Mr Richard Baker Weekly Blog

How to improve results in tummy tuck surgery?

This week I’ve been thinking about how to improve results in abdominoplasty, or ‘tummy tuck’, surgery. The commonest causes of dissatisfaction after abdominoplasty are residual excess skin, particularly when bending forwards, excess skin in the flanks and fluid collection under the skin (seroma). It is important to warn patients before surgery that though the skin can be very tight on the day of surgery, it naturally relaxes over the following weeks to months so that inevitably there is some degree of returning laxity over the following year. However, it is nowhere near to the same extent as before the surgery. In addition, the patient doesn’t get new younger skin, they simply have the excess removed. Unfortunately, aging, weight gain and pregnancy all have the effect of thinning the skin such that it loses the firmness and elasticity of youth. Liposuction helps in removal of loose skin because the suction of the fat layer allows you to stretch the skin further. Obviously, this is more effective the thicker the layer of fat.

Excess skin on flanks is difficult to address with a tummy tuck. The only way to remove a lot of skin from the flanks is to take the incision all the way around to the back in a so-called ‘body lift’. This creates a scar all the way around the waist and is a bigger operation with more risks, and therefore does not often appeal to patients. However, it is particularly suitable for people who have lost a great deal of weight following a gastric bypass, for example.

Lastly, fluid accumulation occurs because a tummy tuck, by definition, creates a large raw cavity under the skin of the abdomen on top of the muscles. I find putting dissolving stitches between the skin and the muscle can help to close off this cavity, although the stitches can sometimes cause discomfort. Drains are helpful for draining fluid in the initial few hours after surgery, although I don’t believe it makes a difference in the subsequent weeks. It varies enormously between patients, and I think different patients react differently to surgery and it is impossible to predict which patients will produce fluid and who won’t. Surgeons have tried spraying various chemicals into the wound to try to stop fluid production and no-one has found a good one yet. However, I am sure in the future research will generate an agent that will allow the skin to stick back down to the muscles and eliminate this problem.




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