Transcription:

Melanie Cole, MS (Host): UAB Medcast is an ongoing medical education podcast. The UAB Division of Continuing Education designates that each episode of this enduring material is worth a maximum of .25 AMA PRA Category 1 credit. To collect credit, please visit uabmedicine.org/medcast and complete the episodes post-test.

Abdominoplasty is one of the most commonly formed aesthetic procedures and has undergone a significant evolution over the past several decades. My guest is Dr. Brad Denney. He’s an assistant professor and double board certified plastic surgeon at UAB Medicine. Dr. Denney, pleasure to have you with us as always. Tell us a little bit about tummy tucks and liposuction, abdominoplasty. What's different now? What are you doing different than maybe 20 years ago?

Brad Denney, MD (Guest): First of all, I think it’s important to know who to consider for a tummy tuck. That’s one thing—People hear the terms tummy tuck and abdominoplasty and they're basically one in the same. Someone who may benefit from a tummy tuck or abdominoplasty is someone who’s had children and they want some improvement in their abdominal contour and in the aesthetics of their abdomen. Because very commonly after pregnancy ladies develop what’s in the medical terminology as rectus diastasis. That’s where the six pack muscles widen because the baby pushes on the stomach. Then after the baby’s born, things don’t come back together the way they were before pregnancy. So a tummy tuck or an abdominoplasty takes care of actually three things. It takes care of any excess fat deposits and we do that by liposuction. It takes care of the rectus diastasis because we will suture those abdominal muscles back together, and then it takes care of any excess skin that may have occurred from this phenomenon. We do that by excising the excess skin. All together that results in improvement of the abdominal contour and the abdominal aesthetics.

Now the tradeoff for that is, of course, we have to do a scar. The scar is typically placed where the bikini line is. So we try to put it low enough where the scar is not noticeable say in a bikini. In terms of how we have done things differently and how advances that we’ve made, we used to not do this procedure combined with liposuction. However, now it is very common to combine a tummy tuck or an abdominoplasty with liposuction because that allows us to taper or feather down the local fat deposits that are seen on the flanks and therefore improving the aesthetics of the abdominal silhouette.

Host:   So do you feel that doing both together is gonna give you the patient, give the patient the best results? How do you determine whether to do them both or just one or the other?

Dr. Denney: Most of the time we do liposuction and abdominoplasty at the same time. However, there are some patients who may not need the liposuction. The liposuction just treats those focal excess fat areas particularly in the flanks and it an be used to decrease the thickness of the layer of skin and fat of the abdominal wall. There are some patients who don’t need this, who don’t need the liposuction because quite frankly they may not have a lot of fat to liposuction, but they may have the rectus diastasis that I mentioned as a result of pregnancy. In that case, those patients often need what is referred to in kind of the general public as a mini or a mini tummy tuck or a mini abdominoplasty. That is where the incision within the bikini line is much shorter than the traditional abdominoplasty. The abdominal skin and fat is elevated off of the rectus muscles, the rectus diastasis is corrected by a suture repair, and then any excess skin—which is usually minimal—is removed. In that situation because the patient does not have excess local fat deposits, liposuction’s not necessary.

Host:   Dr. Denney, is this an option for obese patients or previous bariatric patients? Can a high body mass index cause complications you might not otherwise see?

Dr. Denney:   That is a great question. I think that is important for everyone, patients, to know that tummy tucks and abdominoplasties and liposuction, these are not weight loss procedures. Weight loss procedures are gastric bypasses. Tummy tucks, liposuction, these body contouring procedures are exactly that. They are body contouring procedures. They are not weight loss procedures. In fact, in order to be a good candidate for these procedures, you need to be at your ideal body weight or have a BMI less than 35. That is for several reasons. Number one, if you are at your idea body weight or if your BMI is less than 35, you will have a better aesthetic result following liposuction or an abdominoplasty. Number two, complications following surgery are much less when you are at your ideal body weight or if you have a BMI of less than 35.

A high BMI correlates with a higher risk of complications. These complications can be anything from a DVT or pulmonary embolism to wound dehiscence and problem with wound healing. DVT and pulmonary embolism is something very important to consider with this operation. Because we are tightening the abdominal muscles, we are increasing the pressure on venous blood flow return to the heart. This puts the patient at higher risk for blood clots or DVTs which could eventually become pulmonary embolism in which the worst case scenario can be fatal. So on all our patients we risk stratify them for that risk. If they are at a high enough risk based on something what's called the Caprini score then we will actually keep them on Lovenox injectables at home for up to a month at home after surgery. So achieving an ideal BMI or an ideal weight prior to these operations is very important.

In terms of massive weight loss patients, these patients are absolutely candidates for an abdominoplasty. The difference being is several. One, not only do we want them to be at their ideal body weight or a BMI less than 35, but we also want them to be at least 12 to 18 months out from their gastric bypass which usually correlates to having their weight stable for six months. The reason being is if they're still actively losing weight and we put them through surgery they're at a higher risk for wound healing complications. The other reason is they get a better result aesthetically once they're at their stable weight. The major difference in an abdominoplasty and someone who’s had massive weight loss versus someone who has not is the incision may tend to be longer or larger because we have to excise a larger amount of skin due to the excess skin that develops due to the massive weight loss.

Host:   Thank you so much for that answer. What a comprehensive answer that was. Tell us a little bit about some of your outcomes, and what can a patient or referring physician expect post-operatively?

Dr. Denney:   Outcomes are excellent. Abdominoplasty has one of the highest patient satisfaction scores of plastic surgery. In terms of return to work, not off work. Something that’s hard for some patients is a lot of these patients have just finished having children. That’s one thing. If they want to have a tummy tuck, they should do so knowing that they're done having children because we don’t want to tighten the abdominal muscles and then they decide to have another child. It makes undergoing pregnancy more difficult. After surgery I tell patients to take two weeks off of work. They can't lift anything more than five pounds for four to six weeks. They’ll also be kind of hunched over when they're walking for about a week or so because we’ve tightened the skin at the bikini line. So it’s going to be a little tight there, but eventually after about a week or so they're walking upright again. In terms of referral to our team, we have clinics at the Kirkland clinic and at our Mountain Brook office as well. Those can be generated through 871-4440 or 205-801-8500.

Host:   Do you have some final thoughts which you’d like other providers to know about when it’s important to refer if they have patients that are questioning having abdominoplasty, questions about it, what would you like them to know?

Dr. Denney:   I think the best timing to refer a patient in terms of weight loss is if the patient has had their weight stabilized for more than six months and if their BMI is less than 35. For those who are not massive weight loss patients but those patients who have completed childbirth and they have expressed interested in obtaining a more aesthetic abdomen and improving their abdominal contour then I think that’d be the best time for referral.

Host:   Thank you so much Dr. Denney for joining us. A community physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST. That was another episode of UAB Medcast. For more information on resources available at UAB Medicine, please visit our website at uabmedicine.org/physician. Until next time, this is Melanie Cole.