Mini Tummy Tucks, Short Scar Tummy Tucks, and Standard Tummy Tucks

Mini-abdominoplasty (Mini tummy tuck) Candidates

• The mini-abdominoplasty is generally limited to those patients with minimal infraumbilical skin laxity without epigastric laxity being originally designed to treat patients with lower abdominal deformities through a smaller incision
• Infraumbilical fascial plication may be performed with this procedure; epigastric fascial laxity must be addressed with a more extensive technique
• Some additional lateral flap dissection or midline liposuction is usually needed to avoid an unnatural midline bulge after rectus plication with this technique
• Suction drains are not required

Short Scar Tummy Tuck

• The procedures are scaled-back versions of the full abdominoplasty, with more limited undermining and often a shorter scar include fascial plication of the epigastrium by use of a narrow midline suprafascial tunnel for access
• Adjunctive liposuction is commonly used with the limited abdominoplasty
• The umbilicus may be either transected (floated) or circumscribed and reinset on the flap with closure of the donor site and depends upon extent of skin resection

Tummy Tuck or Abdominoplasty after Massive Weight Loss

• often present with circumferential skin laxity of the torso involving the abdomen, chest, sides, upper back, and flanks as well as laxity in the upper arms and medial and lateral thighs
• patient with massive weight loss is usually a candidate for circumferential body lift
• anterior resection only may be chosen as part of a staged procedure or when circumferential treatment is not an option
• to avoid complications due to prolonged surgical time, procedures should be staged if the planned operations cannot be completed within 5 or 6 hours.  Mommy makeover surgeries can be considered as well.
• for maximum benefit, contour surgery should not be offered until weight has been stable at least 6 months. In the gastric bypass patient, this generally occurs after 1½ to 2 years

Although excess tissue resection will aid in mobility and further weight loss in the still obese patient, the patient should understand that there is an increased risk for wound infection and skin necrosis due to comorbid disease and impaired circulation to the flaps. The obese patient has increased risk for cardiac, pulmonary, and thrombotic complications during and after surgery. To decrease risk, these patients may be offered a panniculectomy with the option of aesthetic abdominoplasty after further weight loss. There does not seem to be an increased complication rate in the nonobese massive weight loss patient.

• After massive weight loss, patients often have improvements in blood pressure, plasma glucose level, respiratory status, and other physiologic parameters
• In addition, the vascular supply to the subcutaneous tissues and skin is relatively robust since the now-decreased tissue volume exerts less perfusion demand on the previously expanded vascular network
• Bypass procedures may be restrictive or malabsorptive or a combination of the two
• The Roux-en-Y gastric bypass is the most commonly performed bariatric surgery and combines elements of both
• These patients may need nutrient supplementation with iron folate and vitamin B12, and they may be susceptible to electrolyte abnormalities
• Both obesity and prior surgery predispose the patient to development of a ventral or incisional hernia
• If the patient has had an open gastric bypass, the vertical midline scar can be incorporated into the operative design
• In addition, the formerly obese patient is more likely to have had a cholecystectomy
• An open cholecystectomy scar (subcostal) is a contraindication to extensive flap undermining

Beverly Hills and Los Angeles Tummy Tuck Articles

Article 1: Goals, History, and Anatomy of the Tummy Tuck
Article 2: Abdominal Wall Anatomy and Physical Exam in the Tummy Tuck Patient
Article 3: Physical Exam in the Tummy Tuck Patient
Article 4: Risks, Limitations, Good and Bad Candidates for Tummy Tuck
Article 5: Subgroups of Tummy Tuck Patients
Article 6: Operative Details and Safety in the Tummy Tuck
Article 7: Mini Tummy Tuck, Short Scar, and Standard Tummy Tucks
Article 8: Postoperative Management and Complications in Tummy Tuck