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.
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.
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!
There’s nothing that makes me wanna holler much more than an anatomically perfect patient for tummy tuck who smokes!
Last week I saw two patients in one day who were both absolutely anatomically perfect patients for tummy tucks. They were both done with child bearing, they were both thin and both had abdominal muscle separation and loose jelly belly skin and they both had c-section scars. This kind of patient makes me almost droll at the thought of how straight forward their surgery would be, how much improvement they would have and, most of all, how happy theywould be with their surgical result.
That was the ectacsy part of the consultation and now for the agony part. Both of these patients were long time and dedicated smokers. And that made them very, very poor candidates for tummy tuck regardless of their favorable anatomy.
The issue with smoking is the damage that smoking does to blood vessels. With many procedures such as tummy tuck, face lift, breast lift and some body lifts, the blood supply of the skin is stressed because the skin must be peeled up for a distance either to remove extra skin or to alter structures under the skin. Peeling the skin up cuts many, many small vessels that provide circulation to the peeled up area and that area is then dependent on a secondary blood supply for post-operative healing. In a smoker, that secondary blood supply is not reliable and the chance for the peeled up skin dying is much higher than a non smoker. We surgeons have a fancy name for things that die – necrosis and it’s a word I loath using in describing a post surgical wound in my post-operative notes.
So I had to deliver the two smokers that bad news that I could not operate on them until they were non smokers for at least three months and even then, they are still at increased risk for healing problems. I am sure I am not the first doctor to tell them they should quit smoking but maybe, just maybe, if they want than tummy tuck enough, they will finally find the strength to kick the habit.
Seattle Plastic Surgeon finds (and fixes) umbilical hernias in about 20% of her tummy tuck patients.
I do a lot of abdominoplasties a.k.a. tummy tucks and I fix a lot of umbilical hernias.
It's not an "outie'. It's a hernia but I'm here to help.
Here’s how I approach this very common problem:
During surgery, I carefully exaimine the umbilicus (that’s belly button in normal speech) to feel if there is any weakness in the abdominal wall. Sometimes the weakness is obvious like in the photo, but often it is not. If I think there is a hernia, I will incise the umbilicus from the center to the 6:00 position and take a look at the abdominal wall underneath. If there is a hernia, it shows up as a little or not-so-little blob of fat that is poking out from the inside to the outside. I coax the little fat blob back into the inside and put 1 – 3 permanent sutures in to repair the small hole in the abdominal wall. Then I stitch up the belly button incision and proceed with the rest of the surgery.
Most of these little hernias are asymptomatic meaning they do not bother the patient. So why do I fix them? Abdominoplasty increases the pressure inside the abdomen just as a tightening procedure would be expected to. This increased pressure can make the hernia worse and an previously asymptomatic hernia can become a problem. The other reason is that patients usually prefer an “innie” and fixing the hernia turns an “outie” into an “innie”.
Now you know yet another one of my secrets. But don’t try it at home. Thanks for reading. Dr. Lisa Lynn Sowder
Seattle Plastic Surgeon recommends a WALKER for recovery from tummy tuck and body lift surgery.
Years ago I did a body lift on a patient who had lost over 100 pounds. She advised me to advise other patients to consider getting a walker for post surgical recovery. She found it so much easier to get up and putter around like we ask our patients to do the very first day after surgery.
Patients who are able to be up and about are much less likely to develop problems with blood clots or areas of lung collapse after surgery. These can both be very serious which is why we never like a patient to take to bed and not move after surgery. It’s not that we like to see patients suffer any more than necessary, we just don’t want any complications.
A patient may feel a little silly using one of these for a week or so but it will make recovery faster and safer and even easier. I’ve seen walkers at second hand stores and even new, they aren’t terribly expensive or maybe there is a family member who has access to one.
Keep an open mind and consider getting a walker for your recovery.
Seattle Plastic Surgeon blogs about spitting stitches a.k.a stitch abscesses a.k.a. a real pain for both patient and surgeon
Healing after surgery in most cases is uneventful. (Uneventful is a good thing when it comes to surgery and flying.) But sometimes uneventful healing can be interrupted by a stitch abscess which always looks way worse than it actually is.
Spitting stitches can occur whenever stitches are left in after surgery. In plastic surgery, we often close incisions just under the surface of the skin with stitches that dissolve over several months. If one of these stitches is a little too close to the skin surface, or works its way up towards the surface, it can cause a stitch abscess which is the skin’s reaction to a foreign substance (in this case the stitch). This is a lot like having a splinter in your foot or finger. It won’t get better until the splinter is removed. The same for a stitch abscess. It won’t get better until the stitch is removed. If you have had surgery and have a little area like in the photo above, give your surgeon a call and make an appointment to be seen. In the meantime, put some warm, moist compresses on the area and don’t freak out! It will be okay!
In most cases, a gentle probing with some sterile tweezers locates the offending stitch and it can be easily removed and the abscess resolves quickly. Sometimes, I will put a patient on antibiotics for a week or so if the inflammation is pretty wide spread or the patient feels lousy and/or is running a fever.
Back in the old days when silk and cotton sutures were used in the deep layers, patients could spit a stitch decades after surgery. Fortunately that is really rare these days although I have had a few patients myself spit permanent stitches years after surgery. It’s just one of those things that can happen but once the suture is removed, healing occurs quickly. Learn more here.
Too old for a tummy tuck? Not if you are really healthy.
Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder answers your questions.
Today I was asked “how old is too old for a tummy tuck”. Well, as with most about everything I do, it depends.
My oldest tummy tuck patient in recent memory was sixty-six and vigorously healthy, as in Danskin Triathlon healthy. She hated her lax skin and finally saw the dismal reality that one cannot exercise their lax skin away.
I did a tummy tuck (abdominoplasty) on her and she had an uneventful recovery. Her only regret is all that time she spent doing crunches!
So if you are a woman of a certain age and in excellent health, you are likely a good candidate for a tummy tuck. If on the other hand, you are obese, hypertensive and diabetic, it’s not worth the risk.
If you have a question about plastic surgery, shoot me an email (sowder@eplasticsurgeons.net) and I’ll try to blog about it.
Seattle Plastic Surgeon shares her dog toy wisdom.
My aussie/border collie/snapping turtle, Stella, just loves her Henrietta and Earl chew toys. Henrietta emits a high pitched squeal when chewed. Earl produces a realistic flatus-like sound. Stella, Henrietta and Earl make for some great hilarlity – for about 30 seconds.
Henrietta and Earl do, however, have some redeeming qualities in that they are very useful for obesity education.
Henrietta has a problem with external obestiy. Her excess fat is mostly external and distributed kind of all over – her hips, back, chest, upper thighs and tummy. This fat is unsightly but not much of a health issue.
Earl, on the other hand, has the dreaded internal belly fat. Earl, who has an inappropriately elevated level of self esteem, will say, “It’s muscle, not fat. Feel it, baby, it’s hard.” Well, it’s not muscle, Earl. It’s belly fat and it puts Earl at risk for diabetes, high blood pressure, stroke, heart attack, etc.
Henrietta’s fat is best addressed with weight loss but it can also be addressed with breast and body contouring surgery. Earl’s fat on the other hand can only be addressed with weight loss. Surgery cannot remove Earl’s internal fat although Stella is doing her best to chew it off.
Thanks for reading! Easily asmused Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder
An article in the Seattle Times today confirmed that Seattle has had one of the wettest, coldest springs in recorded history. My Vitamin D level is probably undetectable. But……..
I still love it here and here is why. Earlier this week I was at the annual meeting of the American Society for Aesthetic Plastic Surgery (www.surgery.org) and got a little taste of what patients in some other parts of the country want in the way of plastic surgery. When it comes to breast implants, it’s “go big or go home”. Ditto for buttocks. Ditto for lips. With liposuction, it is the six pack look for women. Some of these patients after surgery reminded me of some comic book heroines.
I love having patients who have a healthy and realistic idea of what the beautiful human form ought to look like. Almost all my patients share my idea that it would be nice to come out of surgery looking like it could have – on a very good day – occurred in nature.
Maybe my low Vitamin D is just making me cranky, but I just don’t like that totally fake look and (as further proof of an ever loving God), neither to 99% of my patients.
@lisalynnsowder
