Tummy tuck or Abdominoplasty is probably the most important cosmetic surgery procedure with maximum functional improvement to a person who suffers due to fatty deposit with wide recti muscles. It is called “Structural Abdominoplasty”. Though considered in Cosmetic surgery lists, the steps involved in structural abdominoplasty namely tightening the lax abdominal muscles and trimming the loose saggy lower abdominal skin and adipofascial structures are aimed at restoring the normal functional anatomy. This so called structural abdominoplasty sometimes relieves unexplained back pain and incontinence of urine.
Adding on to the sole intention of aesthesis expected out of this procedure,judicious combination of liposuction to this procedure has become a strong associate-Lipoabdominoplastypoularised by DrSaldhana. The liposuction and limited midline dissection is a physiological combination for a robust viable flaps which is the fundamental requirement for primary wound healing without any complications.Above all the quilting sutures propagated by Pollock have obviated the necessity for drains and hence early comfortable rehabilitation and discharge from hospital in addition to the reduced incidence of seroma .
Lipoabdominoplasty has come to stay in the day today practice of abdominoplasty. The judicious combination of liposuction of abdomen and limited dissection are the two crucial steps in this technique . The liposuction component of LA results in a sliding abdominal flap retaining the NV attachments and lymphatic channels. The limited dissection reduces the complications of ischaemia and seroma. The overall improvements are early recovery,less pain, less sensory impairment and better harmonious results due to liposuction of the fatty areas.
Extending the indications to incisional hernias and umbilical hernia has made the management of these conditions easier and safer.
Addressing the sagging mons by lift or additional liposuction gives a better aesthetic outcome.
A careful preoperative work up is crucial for a safe surgeryto achieve the anticipated results. Predominantly intra abdominal visceral fat abdomens are not going to yield a good outcome. The abdomens with fatty pinch,wide divarication and loose saggy pendulous component will give a good result. Preoperative photographic manipulation method will help decide the post operative outcome.
The reconstructed abdomen without an umbilicus looks unattractive like a “golf court without a hole”. Lipoabdominoplasty with robust skin flaps and gentle techniques make it possible to reconstruct the umbilicus primarily.
The traditional abdominoplasty was a very major surgical procedure with hectic preparations like requirements of blood transfusion,long stay in hospital with drains remaining for one week and more. The outcome always associated with morbidities like flap necrosis,woundbreakdown,infections,fat necrosis and many more.At last when you get the wound healed ,there slips the sari or pyjama without her knowledge-thanks to the extensive dissection and loss of sensory nerves to the lower abdomen. After all these hurdles are you looking at an aesthetic abdomen? Never! The fatty abdominal flap takes a sudden dip at the pubic area with dog ears popping out at the corners! It was a misery those days to do an abdominoplasty.
I thank God Almighty who gave the wisdom to the stalwarts like Saldhana,Lockwood and many more who made this procedure safe and enjoyable with an aesthetic touch. Let the innovative mind work and achieve many more healing procedures.
Dr

Dr. James Roy Kanjoor,

MS., MCh., FRCS

Consultant Plastic Surgeon