Mini Tummy Tuck for Mommy Makeover
Mini Tummy Tuck Walkthrough
This is a woman asleep on the operating table and this medical video demonstrates a mini tummy tuck. This woman has had four children and is an active exerciser and is dissatisfied with this lower aspect of her belly. When she stands up or bends over, she has a little redundant skin pudge and this is very concerning to the patient. I am injecting some numbing medicine into the area and now we'll be creating the incision.
The instrument you see in my hand that looks like a pencil is actually called an electrocautery, and it conducts electricity into her tissues and has two buttons. One of the buttons cauterizes blood vessels and the other button creates a cutting mode. And my right thumb will alternate between cutting and cauterizing the tissues.
Because this woman had previous caesarean sections, her tissues are a little bit scarred in and you can kind of see this in this view. The white tissues right there in the midline underneath the break are evidence of scar tissue. Care is taken not to injure the skin, so it has been retracted with my left hand. Again, the electrocautery is being used to control bleeding as well as for dissection purposes.
Because this woman is so fit, she does not need her muscles sewn together. So, this operation is essentially a removal of the redundant skin which is concerning to the patient. This particular surgery does not go up to the belly button. It goes up about halfway and then I pull the extra skin down. Once I am satisfied with the extent of dissection and I need to make the incision longer, I will. I don't make the incision full-length until I know that I'm going to need it all. Ideally, I like to try and keep the scar as small as possible.
I am now going to divide her skin and verify that I'm going to take out the right amount of skin. So, we pull the tissues down and secure them in place. This instrument will hold the two edges together and allow me to continue to trim the tissues. You can see here how much skin will be removed. This woman is relatively tiny. She is five feet, one inches tall and weighs roughly 105 pounds. So, she's very thin and this is probably the only fat she has on her body.
After these sections of skin are removed, the wound will be temporarily closed and then we will begin the closure using several tissue planes. The tissue planes will be closed using sutures at different depths in the tissues to allow a tension-free closure. This will allow this incision to heal as a pencil thin line. This is a very common operation that the more athletically fit women are seeking to have done. It is usually well-tolerated with minimal recovery and they are back exercising within about 10 days.
The women that have had previous caesarean sections are very receptive to this modest increase in the length of their c-section scar. This particular patient had a c-section scar that composed the middle half of the entire length of the incision, so her skin incision or scar was only extended approximately an inch-and-a-half on either side. So, for an inch-and-a-half more scar, she will have a flat belly with no skin folding over. Again, since her muscle tone is so good I do not have to sew her muscles and she will have a very quick recovery.
At this point the fat has been removed. The flap will be again checked to see if there is any areas of bleeding. These will be controlled with this electrocautery and then the wound closure will begin. Her muscle layer is basically the bottom part of that wound, and you can see that the thickness of her skin and fat layer is only about one finger breadth. So now, we will bring her tissues together with staples and, again, these will be removed as the wound is closed. This allows us to fashion the scar in the proper orientation and not to require any excessive skin removal.
After I am satisfied with the tissue edge approximation, these staples will be removed and replaced with sutures. This will be done in a stepwise fashion using interrupted sutures. She will also have deep tissue sutures placed during this wound closure.
There will be multiple interrupted sutures placed and then a running suture will be placed for final wound closure. She will be placed in a garment that she will wear for about seven to 10 days depending on how much tissue I take out, their activity level, and the swelling. This wound can cause some swelling problems after the surgery, especially with aggressive activity. So, we really like to limit the activity for at least the first 10 days. After that, I would prefer her to wear a garment for an additional 10 days only while she's exercising. The final swelling will eventually resolve at about three months.
These patients are very happy and do very well. You are seeing the last layer be placed, which is a running suture.