A ^Retired Plastic Surgeon's Notebook

Tag: abdominoplasty


Tummy tuck t-incision.

October 9th, 2017 — 9:39am

This patient had more muscle laxity that skin laxity. Here she is at 3 months with a very flat tummy. Her scar will fade with time.

I just love doing tummy tucks because this procedure allows me to tighten skin, fix muscle position, remove fat and improve a belly button in one operation.   Usually this can be done with an incision that is admittedly quite long but is where the sun doesn’t usually shine.  But sometimes, maybe 10% of cases, it is necessary to leave a scar in the lower mid-line.  Sometimes a patient really needs a full tummy tuck to correct muscle separation but doesn’t have quite enough skin laxity of remove all of the skin between the pubis and the belly button and in those cases a “t-incision” is necessary.  In most cases, I have a pretty good idea before surgery if I am going to need a t-incision but once in a while I cannot quite get that skin to stretch enough and have to leave a t-incision without prior warning to the patient.   This occurred recently and I had a husband hopping mad at me for the extra scar.  The alternative would have been to make the abdominal skin closure so tight that the patient would never be able to stand up straight again or position the really long horizontal scar quite high which would probably look worse than a nicely healed t-incision.

These intraoperative decisions are very, very difficult and sometimes, quite frankly, agonizing.  I am hoping that this particular patient heals well and her vertical scar becomes a non-issue as is usually the case.  And sometimes I just wish patients and their families could spend a day in my operating room clogs.  It’s not so easy!

Thanks for reading and letting me get that one off my chest!  Dr. Lisa Lynn Sowder

Follow me on Instagram @somdermd and @breastimplantsanity

Body Contouring, Tummy Tuck

MOMMY MAKEOVER A.K.A. MATERNAL RESTORATION

May 14th, 2017 — 7:00pm

motherhoodSeattle Plastic Surgeon Discusses Mommy Makeover on Mother’s Day

Ah, the joys of motherhood! I can wax eloquently about fat little feet, apple cheeks, wet baby kisses and so on but one of the joys I did not expect was a boost in my Plastic Surgery practice, especially my “mommy makeover” patients. Since becoming a mother myself, I speak “mommy” really well. I know first hand the glorious details of feeding, bathing, changing, and schlepping the baby. I can recite the stages of the toddler, the preschooler, the gradeschooler, the tween, the teenager and currently I am becoming an expert on the joys of being the mother of young adults.  

Being familiar with all that being a mother requires makes me much better at counseling patients about the process and timing of a “mommy makeover”.

“Mommy makeovers” usually combine breast surgery (augmentation and/or lift or reduction) with body surgery (usually abdominoplasty and/or liposuction). Most women are healthy enough to have a combination of procedures during one operative session. It is, however, the first couple of post operative weeks that are the most challenging for the patient.

Mommy is used to taking care of everyone but herself. After surgery the Mommy needs to take of only herself. She needs to be “Queen for a Week or Two” and resist the urge to cook, clean, change, wipe, mop, vacuum, load, unload, fold, etc. And if her youngest weighs over 20 pounds, she may not pick him/her up for at least two weeks if breast surgery was done and for at least six weeks if an abdominoplasty was done. The little one can crawl into Mommy’s lap for a cuddle but NO HEAVY LIFTING for Mommy. This also applies to the dog.

It’s very important to for patients to discuss these issues with their families. I’ve had a few ladies who have underestimated their recovery time, have done too much too soon and have turned what should be a relatively comfortable and relaxing recovery into a very sore and frustrating one.

So, calling all mothers interested in a “mommy makeover”: Plan ahead and get your husband and your children and your friends on board. Make a sign for your bedroom door. “DO NOT DISTURB – MOMMY RECOVERING”.

Body Contouring, Breast Contouring, Breast Implants, Breast Lift, Breast Reduction, Mommy Makeover, Plastic Surgery

Progressive Tension Sutures in Tummy Tuck – well worth the extra 15 minutes

May 20th, 2014 — 8:10pm
Progressive tension sutures secure the abdominal fat pad to the muscle.

Progressive tension sutures secure the abdominal fat pad to the muscle.

Seattle Plastic Surgeon explains why she uses progressive tension sutures in her tummy tuck patients.

I saw a patient today for a tummy tuck consultation.  She had spent quite a bit of time researching tummy tucks on the Internet and had a lot of questions about my technique.  I went down her list of questions with her and answered them as best I could.  Her last question, “do you use progressive tension sutures?”, was the first time I have had a patient ask me about that particular part of the procedure.  My answer was a resounding YES!!!

Progressive tension sutures are also called quilting sutures or mattress sutures.  These stitches secure the underside of the abdominal fat pad to the abdominal muscle layer.  They serve several purposes.  They take tension off the incision line which can result in more favorable healing and scarring.  They close off the potential space between the abdominal fat pad and the muscle and help prevent fluid (a seroma) from accumulating.  Drains can come out much sooner:  after 2 – 4 days instead of after 7 – 10 days.  These stitches also help the patient remember not to twist or turn in the first weeks after a tummy tuck because those actions will cause a little twinge.

I have been using progressive tension suture ever since I attended an instructional course in this topic taught by Drs. Harlan and  Todd  Pollock.  My rate of post-operative fluid collections (seroma) went from about 25%  to (honest to God)  ZERO.   This addition to my abdominopasty adds about 15 minutes of operating time but has reduced the time and hassle of draining seromas after surgery.   It’s a good investment in my time.  Every time I see either Dr.  Pollock at a medical meeting, I thank him for introducing me to this very, very useful technique.

Thanks for reading!  Dr. Lisa Lynn Sowder

 

Body Contouring, Mommy Makeover, Tummy Tuck

Downton Abbey – those corsets remind me of tummy tuck surgery

March 11th, 2013 — 11:16am

Seattle Plastic Surgeon riffs on how those Downton Abbey women stay so slim and what it all has to do with the modern day tummy tuck.

A tummy tuck is a little like having an internal corset.

A tummy tuck is a little like having an internal corset.

The ladies of Downton Abbey spend a lot of time having their corsets laced up by their maids – and it’s always right before they go down for dinner.  No wonder they all stay so slim.  Who can overeat when laced up tight?

And this brings me to a recent study about weight loss in ladies who have had a tummy tuck.  This is a common observation in my practice but I had never before seen it reported in the plastic surgery literature.  It seems that the internal corset that is part of most tummy tuck operations results in automatic portion control just like an old fashioned corset does.

Just another great thing about tummy tuck.  You get to wear your corset 24/7 and you don’t even need a maid!

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Now That's Cool, Obesity, Tummy Tuck, Wardrobe Observations

Woman inherits her mother’s plastic surgery fund.

November 8th, 2012 — 12:31pm

Seattle Plastic Surgeon discusses a very thoughtful mother’s last wishes.

“To my daughter, I leave $$$$$ for the purpose of plastic surgery.”

One question I always ask when a patient is thinking about having a plastic surgery procedure is “why now?”    The answer can be very interesting and often very relavent.  Here are some answers I have received over the years:

  • I’ve always wanted to do this but my husband wouldn’t let me and now we have split up and I can do what I want.
  • I’m old enough to make my own decisions now.
  • I saw a photo of myself at my son’s graduation and was shocked when I saw my double chin.  I didn’t think it was that bad.
  • I flipped a house in Ellensburg and have the money.  (This was, of course, before the real estate crash.)
  • I finally have my kids through school and can spend the money on me instead of them.
  • I’ve worked so hard to get down to and stay at this weight and now I want to do this as a reward.

Recently I received an totally unexpected answer to this question.  My prospective patient had recently lost her  mother after a long illness.  In the last few days, the mother confided in her daughter that she had put aside some money for a face lift.  The mother was a fan of plastic surgery having benefited from a breast reduction years earlier.  She wanted to make sure her daughter used this money for plastic surgery, specifically a mommy makeover.  That mother knew that everytime her daughter slipped into her swimsuit and enjoyed her surgical result, there would be a smile and a “Thanks Mom”.

Thank you for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Breast Contouring, Financial Issues, Mommy Makeover

Rectus Diastasis Explained

September 18th, 2012 — 10:45am

Seattle Plastic surgeon thinks a picture is worth a thousand words in explaining what she does with the muscle during an abdominoplasty a.k.a. tummy tuck.  

Check out these drawings of the abdominal wall.  The one on the left shows what I see during an abdominoplasty a.k.a. tummy tuck.  The white area in the middle is the fascia (it looks and feels like packing tape) connecting the two rectus muscles on either side.  With pregnancy and sometimes weight gain, the muscles get separated and the mid-line becomes very weak and the abdominal tone decreases.  This separation is called rectus diastasis which translates into separation of the rectus.

During abdominoplasty a.k.a. tummy tuck, the surgeon peels up the fat and skin layer and exposes this stretched out area.  Then stitches are placed in the fascia where it meets the rectus muscles and used to pull the edges  back together.  These stitches accomplish what exercise really cannot.  Exercise may strengthen the muscle but it does not move the muscle back into a normal position.   

Maybe this explains why I prefer the term adominoplasty to tummy tuck.  The former acknowledges the repair and reshaping that takes place with this operation.  The latter makes it sound like just a quick nip and tuck.   It’s not!  It’s a real operation but one well worth the recovery for the vast majority of patients.

Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Mommy Makeover, Tummy Tuck

Do I get a new belly button?

September 12th, 2012 — 2:29pm

Seattle Plastic Surgeon blogs about a common tummy tuck question.

The belly button does not move, but everything around it does.

I do alot of tummy tucks and patients often have questions about what happens to their belly button.  There is a common misperception that somehow we “move” it.    We don’t “move” the belly button but we move everything else.

At the beginning of a tummy tuck, and incision is made around the belly button and it is released from the skin and fat that surrounds it.  It remains attached to a stong band that runs between the two rectus muscles.   That means that NO, I can’t drop it on the floor!  (A common worry with tummy tuck patients).

Then the lower incision is made and the abdominal fat and skin is peeled up to and beyond the belly button.  Then the fat and skin is pulled down with the patient flexed a bit at the waist and the excess is excised, usually the fat roll between the pubis and the belly button.

The belly button is then brought out through a little incision in the remaining fat and skin and stitched into place.   Then the lower incision is closed. 

So the belly button see’s very little action during a tummy tuck.  It just sits there awaiting its new home while everything else is being thinned,  tightened and excisied. 

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Tummy Tuck

Improved posture – another benefit of tummy tuck.

September 6th, 2012 — 2:45pm

Seattle Plastic Surgeon observes that many of her tummy tuck patients have improved posture after surgery.

These waistline close up photos show marked improvement in this tummy tuck patient’s posture.

Tummy tuck is one of those great operations that improves both form and function.

Removing the excess skin and fat makes the torso look better but tightening the muscle layer makes the torso function better. 

This before and after photo shows this very clearly.   On the left, the patient had lordosis a.k.a. a sway back.  On the right, after surgery, her lordosis is almost gone.  The tightened abdominal muscles are now working better to support her back. 

Also, many patients who have low back pain prior to surgery find that they have much less pain after surgery. 

The abdominal muscles are important for back support.  Crunches may help but if the abdominal muscles have been separated by pregnancy, a tummy tuck may be necessary to get them back in the correct position. 

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Now That's Cool, Tummy Tuck

Pregnancy after tummy tuck?

August 28th, 2012 — 10:19am

Seattle Plastic Surgeon discusses one of life’s little surprises.

I have seen 2 patients in the past week who had babies after having had a tummy tuck.  These were surprise pregnancies and both patients had been concerned about 1) the effect of their surgery on their baby and 2) the effect of their baby on their surgery. 

The post tummy tuck abdomen is perfectly capable of s-t-r-e-t-c-h-i-n-g and there is no evidence that the tightened abdomen  interferes with pregnancy. 

If after delivery, the abdomen does not return to a satisfactory shape, re-tightening can be done but in my two patients, their tummies snapped back into shape after a couple of months and a lot of crunches and no re-tightening was needed.    

Soooooo……………………if you have a tummy tuck and then get a little surprise, make an appointment to see me a couple months after delivery and I’ll take a look and let you know if re-tightening is indicated.  Make sure to bring the little surprise package in with you.  We all love babies in my office!

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Mommy Makeover, Tummy Tuck

Fat Necrosis: it looks and sounds worse that it really is.

August 24th, 2012 — 9:52am

Seattle Plastic Surgeon explains fat necrosis.

Fat necrosis often gets much, much better with a little tincture of time and usually does not require reoperation.  It occurs most frequently in overweight patients who have a thick layer of fat.

     Recently I re-operated on an abdominoplasty patient of mine for fat necrosis.  The term, fat necrosis, sounds so awful that I am compelled to blog about this uncommon and totally manageable problem that can occur after any surgery that removes and/or rearranges fat. 

     Fat necrosis occurs when the blood supply to the fat is inadequate.  The fat cells die and as they die they release fatty acids and other chemicals that causes inflammation and swelling and sometimes pain.  Usually fat necrosis presents as a non-tender lump but in my patient’s case, the area was quite painful. 

     Fat necrosis can look a lot like a wound infection to the patient.  Diagnosis is made by evaluating the patient for other signs of infection such as fever or chills and examination of the surgical site.   Fat necrosis has a very doughy texture.   It feels just like bread dough under the skin and is rarely very tender.

    In most cases the lump shrinks over time and ends up as a firm little lump that many patients just ignore,  If it is a bother, the lump can be excised under a local anesthetic through a small incision.  

       The lady I re-operated on had an area of fat necrosis the size of a small plum.  Two days after removal, she felt like a million bucks and is on her road to a quick recovery from this “lump in the road”. 

    

  Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Breast Reduction, Obesity, Postoperative Care, Tummy Tuck

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