The Problem:
Women who have completed their childbearing are often confronted with abdomens that reveal stark evidence of their fertility. The flat, tight abdomen of a teenager has yielded to an abdomen with various accumulations of fat, lax skin, some protrusion and occasional stretch marks. If a caesarian section has been done, there is a scar attributable to that as well. While the childbearing years may be over, there are many future years to enjoy life and to wear a bikini, if possible. Thus, there has been increasing interest in rejuvenation of the abdomen.

How is it performed?
As a result of the advances in techniques, the new mini tummy-tuck with umbilical "float" has been developed. Prior to surgery, the patient is stood upright and outlines of all excess fat pockets made on the patient's skin. The operation is performed on an outpatient basis under "twilight sleep" intravenous sedation, which is administered by a board certified anesthesia physician. In addition to the intravenous sedation, the anesthesiologist will administer an epidural anesthetic, or saddle block, which is commonly utilized for women during childbirth. It is safe and very effective.

In the operating room, a tumescent technique is utilized in which fluid is injected into all the outlined areas to soften the fat and make its removal more precise. Liposuction, utilizing fine instruments, is then performed on all the fat bulges. Fat pockets can be contoured anywhere, from the fold under the breast down to the pubic area and from hip to hip, including the flanks and love handle areas. The goal is to produce a thin and uniform layer of fat over the entire abdomen and flanks.

A horizontal incision is then made just above the pubic hairline in a convenient skin crease. If a horizontal cesarean section scar is present, then the new incision is placed beneath the C-section scar so as to remove it at the same time that the extra skin is removed. The loose skin is then carefully lifted from the underlying muscles. The muscles themselves are surgically tightened so as to flatten the abdomen and take up the slack, lax tissues which were a result of pregnancy. The navel (umbilicus) is then carefully detached from the muscle layer underneath the skin. This frees the skin of the abdomen so that it may be pulled down and tightened. It will allow for tightening of the skin located between the navel and the chest as well. The navel is then "floated downwards" and reattached to the newly tightened abdominal muscles at a point approximately ½ " to ¾ " lower than its original site. This new location is not noticeable at all. At this point, the pubic area, including the mons pubis, which may have settled downwards by gravity and through pregnancy, is lifted up and attached at a higher level to the muscle layer. The remaining skin is then pulled down and excess skin measured and carefully trimmed off. The skin is then sutured to the mons pubis area with multiple dissolving sutures in many layers so that there are no stitches to be removed.

Interesting Additions:
A thoughtful look at a youthful, athletic abdomen reveals certain features. A vertically oriented navel is youthful. A horizontal navel, frequently seen after pregnancy is not youthful. The mini tummy-tuck with umbilical "float" will produce a vertically oriented navel. Also, an athletic and youthful abdomen will often times have a vertical groove extending upward from the navel. Utilizing liposuction, a technique entitled Abdominal Etching, can create this groove. Finally, the mons pubis is elevated to a more youthful position.

What can I expect after surgery?
You will recuperate at home and may experience some discomfort for several days. Pain medication will be provided for you. You cannot shower until the first dressing change, which occurs several days after surgery. There will be some swelling of the abdomen, which takes between 7 and 10 days to resolve. You will be able to walk around on the day after surgery and in fact, this is encouraged. It is estimated you should be realistically able to return to sedentary work within 10-14 days after surgery. Athletic activities may be resumed approximately 3-4 weeks after surgery. There is ongoing healing under the skin, which will require at least another 6 months for resolution. It is common for there to be diminished sensation on the skin of the abdomen; the sensation usually returns slowly over a number of months.

What are the anticipated results?
The operation is designed to provide a smooth, flat, graceful, athletic contour to the abdomen. The small additions such as a groove in the upper midline, a vertically oriented navel and an elevated mons pubis all speak of a youthful, taut abdomen. It is therefore quite possible to wear a low cut bikini after this rejuvenative surgery.

For those who plan additional pregnancies:
Liposuction of the abdomen would certainly be helpful to you. However, it would perhaps be unwise to perform a mini tummy-tuck if future pregnancies are planned, because the pregnancy would undo most of the benefits of the operation.