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Belly Up

Liposuction or Abdominoplasty: That is the Question

The female abdomen is a very special anatomical area; not only is it the focus of body contour in fashion photos, it is the place of procreation, reproduction and the continuation of the family tree. Women exercise, measure and evaluate their abdomen regularly upon dressing and shopping for new clothes. It is not surprising that the shape of the abdomen is addressed during almost half of all new patient consultations with the plastic surgeon. Changes may occur with pregnancy, with weight gain and loss, and with any abdominal surgery, which may disrupt the muscular balance and alignment.

Most women store fat in the abdominal wall, which is the space between the skin and the muscles. This fat is particularly unattractive because it effects the waist to hip ratio. Some of us, particularly men, store fat within the abdomen in a structure called the omentum or around the abdominal organs, themselves. The omentum is a fatty apron, which protects and encloses the bowels. Fat in the abdominal wall is amenable to liposuction or liposculpture, but the internal fat is not correctable with plastic surgery. The plastic surgeon must make the distinction between the two fatty placements as a very important diagnostic requirement prior to body contouring surgery. In that regard, post-operative expectations can more realistically be determined and achieved.

When liposuction or liposculpture alone is being considered, the skin of the abdomen must be healthy, with good elasticity. When stretch marks are prevalent, there is indication that the skin has been badly damaged. It will not contract and respond favorably to liposuction alone. However, when the proper indications are met, and the skin is relatively healthy, the results can be very satisfying, sparing the extensive surgery of a tummy tuck or abdominoplasty.

After the female abdominal wall has been stretched through pregnancy or opened during surgery, very often, the musculature does not adequately support the internal structures, or the back, and a protuberance (pooch) is noted. In the time following the child-bearing years, often the patient can benefit from muscle repair by permanently attaching the two, central, rectus muscle bellies together. Thereby a flattening of the abdomen is achieved and the waist is reduced in circumference. After these muscles are surgically repaired, the excess skin is removed, resulting in a scar around the umbilicus and in the lower abdomen, often from right hip bone to left hip bone. This surgical process is termed an abdominoplasty and results in a permanent repair of the floppy belly. Most patients will benefit from a good diet and exercise program before and six weeks after abdominal surgery. The better toned, the muscle, the more favorable the repair.

Of course, diet and exercise alone, can greatly improve the abdominal contour, but in those patients whose muscles are severely stretched or have been detached, exercise will not fix the problem. In fact, sometimes, the muscle connections can tear, resulting in a hernia, or weakness, which allows the bowel to protrude through the abdominal wall. Once this defect forms, a surgical repair is necessary to correct the problem. If the repair is performed by a general surgeon, often an abdominoplasty can be offered in conjunction. Regardless of the approach, the best results are found in the person who is fit and properly nourished prior to surgery. The results should last a life time!

MARCIA V. ORMSBY, MD