Home . Body . Tummy Tuck . Advanced Techniques in Tummy Tuck Surgery
A tummy tuck is a wonderful surgery for rejuvenating the abdomen, mainly in women with loss of integrity of the abdominal muscles and with extra skin. Many plastic surgeons can perform a good tummy tuck surgery, but advanced cases require advanced expertise, such as provided by Dr. Khalifeh. On this page, we will highlight a complicated case that took 6 months of planning but yielding a lasting reconstruction of a complicated abdomen. The story starts with our patient getting married and having had 3 wonderful children, a blessing indeed. But the degree of attenuation of the abdominal wall and lack of return to normal bothered her, and since she was done having children, she and her husband came to see me.
On the frontal view note the extreme laxity and the bulge underneath the abdomen. On palpation, the bulge was rock solid, as opposed to a soft texture. This was indicative of a glob of fat that herniated, and then got incarcerated and converted by the body into fibrous tissue, a rare sequela of hernias.
This was confirmed via a ct scan, as well as a biopsy. In complicated cases, confirmation via studies is helpful, as we do not want to get in there and realize we are dealing with something we did not anticipate. See the CT scan below, confirming the mass is solid.
Next we examine the side view, where the extreme amount of laxity and the intrabdominal bulge is seen again. This is way beyond normal, and in Dr. Khalifeh’s experience this level of attenuated fascia requires repair and reinforcement to avoid quick recurrence. This absence of fascia band basic near evisceration of intraabdominal contents is very uncomfortable to live with and requires constant external support via compression for the patient to be comfortable.
The surgery began by making a customized lower abdomen incision that would close nicely by the end of the surgery. We proceeded with peeling the skin off the hernia layer and the remnant muscle layer.
In my experience, once a muscle becomes this weak, the central sutures alone will not keep in place during the healing period. Therefore, I used a long-term strength layer called Phasix, which will stay long enough until the muscle layer rebuilds strength. Phasix will be absorbed by the body (permanent meshes have issues, so a long term but absorbable mesh is the best solution). This piece of mesh alone costs about $9,000, so we typically get insurance to help cover the costs of the hernia repair during a tummy tuck. They normally will agree to do so in the most severe cases.
The patient was kept one night in the hospital and discharged with drains. The drains are typically kept for about 4 weeks in cases where I use mesh, a bit longer than my 1-2 weeks for regular tummy tucks. The recovery to return back to work is about 4 weeks, and continue exercise will be about 10 weeks.
Here are pictures 2 months post-surgery
