Tummy Tuck (Abdominoplasty)
Our tummy tuck (abdominoplasty) approach differs from standard techniques. The addition of the Progressive Tension Suture technique allows secure healing, preventing fluid accumulation without the use of drains. In addition, it allows more rapid return to upright posture and normal activities.
Abdominoplasty is a surgical procedure that not only addresses removal of fat but also the tightening of skin excesses and the repair of muscle separation often associated with pregnancies or weight loss. Patients are evaluated and there are a variety of procedures to address individual needs. The procedure should be individualized to the patient. For instance, an excess of skin and/or muscle separation limited to below the belly button can be addressed with a limited or mini-tummy tuck. When the skin and muscle issues involve the entire front of the abdomen, a full abdominoplasty is needed. Liposuction is often carried out at the same time to further enhance the final result.
Unfortunately, all surgical procedures have potential risks. The most common complication of tummy tuck is persistent fluid collections called seromas. This occurs because a large space is left behind by the procedure in a very mobile part of the body. As you move your abdomen to sit up, walk or even breath, these tissues that are trying to heal may be disrupted causing the formation of seromas. In an attempt to prevent this complication, most surgeons place tubes called drains to try to remove the fluid produced.
Typically, 2-3 drains are placed into the surgical site and they remain until a minimal fluid output is seen. This can be anywhere from one to four weeks. Even with the proper use of drains, seroma formation may be as common as 20% or greater. We have developed a “no-drain abdominoplasty” which involves a simple suturing technique to secure the abdominal tissues so that they can heal without disruption. This unique method speeds and eases patient recovery, while reducing seromas and other potential risk.
Our Approach to Tummy Tuck (Easier recovery, less risk)
- During the initial consultation, the surgeon will create an individualized evaluation and treatment plan to address the patient’s specific needs. During this visit the surgeon will explain the technique, expected convalescence, and anticipated results.
- The surgical technique that we use is the progressive tension suture technique, which was originated and published by our surgeons. Our experience of over 30 years using this technique in Dallas and Allen, TX, has produced a high percentage of excellent results and the following advantages:
- NO DRAINS required, which minimizes post-operative care.
- EARLY RESUMPTION OF UPRIGHT POSTURE AND PHYSICAL ACTIVITY which is an improvement over traditional methods that require a severe limitation of activity and ambulation in a bent posture for several weeks.
- Complications are dramatically reduced by the use of Progressive Tension Sutures (PTS).
We originated the progressive tension sutures (PTS) procedure that greatly simplifies our tummy tucks, significantly reduces surgical complications, improves our patients’ results, and shortens our patients’ convalescence. We have been using this technique over the past 30 years and have found it to be reliable and long lasting.
Following the appropriate management of the deeper tissues of the abdomen including muscle repair, the skin redraping and tightening is accomplished by the use of PTS. These are sutures that advance and anchor the skin to the underlying tissues. This is a very simple, yet effective technique that has the following advantages:
- Pull is distributed over the entire skin surface (instead of only at the skin closure) improving skin redraping;
- No tension on the skin closure, resulting in less obtrusive scarring;
- Direct suture of the bellybutton from the underneath surface of the flap, enhancing the appearance of the bellybutton;
- Elimination of the space under the skin flap and secure anchoring of the skin flap to the underlying tissues; this eliminates the most common complication of the procedure which is seroma formation (fluid collection);
- Secure anchoring of the flap permits early return to the upright posture and speeds convalescence;
- No drains or pressure dressings are necessary.
Modified Tummy Tuck:
Liposuction can be utilized in both the upper and lower abdomen. The modified abdominoplasty surgery then consists of making a relatively short transverse incision, elevating the skin and fat of the lower abdomen (called a flap) and repairing the muscle separation or diastasis rectus. The incision is then closed after removing excess skin. This procedure is usually done as an outpatient.
This is an illustration of a full abdominoplasty (tummy tuck); modified abdominoplasty is only below the belly button.
Full tummy tuck, illustrated above, is similar but more extensive as it involves elevating the skin flap over the entire abdomen and repairing the muscle separation. This procedure may be done as an outpatient, but an overnight stay may be required.
- Power-Assisted Liposuction (PAL) is a relatively new adjunct to traditional liposuction. It is a device that reciprocates or moves the cannula in and out at a very high rate of speed. This vibrating effect cuts through the fatty tissues, facilitating the fat removal. The device is particularly helpful for fibrous areas, can be done through small incisions and adds no increase in risk or expense. PAL is surpassing ultrasonic-assisted liposuction (UAL) in use among plastic surgeons, with safety concerns and expense being the major considerations. We use PAL exclusively in our practice.
- Tumescent Liposuction or Super-Wet Fluid Infiltration refers to injection of the area to be suctioned with saline (salt water solution), local anesthetic, and epinephrine. This solution plumps up the tissues, making fat removal easier, constricts blood vessels, which reduces bleeding, and block nerves, providing painless surgery. The super-wet technique uses less volume of fluid than the tumescent technique.
- Progressive Tension Sutures (PTS) is a surgical technique used in abdominoplasty (tummy tuck) that our practice has developed and reported in the Journal of Plastic and Reconstructive Surgery, June 2000. The basic concept is that of a controlled redraping and advancement of the abdominal skin flap by the placement of multiple sutures from the skin flap to the deep tissue. Read more about PTS above on this page.
The progressive tension sutures are placed from the skin flap to the deep fascia as the abdominal flap is advanced. This downward advancement is maintained as each suture is placed and tied, hence the name, “progressive tension sutures.” In this manner, tension is redistributed over a broad area of the abdominal flap, as opposed to the conventional procedure in which all the tension is concentrated on the incision. The PTS technique allows closure of the incision with virtually no tension. This improves the quality of resulting scars and prevents healing problems.
However, the most important benefit of PTS is the secure anchoring of the skin flap to the underlying tissues. The attachment of these tissues allows the entire abdominal wall to immediately move as a unit, which prevents disruption of early healing. It is our opinion that this is the primary reason that this technique prevents seroma formation (fluid collection) – the most frequent complication of abdominoplasty.
Complications, such as excess scarring, healing delay and fluid accumulation are usually prevented by this technique. As with any surgery procedure, we have seen complications after a tummy tuck; however, they have been uncommon and usually minor. This technique is as simple and logical as it seems.
Abdominal deformities, such as abdominal fullness, excess skin, excess fat, etc., most of which are related to pregnancy or genetics, can be corrected with liposuction and/or abdominoplasty. Most patients are pleased with the end results of this surgery, when it is appropriate, well implemented, and successful. However, patients should consider the following:
- An accurate diagnosis by a surgeon trained to do ALL types of body contouring surgery is important. Partially trained physicians are offering liposuction in general practice, gynecology, dermatology and other medical practices. The doctors may offer liposuction, but most are not trained or interested in the more complex abdominoplasty. Results following liposuction in a patient who is actually a tummy tuck candidate are usually disappointing.
- There are many variations in techniques of performing abdominoplasty and there is considerable variation in results, rate of complications and length of severity of convalescence. To assume all tummy tuck techniques are the same would be a mistake. Before having surgery, understand the basics of the technique, average length of convalescence (especially restrictions after surgery), and the surgeon’s rate of complications.
Progressive tension sutures in abdominoplasty, Pollock, T. and Pollock, H., Clinics in Plastic Surgery(October) 2004; 31(4), pp.: 583-589.
Reducing Abdominoplasty Complications, Pollock, H., and Pollock, T., Aesthetic Surgery Journal. (September/October) 2002; 22 (5), pp. 371-372.
Progressive Tension Sutures: A Technique to Reduce Local Complications in Abdominoplasty, Pollock, H., and Pollock, T., Plastic and Reconstructive Surgery (June) 2000; 105 (7), pp. 2583-2586.
Patients are welcome to view this video of a tummy tuck, but they are cautioned that due to the graphic nature of surgery, some of the video may be disturbing. A less clinical version of the PTS procedure can be found here.