and head and another pillow or two under your knees. For the first week or so, you will even walk in a slightly bent-over posture and gradually straighten up over the course of the first week.



Patient Selection
Generally, people seeking abdominoplasty have significant looseness of the abdominal wall skin and muscles either following pregnancy or major weight loss. And in selecting patients for this procedure, we prefer that their weight loss has been completed, or, in the case of pregnancy, that they do not plan to have no further pregnancies. Readers of People Magazine and US Weekly might think that a tummy tuck after each pregnancy is fashionable among the Hollywood set and while among Dr. Grossman’s Hollywood patients it does occasionally occur that they have a “tummy tuck” following each pregnancy, this is a “business necessity” but not the best plan as further pregnancy will, of course, tend to re-stretch the abdominal wall and entail additional surgery.



Types of Abdominoplasty and the Surgery
At Grossman Plastic Surgery®, there are essentially 3 types of  abdominoplasties or “tummy tucks”. They differ in length of incision, treatment of the “belly button”, and muscle tightening. The types are:

• Standard/classic
• Modified classic
• Mini-tummy tuck (mini-abdominoplasty)

In the “standard/classic abdominoplasty”, the main incision (scar) extends from hip-to-hip in the bikini-line area. The incision is placed as low as possible so that it is hidden under a bathing suit bottom or bikini underpants. A second incision goes around the belly-button and releases it from the skin around it. The skin and fat layer are lifted and separated from the muscles all the way from the pubic area up to the ribs. Then, the muscles are tightened with several layers of stitches creating a tight, flat wall. Next, all of the excess skin is removed and the incision closed. The belly-button is brought back out and stitched in place in the center of the abdomen. Generally, in this classic procedure, all of the skin from the level of the belly-button to the pubic area is removed.

The “modified tummy-tuck” refers actually to several variations. This technique is usually used when there is not enough loose skin to remove all of the skin from the belly-button to the pubic area. Under these circumstances, the bikini-line incision is made, but instead of releasing the belly-button from the skin around it, the belly-button is released from the muscle wall and is the slid down about 1 inch or so lower which allows for some of the skin excess to be removed. The muscle wall is tightened in the usual way.

The “mini-tummy-tuck” procedure is appropriate when the muscle weakness and “pot belly” is limited to the area from the belly-button to the pubic area. In this case, the incision is essentially the length of the pubic hairline or about the length of a C-section scar. Through this limited incision, the lower half of the muscle wall is tightened and whatever skin excess is present is removed.



Anesthesia
Dr. Grossman and Dr. Capraro perform “tummy tuck” under general anesthesia in our Ambulatory Surgery Center at Denver’s prestigious Rose Medical Center (http://www.rosemed.com/) .  Patients having “classic” complete abdominoplasty or “modified classic abdominoplasty” are kept at least one night in the hospital (6 North Suites). But activity is initiated on the night of surgery.
Mini-abdominoplasties (where just the lower half of the abdomen is treated and tightened) can sometimes be performed under sedation and local anesthesia  (twilight sleep) or spinal/epidural anesthesia, though Dr. Grossman prefers general anesthesia. Mini-abdominoplasties also can frequently be done as an out-patient/day-patient (home following surgery).

• Mini-abdominoplasty tightens the lower abdominal wall muscles and the skin below the belly button only (shortest scar).
• Standard or “classic” abdominoplasty tightens all of the abdominal wall muscles and skin from the ribs to the pubic bone (standard scar from hip-to-hip).
• Extended “classic” or “modified classic abdominoplasty” tightens the abdomen and the flanks or sides (longest scar extending around the flanks onto lower back).

After Surgery
Following surgery, a soft dressing is applied and held in place with an abdominal binder. At the end of the first week, the binder is replaced with a girdle. While other plastic surgeons usually insert drains beneath the abdominal skin, Drs. Grossman and Capraro rarely do. They have found that by using a biological tissue sealant and adhesive to seal the abdominal skin back to the muscles, they can usually avoid the need for drains. Dr. Grossman has pioneered the use of this biological sealant in cosmetic plastic surgery procedures since 1999. If drains are necessary, they are usually removed after about 1 week. Most patients are next admitted overnight and discharged the following morning. Your bed will be positioned to avoid any tension on the incision. During the night, the nurses will begin having you exercise by walking. While activity (particularly walking) is begun on the night of surgery and is a part of the daily routine, it is important that abdominal muscles be at rest. There should be no activity that causes you to tighten/use your abdominal muscles. For example, walking is the best activity, but this does not include walking up an incline, since you activate your abdominal muscles when walking uphill. It takes about 6 weeks for the body to develop enough scar tissue to support the abdominal wall. Therefore, no resistance/weight lifting for 6 weeks.   Stair climbing should be avoided where possible; when climbing stairs it should be slowly. Discomfort and pain are features of any surgery. A tummy tuck is uncomfortable because of the need to be bent at the waist and knees when you are in bed or when walking, as well as the tightness of the abdominal wall. Patients often complain of back pain as well as abdominal wall discomfort and tightness. You will, however, have more than enough pain medicine available to deal with the discomfort.