As we age, many people will gain weight around the abdominal area. This is particularly true after childbearing, when the abdomen is stretches to accommodate a growing new life. When the skin is over-stretched, however, the skin cannot snap back to its original form. The skin has three layers, the epidermis (outer layer), dermis (middle layer), and subcutaneous fat (inner layer). Once the dermis is damaged, it leaves unsightly marks called “striae.” The presence of striae, or stretch marks, is an indication that the overstretched skin has lost its elasticity, and no amount of exercise will cause the skin to revert to its original shape. Sometimes these stretch marks will fade over time, but they cannot be erased through creams or lotions.
In order to remove the excess skin and eliminate the stretch marks, many women will choose to undergo an “abdominoplasty,” or tummy tuck. An abdominoplasty involves resecting the excess skin and striae from the lower abdomen, leaving a permanent scar that is located from hip to hip. Prior to surgery, we advise our patients to bring a bikini bottom that they would like to wear so that we can try to design the scar within the borders of their clothing. If the patient’s body habitus allows it, the scar can be placed low enough to be hidden under their clothing. Furthermore, all scars eventually fade over the years, but some patients have a genetic tendency to scar very well so that their scars are difficult to see. Ultimately, however, patients who undergo an abdominoplasty are accepting a permanent scar in return for an improved shape.
In many women, the changes in the abdominal shape are not just limited to the skin. Often, women also develop an abdominal bulge because the rectus abdominis muscles are pulled apart. The separation of the rectus abdominis muscles is called a “rectus diastasis,” and is due to a thinning of the connective tissue. A rectus diastasis usually leads to weakening of the abdominal muscles, and can make it difficult to lift objects. It can also cause lower back pain, weakened pelvic alignment, and altered posture. Unfortunately, abdominal exercises do not improve the bulge; instead the protrusion usually becomes worse when the abdominal muscles are tensed. In order to correct a rectus diastasis, the stiff wrapping around the muscles, called the “fascia,” are sutured together surgically or “plicated” in an abdominoplasty. The resulting internal corset also has the additional benefit of improving the patient’s waistline.
During an abdominoplasty, the patient’s abdominal skin is dissected off of the abdominal fascia. This allows the plication to be performed to correct any rectus diastasis. In addition, the patient’s belly button, or “umbilicus,” is isolated, and a new opening is created for the umbilicus to come out. Since a large potential space will be created, the patient will need drains after surgery. The drains usually last about 1-3 weeks. Patients should be able to walk immediately after surgery. Depending on how much extra skin and fat is removed, however, and how tight the plication is, patients may need to walk hunched over for a few weeks to allow their skin and fascia to stretch before they can stand up straight again. Sometimes, patients will feel numbness in their abdominal skin, but normal sensation usually returns after several months.