Physical Exam in the Tummy Tuck Patient

Physical Exam for the Tummy Tuck Patient Continued

If there is skin laxity, the lower abdominal skin should be pinched to determine the amount that can safely be excised. If the umbilicus is neither mobile nor ptotic and is not distorted by pinching the redundant infraumbilical tissue, the umbilicus usually does not need to be transposed. Upper and lower abdominal skin laxity with significant umbilical ptosis should be addressed with full abdominoplasty. The amount of lateral and back skin laxity should also be assessed to determine whether a high lateral tension abdominoplasty, abdominoplasty with thigh lift, or circumferential body lift would be appropriate.

Pinching the subcutaneous tissue between thumb and forefinger in various locations helps assess the differences in thickness of the subcutaneous layer. Note any local deposits or differences between left and right.

Dr. Hughes will distinguish between intra-abdominal and subcutaneous fat. The relative contribution of subcutaneous fat and intra-abdominal contents to the abdominal contour defect will be assessed and discussed with the patient. Only subcutaneous fat can be remedied surgically. Intra-abdominal fat is not amenable to removal during the tummy tuck procedure.

Dr. Hughes will assess for midline abdominal protuberance in the standing patient. He will ascertain whether the prominence is epigastric, infraumbilical, or both. Dr. Hughes will assess the strength of the abdominal wall musculature as well as diastasis recti and musculoaponeurotic laxity that may be amenable to plication and correction during the tummy tuck.

The abdomen will be palpated for masses, organomegaly, and hernias. If a ventral or umbilical hernia is discovered, Dr. Hughes can usually repair most of these hernias during the tummy tuck procedure.

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