Tummy Tuck with Muscle Tightening

In this video, the Medical Director of the Loudoun Center for Plastic Surgery, Dr. Michael J. Brown, shows a tummy tuck with muscle tightening plastic surgery procedure.

Tummy Tuck Walkthrough

This plastic surgery video deals with a woman who has had multiple childbirths and a very lax abdominal wall with a lot of redundant skin, and she would like to have her tummy contour improved. So she is having a full abdominoplasty or in lay terms a tummy tuck.

I start these procedures actually dissecting around the belly button, and so what you see here is an incision created around the belly button. And now I'm using a surgical instrument called electrocautery. It looks like a pencil with a blue wire coming out of the back of it. That controls the bleeding by conducting current through the patient. It doesn't hurt the patient. It's a wonderful invention, so it allows us to treat the patient in two ways. It allows me to cut the tissues, and it also allows me to cauterize blood vessels. So it controls bleeding and aids in cutting.

So after I dissect around the umbilical stalk, or the belly button, I insert a canula, which puts a wetting solution in which will control bleeding and also control pain. So this is a relatively large incision, that is placed in a controlled fashion, in a very precise position to allow it to be hidden by her clothes.

Depending on the fashions, the incision has really changed over the years. The incision used to swing a lot higher and be more V-shaped, when the swimsuits were more french cut or much higher. Now that the fashion is a low cut bathing suit, or low cut pants, the incision has had to be lowered over the years and so this particular patient was done very recently, so her incision is being keep relatively low.

At this point, I have dissected through her fat, and I am right on top of her abdominal wall The very bright light you see is actually a head light that I wear that helps me see exactly where I am and help control the bleeding.

So I will elevate this flap to where the belly button hole was, and now you can see where my finger has come through where the belly button stalk is, and the reason why I do that is to protect the belly button. I really don't want to injure the blood supply to the belly button. So I have raised this flap and now I can go ahead and divide it in the middle to allow me to continue to elevate the flap with the best exposure possible and this will absolutely, it might take a little bit more time to divide this, but it really improves my exposure, which will ultimately give the patient a better result.

So there I have dissected all around the belly button and up to her rib cage, and you get a very good appreciation of the area that I'm operating on. So you can see I've marked her area where her muscles are with a marking pen. Now I'm injecting a long acting numbing agent, which will make the patient very comfortable for the first 12 to 14 hours.

Now at this point, I'm going to go ahead and grab one side of the fascia it's like a burlap covering over the muscle, and I will then grab the other side of the burlap or fascia and I will sew them together. This will be done using a running stitch. This stitch actually does dissolve over time but I reinforce this layer with a permanent stitch that does not dissolve.

So what you will see here is that I take that purple line and I sew to the other purple line and this is done in a very controlled fashion and this will really tighten up her abdomen, and it makes a wonderful improvement in some cases where women have lax abdominal walls that may have been stretched over time.

What you will see here is that by the time I'm done all the purple is gone and it's actually been folded into itself so her tummy is a lot tighter than it was. At this point, we are ready to go ahead and cut off all of this redundant skin.

Now she was a relatively large woman so she's got a lot of skin and she had very large babies. So she has a lot of stretch marks. So her skin quality is not ideal and that's one of the benefits of the surgery is I get to cut away a lot of this bad skin. Unfortunately in her particular instance, she will be left with some skin that has a lot of stretch marks still in the lower half of her abdomen.

The nice part is the upper half of abdomen will have no stretch marks on it. So basically all the stretch marks that she had below her belly button have all been cut off, and the stretch marks that were above her belly button are now below her belly button. So I will go ahead and cut off these pieces of skin and fat and I will do one side at a time. And then I will do the other side.

Then I will be able to assess how her wound edges look, and how the wound will come together. So at this point I'm taking off the other side, and you can get a sense for the power of this instrument. It really makes it to where she is not losing any blood. So although it's a very graphic surgery it's not a very bloody surgery. And yes, that is what the fat looks like. So all this fat will come off with the skin and you can really see how this will narrow her waist in two dimensions. Not only will it make her belly less protuberant it will also narrow her waist line significantly.

So here you can see she has this defect which will actually come together very nicely. At this point she's had half of her belly closed and I'm going to pull her belly button or umbilical stalk out so I have to find where it is and no where I want to put it.

Speaker 1:
And I do that by feel and by sight. I will cut out some redundant skin and fat, and then I will create a hole that will allow me to pull the umbilical stalk out of the wound. I will then close the wound in two layers. What you are seeing here is the first layer being put in and that will basically reposition the umbilicus or the belly button where I want it.

You will also notice that the wound has a lot of puckering on the top aspect of it. That's actually not by mistake, and it's done on purpose. The reason why that's like that is because this layer you can see how thick it is, that fatty layer. It is so thick that you don't want to close it with any tension. So now you are you going these bites be put in. These are relatively big stitches and there is a strength layer there. What that does is this strength layer allows me to close the wound under significant tension but not have tension on the skin and that's important because I really don't like widened thickened scars, that you can see with some tummy tucks.

Within about six or eight weeks, all that puckering is gone and she has a very smooth flat abdomen. But initially it's actually disconcerting to the patient but with a reassurance and some patience they realize that it will all go away, and it does. It goes relatively quickly. But it's really beneficial to do that.

You can kind of get a sense here of what those deep stitches alone will do. And then what it looks like after it's been closed but again all that puckering will go away over time.