Q & A: Tummy Tucks and Liposuction

Q: I’m totally confused after two consultations for the Tummy Tuck procedure: one physician suggested liposuction during the procedure and the other said this can cause problems. Also, will I need a vertical scar during the procedure? 

A: Regarding Liposuction with the Tummy Tuck:

• Many feel that liposuction in the upper abdominal area during a tummy tuck can cause poor healing issues above the pubic area.
• Many physicians are willing to do some limited liposuction in the upper abdominal area in a healthy non-smoking patient.
• I prefer limited liposuction above and more aggressive fat removal at the waist with the possibility of a small in office liposuction procedure done down the road if necessary.

Regarding the need of a vertical scar from the umbilicus to the pubic area:

• In the vast majority of patients I feel a vertical scar is not necessary. 
• The patient that may benefit is one that has lost a considerable amount of weight and has skin laxity from top to bottom as well as side to side. 

For more information, please visit my websites: www.ruckermd.com and www.enza.com. Feel free to leave comments and questions below.

Profiles Summer 2012 is here!

Profiles Summer 2012 is here! 

Click here to read on: 

• Spot-free skin
• What's really to blame for aging skin?
• Pelleve wrinkle reduction system
• Mommy makeover
• Can you get a tighter tummy?
• Top running foot injuries in women
• Creating the perfect smile
• Raising the bar with Crossfit

Mommy Makeover

Childbearing can be one of life’s most rewarding experiences, but it can also take a toll on the mother’s body, often causing women to lose their hourglass figures. Each woman is affected differently, with age and genetics playing a significant role in how her body recovers. Even with the assistance of a personal trainer and a proper diet plan, both of which I strongly recommend, many women may find it difficult to get it all back together after pregnancy. This can cause a dilemma for mothers. They may feel guilty for thinking about themselves at a time when they feel they should be focused on their family. Many of our patients find that it’s essential to focus on both.

They want to feel good, look youthful and sexy and regain their self-confidence. They realize that having a positive self-image can also improve their relationships with loved ones.

Mrs. M, now 38, didn’t like her shape after pregnancy. “I lost fullness up top, I had badly stretched skin and nothing was where it was supposed to be, even though I was doing endless sit-ups,” she said. “ I just wanted my body back.”
A Mommy Makeover is a combination of plastic surgery procedures that may include a breast reduction or breast lift (with or without breast implants), a tummy tuck and liposuction. These procedures lift and tighten slackened skin and reduce the unwanted, hard to remove pregnancy fat.

Before

After

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Breast Reduction

This procedure has been helpful for women with large pendulous breasts who have medical problems caused by the excess weight of the breasts, which can often occur after pregnancy. These problems can include:
• Back and neck pain
• Skin irritation beneath the breast
• Skeletal deformities
• Bra strap irritation
• Breathing problems
• Occasional tingling sensation in the hands

The goals of breast reduction are to:
• Make your breasts look balanced when you are wearing a bra
• Regain your younger breast contour
• Reduce the size of the nipple areola to fit the smaller breast size
• Reduce the overall breast size to reduce the associated symptoms and to make the breast proportional to the rest of the body
Breast reduction is performed in a hospital under general anesthetic. Care is taken to make the breasts symmetrical and to preserve sensation to the nipple, as well as, hopefully, the ability to breast feed. Both of these goals are addressed by leaving the nipple areola attached to a pedicle of breast tissue. Through this pedicle run the nerves and vessels that help preserve sensation and a good blood supply to the nipple areola.
All incisions are closed under limited tension, resulting in a smaller breast and areola and a lifted breast contour. We have found that if symptoms are well documented, most of these procedures can usually be covered by insurance. Please visit my website, www.ruckermd.com, to view before and after pictures of breast reduction patients.

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Breast Lift
You’ve nurtured your children, now, your body could use a little help getting back to normal. Stretched and sagging breasts are common after child rearing. The breast lift (mastopexy) has become one of the most requested procedures in plastic surgery, with approximately 100,000 breast lift procedures performed in the U.S. in 2007.

Over time, a woman’s breasts lose their youthful shape and fullness. These changes may be the result of pregnancy, breast-feeding, weight fluctuations, aging and the natural effects of gravity. Heredity can also contribute to breast sagging. Many women are born with poor skin elasticity resulting in a loss of breast firmness.

A breast lift raises and firms the breast by removing excess skin and tightening the surrounding breast to reshape and support the new breast. The nipple areola may become enlarged over time. A breast lift will reduce the areola to place it in better proportion with the newly shaped breast. The goals of the breast lift are to improve a female breast that:
• Sags or is pendulous, but is proportionate with the body frame
• Has lost firmness and skin elasticity
• Has a flatter elongated shape
• Has a nipple and areola that point downward
As with breast reduction, we do not detach the nipple areola complex during a breast lift, in an effort to maintain nipple sensation later. It has been my experience that most patients want to be a “perky ‘C’ cup” after a breast lift. This is an outpatient procedure when performed by itself.

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Liposuction 

After pregnancy, unwanted, fat deposits on the hips, thighs, abdomen and buttocks can be extremely difficult to remove, even with an exercise and dietary program. Liposuction can be performed on any part of the body to remove fat deposits and sculpt a more pleasing contour. This procedure is best for someone of normal weight with good skin tone. Several areas can be reduced at the same time. Because the fat cells are permanently removed, the bulge cannot come back in that place. Your new figure should be a motivation to exercise and be mindful of a healthy diet. Liposuction is usually performed on an outpatient basis under general anesthesia, taking approximately 1-3 hours. Body contouring procedures are considered cosmetic and not covered by insurance.

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Tummy Tuck (Abdominoplasty)

The human body is more like plastic than rubber. Childbirth may leave you with loose abdominal skin and stretched abdominal muscles. The tummy tuck (abdominoplasty) procedure helps to flatten your abdomen by removing excess skin and fatty tissue. Tummy tuck should not be confused with liposuction, although your surgeon may elect to perform liposuction to improve the overall results.
Tummy tuck is the recommended treatment for sagging or projecting lower abdominal wall tissues. Good candidates are women who have muscles and skin stretched by multiple pregnancies, and men and women, who, after massive weight loss, still have excessive fat deposits or loose skin in the abdominal area. The procedure is usually done as an outpatient under a general anesthetic and will take 1-2 hours. 


There are several options for tummy tuck.

Your surgeon will examine you and then discuss your desired results and the anticipated outcome for each.
Complete abdominoplasty. The incision is made in the lower abdominal wall area, from hipbone to hipbone. Excess tissues beneath the umbilicus (belly button) are removed and the scar is hidden beneath the panty line.
Belt abdominoplasty is usually for patients who have lost a considerable amount of weight. The laxity of the skin and fatty tissues occurs on the abdomen and around to the back requiring a circumferential excision of these tissues to get the best result.
Partial or mini abdominoplasty is often performed on patients whose fat deposits are located in a small area beneath the belly button. This procedure can be done in the office with IV sedation.

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What are the risks of having multiple procedures?

Several studies have found that the combined Mommy Makeover procedure was not significantly more risky for the patient than a single procedure would be. It is important to stress that these procedures are best performed by Board Certified plastic surgeons at a fully-equipped surgical facility. I believe that the best way to avoid complications is to select my patients carefully. We try to avoid performing these procedures on patients with any significant medical problems that may compromise their recovery.

The benefits to the patient of performing multiple, carefully selected procedures as opposed to several separate procedures are:
1. A reduced overall time under anesthetic
2. Downtime for recoveries can be combined, especially when time away from work and other responsibilities is an issue
3. Reduced cost for combined use of surgical facilities, 
anesthesia, and medical staff.