Procedures / Body

Tummy Tuck (abdominoplasty)

This procedure is more invasive than the panniculectomy.  It is a better procedure than an panniculectomy because it allows for more access to and treatment of the abdomen.  During this type of procedure, an incision is made along the belt line.  Dissection is performed to the ribcage and the abdominal muscles are exposed.  The abdominal muscles are tightened from the bottom of the breast plate (xiphoid) to the top of the pubic region.  Excess abdominal skin and fat are removed and the incision is closed.  Most hernias can be corrected through this approach. 

There are four different types of abdominoplasty incisions: horizontal, vertical, inverted T, and under the breast (infra-mammary).  Each incision type has its own benefits. In consultation,  Dr. Katzen will tailor an abdominoplasty incision that addresses your abdominal wall concerns.

Horizontal abdominoplasty

This is one of the most common types of abdominoplasties performed worldwide.  This type of abdominoplasty is best for patients with a significant amount of skin and fat in the lower abdominal region, above the pubic region.  The incision extends from hip to hip and removes excess skin and fat from the top of the pubic region to at least above the belly button (umbilicus).  During this procedure, the abdominal wall muscles are tightened, the excess abdominal skin and fat are removed, any hernias are fixed, and the belly button is recreated.  The resulting scar is a horizontal scar.  Depending on the location of the excess skin, the position of the horizontal incision can be modified.  A very low incision can be created, resulting in what is called a “hip hugger” incision. Alternatively, to achieve a more hour-glass figure, the “hip hugger incision” can be modified such that an incision is made high over the hips and low in the pubic region.  This results in what is called a French cut; the scar is high like a French cut bikini.  This is also called a high-lateral tension abdominoplasty. 

Vertical abdominoplasty

This abdominoplasty is best suited for patients with excess abdominal skin and fat from the xiphoid or sternum to the belly button.  This may also be a good type of abdominoplasty for patients who have already had a horizontal abdominoplasty or panniculectomy and still have excess abdominal skin and fat.  The vertical abdominoplasty incision extends from the breast plate (xiphoid) to the belly button and then to the pubic region.  This form of abdominoplasty removes excess abdominal skin and fat in a vertical dimension.  Just like the horizontal abdominoplasty, abdominal skin and fat are removed, the abdominal wall muscles tightened, any hernias are fixed, and the belly button is recreated.   The resulting scar is a vertical scar.  This type of abdominoplasty is also very useful in the creation of an hour-glass figure.  This abdominoplasty truly brings in the sides and leads to more curves over the hips.  

Inverted T abdominoplasty

This abdominoplasty combines both the horizontal and vertical abdominoplasty.  This abdominoplasty not only removes excess skin and fat from the central abdomen in a horizontal fashion, but also a vertical fashion.  Similar to the horizontal and vertical abdominoplasty, skin and fat are removed, muscles tightened, and the belly button repositioned.  This procedure allows for more removal of skin and fat than the traditional horizontal or vertical abdominoplasties alone.  The resulting scar is a in the shaped of an upside down letter “T”.   

Under the breast (infra mammary)

This abdominoplasty is best suited for patients who have excess skin and fat of their upper abdomen.  This type of abdominoplasty is not used as frequently as the horizontal, vertical, and inverted T.   The main benefit of this procedure is that the scar is hidden.   

The Consultation

You and Dr. Katzen will examine your abdomen to determine which areas of your abdomen you feel need to be corrected.  During consultation, Dr. Katzen will review with you the different types of abdominoplasties.  You and Dr. Katzen will plan an incision type that best fits your body.  Often, abdominoplasties are covered by insurance.  To obtain insurance coverage, one must document rashes, difficulties keeping the skin clean and free from infection.  Dr. Katzen can review with you the likelihood of insurance approval. 

The Procedure

Most abdominoplasties take between 3 to 4 hours.  Because the length of the incision for an  inverted T incision is much longer than the standard abdominoplasty, this surgery takes about 4 to 5 hours.  Dr. Katzen only performs surgery with board certified anesthesiologist in a board certified surgery center or hospital.  Before the surgery, markings are placed were the incisions are planned.  The abdomen is then sterilized and draped.  Once the patient is completely asleep, incisions are made.  Dissection is carried through the abdomen and excess abdominal skin and fat are removed.  The incisions are then closed with sutures. You will wake up with an abdominal binder in place.   Typically, you will spend 1 to 2 hours in the recovery room.  After the recovery room, you may be allowed to go home or spend the night with a nurse either at a surgery center or a hospital.  An abdominal binder is worn for several weeks to flatten the scar and minimize swelling.    Depending on work type, most patients are able to return to work approximately 10 to 14 days after an abdominoplasty.