Tummy Tuck Mesh? Most common is a full tummy tuck. This removes loose skin between the pubic area and the belly button, using the skin of the upper abdomen to expand and cover where the skin was removed. The result is a bikini line scar from hip to hip, and a scar around the belly button.
In addition to skin removal and tightening, a muscle separation (called a diastasis) can be repaired and any localized fat can be removed. Liposuction can be added to the sides or adjacent areas if needed. read more on Tummy Tuck Mesh Complications/Abdominoplasty.
Tummy Tuck Mesh
- The newest addition to our list is the tummy tuck with mesh reinforcement of diastasis repair. I introduced this in an earlier blog as part of the Mothers of Multiples (MoMs) Makeover, because the muscle separation is often much wider after twins/triplets pregnancy. We have two excellent options for the mesh: Galaflex (same material we use for the internal bra) and Durasorb. These are soft, strong, and slowly dissolve allowing the body to build a layer of natural tissue for long-term support. Additionally, the mesh allows the waistline to be pulled in wide diastasis repair with mesha bit more.
- A tummy tuck with T-closure is a variation of the full tummy tuck that is done when the upper abdominal skin can’t be expanded enough to cover the lower abdomen while still keeping the scar low. The vertical part of the upside-down “T” fades nicely over time and the rest of the scar is in the usual bikini line. In the picture below, the blue line is where a full tummy tuck would normally be done but the skin in the upper abdomen could not be stretched enough to create a low scar.
- For patients with large weight loss, a variation of the T-closure called the Fleur de Lis tummy tuck is sometimes done. This pulls more skin in from the sides as well as top to bottom, with the vertical scar all the way up to the belly button or higher.
- A mini tummy tuck removes skin from the lower abdomen only, and so does not have any effect on the upper abdomen. It can be combined with liposuction of the upper abdomen and adjacent areas when necessary.
- A mini tummy tuck with umbilical float has the same amount of skin removal, but the belly button (or “umbi”) is detached from underneath allowing access to the upper abdomen. This means that a muscle separation (rectus diastasis) can be repaired all the way into the upper abdomen. The umbi is re-attached, sometimes a little bit lower than its original position. This can give a little bit of smoothing of the skin just above it.
- A reverse tummy tuck is really more of an upside-down tummy tuck, because it removes skin from the upper abdomen and pulls the skin upward. Think of it as a sort of upper mini tummy tuck, because it has no effect on the lower abdomen. The scar is under the crease along the bottom of the breasts, so it works especially well when a breast lift or revision surgery is planned with an incision in that location. A mini version of the reverse tummy tuck removes a crescent of skin below the breasts without connecting the scar across the middle.
- An extended tummy tuck is a full but extended to remove more skin on the sides. This is often done when there has been substantial weight loss. The scar is longer but the benefit is more tightening on the sides.
Abdominoplasty
A tummy tuck — also known as abdominoplasty — is a cosmetic surgical procedure to improve the shape and appearance of the abdomen.
During a tummy tuck, excess skin and fat are removed from the abdomen. Connective tissue in the abdomen (fascia) usually is tightened with sutures as well. The remaining skin is then repositioned to create a more toned look.
You might choose to have a tummy tuck if you have excess fat or skin around the area of your bellybutton or a weak lower abdominal wall. A tummy tuck can also boost your body image.
Why it’s done
There are a number of reasons you might have excess fat, poor elasticity of the skin or weakened connective tissue in your abdomen. These include:
- Significant changes in weight
- Pregnancy
- Abdominal surgery, such as a C-section
- Aging
- Your natural body type
A tummy tuck can remove loose, excess skin and fat, and tighten weak fascia. A tummy tuck may also remove stretch marks and excess skin in the lower abdomen below the bellybutton. However, a tummy tuck won’t correct stretch marks outside of this area.
If you’ve previously had a C-section, your plastic surgeon might be able to incorporate your existing C-section scar into your tummy tuck scar.
A tummy tuck can also be done in combination with other body contouring cosmetic procedures, such as breast surgery. If you’ve had fat removed from your abdomen (liposuction), you may decide to have a tummy tuck because liposuction removes tissue just under the skin and fat but not any excess skin.
A tummy tuck isn’t for everyone. Your doctor might caution against a tummy tuck if you:
- Plan to lose a significant amount of weight
- Might consider pregnancy in the future
- Have a severe chronic condition, such as heart disease or diabetes
- Have a body mass index that’s greater than 30
- Smoke
- Have had a previous abdominal surgery that caused significant scar tissue
Risks
A tummy tuck poses various risks, including:
- Fluid accumulation beneath the skin (seroma). Drainage tubes left in place after surgery can help reduce the risk of excess fluid. Your doctor might also remove fluid after surgery using a needle and syringe.
- Poor wound healing. Sometimes areas along the incision line heal poorly or begin to separate. You might be given antibiotics during and after surgery to prevent an infection.
- Unexpected scarring. The incision scar from a tummy tuck is permanent, but it’s typically placed along the easily hidden bikini line. The length and visibility of the scar varies from person to person.
- Tissue damage. During a tummy tuck, fatty tissue deep within your skin in the abdominal area might get damaged or die. Smoking increases the risk of tissue damage. Depending on the size of the area, tissue might heal on its own or require a surgical touch-up procedure.
- Changes in skin sensation. During a tummy tuck, the repositioning of your abdominal tissues can affect the nerves in the abdominal area, and infrequently, in the upper thighs. You’ll likely feel some reduced sensation or numbness. This usually diminishes in the months after the procedure.
Like any other type of major surgery, a tummy tuck poses a risk of bleeding, infection and an adverse reaction to anesthesia.
How you prepare
You’ll talk to a plastic surgeon about a tummy tuck. During your first visit, your plastic surgeon will likely:
- Review your medical history. Be prepared to answer questions about current and past medical conditions. Talk about any medications you’re taking or have taken recently, as well as any surgeries you’ve had.Tell your doctor if you are allergic to any medications. If your desire for a tummy tuck is related to weight loss, your doctor will likely ask detailed questions about your weight gain and loss.
- Do a physical exam. To determine your treatment options, the doctor will examine your abdomen. The doctor might also take pictures of your abdomen for your medical record.
- Discuss your expectations. Explain why you want a tummy tuck, and what you’re hoping for in terms of appearance after the procedure. Make sure you understand the benefits and risks of the procedure, including scarring. Keep in mind that previous abdominal surgery might limit your results.
Before a tummy tuck you might also need to:
- Stop smoking. Smoking decreases blood flow in the skin and can slow the healing process. In addition, smoking increases the risk of tissue damage. If you smoke, your doctor will recommend that you stop smoking before surgery and during recovery.
- Avoid certain medications. You’ll likely need to avoid taking aspirin, anti-inflammatory drugs and herbal supplements, which can increase bleeding.
- Maintain a stable weight. Ideally, you’ll maintain a stable weight for at least 12 months before having a tummy tuck. If you’re severely overweight, your doctor will recommend that you lose weight before the procedure. Significant weight loss after the procedure can diminish your results.
- Arrange for help during recovery. Make plans for someone to drive you home after you leave the hospital and stay with you for at least the first night of your recovery at home.
What you can expect
A tummy tuck is done in a hospital or an outpatient surgical facility. During a tummy tuck, you’ll be under general anesthesia — which makes you completely unconscious and unable to feel pain. In some cases, you might be given a pain-relieving medication and be moderately sedated (partially asleep).
Before the procedure
There are a number of different procedures for a tummy tuck, depending on your goals and the extent of change you would like to see. During the typical tummy tuck, your plastic surgeon makes incisions to remove most of the skin and fat between your bellybutton and pubic hair in a horizontal oval or elliptical shape. Connective tissue (fascia) that lies over the abdominal muscles is then tightened with permanent sutures.
The amount of excess skin removed and the type of procedure you have will determine the shape and length of the incision. The incision above the pubic hair will be stitched together and will leave a scar that falls along the natural crease within the bikini line.
Your plastic surgeon will also reposition the skin around your bellybutton. Your bellybutton will be brought out through a small incision and sutured in its normal position.
During the procedure you might be given an antibiotic to prevent infection.
The procedure typically takes about two to three hours.
After the procedure
After a tummy tuck, your abdominal incision and bellybutton will likely be covered with surgical dressing. Small tubes might be placed along the incision site to drain any excess blood or fluid.
Members of your health care team will help you walk as early as the first day after a tummy tuck to help prevent the formation of blood clots.
You’ll likely be given pain medication. It’s normal to have swelling in the surgical area.
Drains might be left in place for several days after surgery. Your doctor or another member of your health care team will show you how to empty and care for your drains. You might need to continue taking an antibiotic as long as the drains are in place.
Your surgeon might also prescribe a blood-thinning medication for a short time after your tummy tuck.
You’ll wear a supportive abdominal garment (abdominal binder) for about six weeks after your tummy tuck. This helps prevent fluid buildup and provides abdominal support while you heal. Your doctor will explain how to care for your scar.
Tummy Tuck Mesh Complications
Abdominoplasty is a well-established procedure that consistently ranks in the top 5 most common cosmetic surgical procedures performed in the United States per year. In cases of severe myoaponeurotic laxity some surgeons choose to supplement their procedure with the placement of mesh to reinforce their plication. Some surgeons place mesh on a more routine basis. There is limited data in the literature to substantiate the use of synthetic mesh. This is a case report and review of the literature for the use of mesh reinforcement during abdominoplasty.
Materials and Methods:
A case report is presented, detailing the infectious complications suffered by 1 patient subsequent to abdominoplasty with mesh reinforcement. A thorough review of the literature was performed. Literature was evaluated with respect to the number of patients, age range, type of mesh, method of fixation, follow-up interval, complications, and cosmetic results.
Results:
Four studies were found assessing the use of mesh reinforcement during abdominoplasty. Number of patients was limited, ranging from 18 to 52. Types of mesh included Polypropylene, Prolene, and Vicryl. No infection, dehiscence, or extrusion of mesh were reported. Authors report stable repair with follow-up ranging from 6 months to 54 months in cases involving severe myoaponeurotic laxity only.
Following review of the literature, it is clear that the evidence to support routine placement of mesh during abdominoplasty is lacking. As demonstrated by the case report described, placement of mesh in any procedure puts the patient at risk for undue sequelae. Our recommendations are as follows:
1.
Do not use mesh reinforcement during routine abdominoplasty.
2.
In only the worst cases of myoaponeurotic laxity, consider placing mesh using an onlay technique or in a submuscular layer (if experienced with this procedure), recognizing the limitations of the current literature on this subject. In either case, the surgeon should be aware of the significant risks of complications involved with these procedures, including seroma, umbilical and flap necrosis, as well as infection.
3.
If mesh is placed at the time of surgery, make certain that the patient is aware of the fact.
4.
In cases of wound infection where mesh was placed, have a high suspicion for mesh infection and a low threshold for reoperation.