Reverse abdominoplasty or tummy tuck is only suitable for a small subset of patients. For the vast majority of patients though, the standard technique or hip-to-hip incision within the lower abdomen remains the best approach since it can remove the excess skin in both the upper and lower abdomen.
Reverse abdominoplasty primarily targets skin laxity in the upper abdomen, thus it only favors women whose lower abdomen appears relatively tight, according to experts at Inland Empire Plastic Surgery Institute.
The technique typically uses one long incision within the breast fold. While most of the scar aspect is hidden within the natural breast fold, it might become visible in the sternum area (medial chest), especially in small-breasted patients. Nevertheless, most scars fade about 6-12 months that they blend with the skin.
The procedure can be incorporated with “auto” breast augmentation in which the patient’s own [excess] tissue from the upper abdomen is used to add volume in the breast; hence she can avoid implants and the risks that come with them such as leak/rupture, scar capsule hardening (capsular contracture), and possible replacement in the future.
However, it is important to note that “auto” breast augmentation via reverse abdominoplasty is a highly complex procedure. To achieve more natural results, it is often combined with fat transfer in which excess fats are liposuctioned from different parts of the body such as the flanks, thigh, hips, etc., then later used to reshape the breasts.
For the right candidates, reverse abdominoplasty can produce impressive results from the cosmetic point of view. However, proper wound closure is critical to prevent poor scarring or scars migrating inferiorly that they become visible on the upper abdomen.
Once the excess skin the upper abdomen is removed, the remaining tissue is attached to the rib fascia, which is noted for its additional strength and thus preventing scar migration and sagging recurrence.
Aside from women who prefer auto breast augmentation, the technique may also suit previous abdominoplasty patients who develop sagging, which for some reason only affects their upper abdomen and not its lower aspect. Aging, weight fluctuations, and sun exposure are the most common factors that contribute to abdominal laxity.
While there are different types of plastic surgery after weight loss, they all share one goal: To address contour deformity due to poor skin tone and “redundancy,” soft tissue laxity, and highly fibrous fats.
All body contouring surgeries for massive weight loss (MWL) patients will require direct excision, thereby the appearance of scar is an inevitable tradeoff if they want to achieve a near normal appearance and/or find relief from pain, irritation, and skin breakdown caused by the large folds of skin.
Below is the list of the most common types of plastic surgery after weight loss, according to California Surgical Institute website.
* Tummy tuck. While the standard technique uses a hip-to-hip incision, MWL patients typically require a longer flank-to-flank incision for further contouring. Despite the resulting scar, studies have suggested that it can result in high patient satisfaction due to notable improvements in the quality of life and body functions, as the redundant skin in the abdomen is the most problematic—i.e., it causes irritation and foul odor.
* Thigh lift. Depending on the location of redundant skin, it may involve incisions within the groin and gluteal crease, on the inner thigh that could be extended into the knee area, in the hips, or a combination of these incision patterns.
* Buttock lift. Most MWL patients require a horizontal incision on the upper butt cheeks.
* Lower body lift. This accomplishes the goals of tummy tuck, outer thigh lift, and buttock lift under one operation as it uses a belt-like incision.
* Arm lift. For MWL patients, it typically uses a long incision on the inner arm or somewhat more posteriorly (starting from the armpit to the elbow), depending on the location of redundant skin.
* Breast enhancement. Female patients may require breast lift and/or reduction, while males may need gynecomastia surgery to correct their woman-like breast caused by the excess skin and/or fat.
* Liposuction. As a stand-alone procedure, it does not provide optimal results for MWL patients who really require an excision-based body contouring surgery because this is the only way to remove the large folds of skin.
Liposuction for MWL patients is often needed for debulking, or removing large amount of excess “fibrous” fat, which does not respond to further weight loss. Most surgeons perform the procedure at least six months prior to an excision-based surgery.
While “simultaneous” liposuction is sometimes acceptable, MWL patients generally require a stage approach to minimize the amount of surgical trauma and to reduce the risk associated with fluid imbalance and bleeding.
This mommy makeover FAQ list aims to help you decide if body contouring to reverse the effects of pregnancy is a good procedure for you.
- Questions: What are the most commonly combined procedures?
Answer: There is no standard approach since it all boils down to the underlying anatomies and cosmetic goals; however, a good number of patients combine breast enhancement surgery (augmentation or lift) and tummy tuck in one surgical setting.
- Q: How long is the operation?
A: There are many factors that affect the operating time, although most surgeons agree that keeping an elective surgery under six hours is one effective way to minimize bleeding and other complications.
- Q: Does it always result in scarring?
A: Any time the skin is cut or injured, scarring inevitably occurs. Nevertheless, mommy makeover surgeries typically use incisions that are placed within the natural creases of skin (e.g., breast crease during breast implant surgery) and beneath the underwear area (e.g., tummy tuck and butt augmentation or lift) to hide the scars.
- Q: How much does it cost?
A: The number of operations, facility, professional fee, and clinic location are just some of the key factors that affect the total price. But to provide some rough estimate, $6,000 – $9,000 is the average cost of breast enhancement surgery, $4,000 – $6,000 for tummy tuck, and $3,000 – $5,000 for abdominal liposuction.
For this reason, a good number of mommy makeover patients can expect to pay between $10,000 and $30,000.
- Q: What are the financing options available?
A: Regular and health care credit cards, home equity loans, personal bank loans, and in-house financing are just some of the options one may consider.
6. Q: What are the ways to maintain the effects of mommy makeover?
A: Healthy lifestyle, proper diet and regular exercise for weight management, avoidance of pregnancy, and good skin care regimen are the keys to maintain the effects of mommy makeover or any body contouring surgery.
7. Q: Who performs mommy makeover surgeries?
A: While some states allow non-specialists (i.e., doctors who have no specific training in plastic surgery) to offer cosmetic surgery, a prudent patient should only choose someone certified by The American Board of Plastic Surgery.
The “right” surgeon should also be performing mommy makeover procedures on a regular basis for a minimum of 10 years. It is important to note that experience has a huge impact on the surgery’s success and patient satisfaction rate.
Mommy makeover surgeons focus on plastic surgery procedures that reverse the effects of pregnancy, such as tummy tuck and breast enhancement. But to achieve good long-term results, these are best performed when the patient is done having children, as suggested by renowned body contouring expert Dr. Tarick Smaili.
Qualified mommy makeover surgeons must meet the strict requirements stated below.
As of this writing, there are several medical boards that “certify” doctors who want to offer cosmetic plastic surgeries. However, the American Board of Plastic Surgery, which requires the highest and most stringent requirements, remains the “gold standard.”
ABPS doctors are also required to take a rigorous oral and written exam every 10 years, and are mandated by board regulation to perform surgery only in accredited operating rooms and to adhere to a high level of patient care.
- Extensive and relevant experience
Plastic surgery has a wide range of subspecialties, e.g., facial rejuvenation, nose reshaping surgery, body contouring after weight loss, mommy makeover, breast enhancement, etc.
The general rule of thumb is to choose a surgeon whose patients are mostly women who want to reverse the effects of pregnancy. Ideally, he should be performing mommy makeovers for 10 years on a regular basis.
- Extensive collection of before-and-after photos
The before-and-after photos from previous surgeries can help the patient evaluate her doctor’s technical and artistic skills. It is also ideal that she finds a few “subjects” whose body frame (i.e., height, body shape, and area of concern) closely resembles hers.
- Offer good rapport and honest discussion
A good surgeon will make every effort to promote honest and transparent communication, which in turn could allow his patient to settle realistic goals and feel comfortable with whatever surgery she may choose.
Meanwhile, a prudent patient should avoid anyone who makes unrealistic promises or forces her to have more surgeries than she actually wants.
- Prioritize patient safety above all
A good surgeon will always prioritize patient safety above anything else. For this reason, he only performs surgeries in accredited hospitals or outpatient centers, uses all efforts to minimize surgical trauma (e.g., limiting the operating time), and conducts strict patient selection.
It is important to note that patients with healing problems and other serious medical conditions and those with unrealistic goals are poor candidates for any type of cosmetic plastic surgery.
Abdominal plastic surgery after weight loss generally deals with heavy folds of redundant skin that not only cause poor body proportion, but may also result in foul odor due to trapped sweat and moisture, which in turn can lead to skin breakdown and non-healing irritation.
Panniculectomy is one of the most commonly performed plastic surgeries after massive weight loss, i.e., losing more than 100 pounds. It uses a long horizontal incision within the lower abdomen to remove large amounts of skin.
While panniculectomy and tummy tuck both use a long horizontal incision, the former is primarily designed to excise large skin folds that are caused by massive weight loss.
Tummy tuck, meanwhile, is more about contouring the abdominal area by merging two basic principles: remove the excess skin and reshape the underlying muscle with the use of internal sutures. For this reason, the procedure is not just suitable for MWL patients, but also for women who want to reverse the effects of pregnancy.
Occasionally, these two procedures are performed in stages. For instance, MWL patients who are still expecting further weight loss may undergo panniculectomy to address their non-healing skin irritation caused by the heavy folds of tissue. At a later date, they could opt for tummy tuck after they achieve their weight goal and desire for additional contouring.
A good number of MWL patients could also benefit from large-volume liposuction or fat removal surgery. One ideal approach is to perform it prior to tummy tuck, so the surgeon can see how much the skin would respond. Removing the fat may aggravate the sagging appearance, although younger skin to some extent may redrape to the new contour.
Months after large-volume liposuction, subsequent tummy tuck is ideal to remove the hanging skin and reshape the weak or splayed abdominal muscle that contributes to the sagging appearance.
To reshape and tighten the abdominal muscle, plastic surgeons in Los Angeles may either use permanent or absorbable sutures. Irrespective of the technique used at the time of surgery, at six weeks there is already a strong muscle adhesion that can protect the results from minimal to moderate weight gain and even unexpected pregnancy.
Nevertheless, it remains highly ideal to maintain a normal weight and avoid pregnancy to preserve the results of surgery.
While abdominal plastic surgery after weight loss is generally categorized as cosmetic procedure, thus it is not typically covered by health insurance, studies have suggested that it can play a critical role in long-term weight management since the new contour can serve as a strong motivation to lead a healthy life.