Abdominoplasty - · PDF file Abdominoplasty Definition Also known as a tummy tuck,...

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Transcript of Abdominoplasty - · PDF file Abdominoplasty Definition Also known as a tummy tuck,...

  • OTHER

    “Abdominal Defects.” Medical and Scientific Information On- line, Inc. [cited April 8, 2003]. .

    National Birth Defects Prevention Network. January 27, 2003 [cited April 8, 2003]. .

    Monique Laberge, Ph.D.

    Abdominoplasty Definition

    Also known as a tummy tuck, abdominoplasty is a surgical procedure in which excess skin and fat in the ab- dominal area is removed and the abdominal muscles are tightened.

    Purpose

    Abdominoplasty is a cosmetic procedure that treats loose or sagging abdominal skin, leading to a protruding abdomen that typically occurs after significant weight loss. Good candidates for abdominoplasty are individu- als in good health who have one or more of the above conditions and who have tried to address these issues with diet and exercise with little or no results.

    Women who have had multiple pregnancies often seek abdominoplasty as a means of ridding themselves of loose abdominal skin. While in many cases diet and exercise are sufficient in reducing abdominal fat and loose skin after pregnancy, in some women these condi- tions may persist. Abdominoplasty is not recommended for women who wish to have further pregnancies, as the beneficial effects of the surgery may be undone.

    Another common reason for abdominoplasty is to remove excess skin from a person who has lost a large amount of weight or is obese. A large area of overhang- ing skin is called a pannus. Older patients are at an in- creased risk of developing a pannus because skin loses elasticity as one ages. Problems with hygiene or wound formation can result in a patient who has multiple hang- ing folds of abdominal skin and fat. If a large area of ex- cess tissue is removed, the procedure is called a pan- niculectomy.

    In some instances, abdominoplasty is performed si- multaneously or directly following gynecologic surgery such as hysterectomy (removal of the uterus). One study found that the removal of a large amount of excess ab- dominal skin and fat from morbidly obese patients dur-

    PERIODICALS

    Kurchubasche, Arlet G. “The fetus with an abdominal wall de- fect.” Medicine & Health/Rhode Island 84 (2001): 159–161.

    Lenke, R. “Benefits of term delivery in infants with antenatally diagnosed gastroschisis.” Obstetrics and Gynecology 101 (February 2003): 418–419.

    Sydorak, R. M., A. Nijagal, L. Sbragia, et al. “Gastroschisis: small hole, big cost.” Journal of Pediatric Surgery 37 (De- cember 2002): 1669–1672.

    White, J. J. “Morbidity in infants with antenatally-diagnosed anterior abdominal wall defects.” Pediatric Surgery Inter- national 17 (September 2001): 587–591.

    ORGANIZATIONS

    American Academy of Pediatrics. 141 Northwest Point Boule- vard, Elk Grove Village, IL 60007-1098. (847) 434-4000. .

    GALE ENCYCLOPEDIA OF SURGERY 7

    A bdom

    inoplasty

    KEY TERMS

    Abdomen—The portion of the body that lies be- tween the thorax and the pelvis. It contains a cavi- ty with many organs.

    Amniotic membrane—A thin membrane that con- tains the fetus and the protective amniotic fluid surrounding the fetus.

    Anesthesia—A combination of drugs administered by a variety of techniques by trained professionals that provide sedation, amnesia, analgesia, and im- mobility adequate for the accomplishment of the surgical procedure with minimal discomfort, and without injury, to the patient.

    Gastroschisis—A defect of the abdominal wall caused by rupture of the amniotic membrane or by the delayed closure of the umbilical ring. It is usual- ly accompanied by protrusion of abdomen organs.

    Hernia—The protrusion or thrusting forward of an organ or tissue through an abnormal opening into the abdominal sac.

    Omphalocele—A hernia that occurs at the navel.

    Peritonitis—Inflammation of the membrane lining the abdominal cavity. It causes abdominal pain and tenderness, constipation, vomiting, and fever.

    Short bowel syndrome—A condition in which di- gestion and absorption in the small intestine are impaired.

    Ultrasound—An imaging technology that that allow various organs in the body to be examined.

    Umbilical ring—An opening through which the umbilical vessels pass in the fetus; it is closed after birth and its site is indicated by the navel.

    Enc of Surgery Vol. 1 - 1#1AB51 10/23/03 3:43 PM Page 7

  • GALE ENCYCLOPEDIA OF SURGERY8

    A bd

    om in

    op la

    st y

    Abdominoplasty (tummy tuck) surgery. Portions of the lower abdominal tissues have been removed and the navel reposi- tioned.The remaining skin flaps will be sutured. (Photography by MM Michele Del Guercio. Reproduced by permission.)

    of all plastic surgery procedures. Female patients ac- counted for 97% of all abdominoplasties. Most patients were between the ages of 35 and 50 (58%), with pa- tients under 35 accounting for 20% and patients over 50 accounting for 22%. Eighty-two percent of all plastic surgery patients during 2001 were white, 7% were His- panic, 5% were African American, and 5% were Asian American.

    Description The patient is usually placed under general anesthesia

    for the duration of surgery. The advantages to general anesthesia are that the patient remains unconscious during the procedure, which may take from two to five hours to complete; no pain will be experienced nor will the patient have any memory of the procedure; and the patient’s mus- cles remain completely relaxed, lending to safer surgery.

    Once an adequate level of anesthesia has been reached, an incision is made across the lower abdomen. For a complete abdominoplasty, the incision will stretch from hipbone to hipbone. The skin will be lifted off the abdominal muscles from the incision up to the ribs, with a separate incision being made to free the umbilicus

    ing gynecologic surgery results in better exposure to the operating field and improved wound healing.

    Contraindications

    Certain patients should not undergo abdominoplas- ty. Poor candidates for the surgery include:

    • Women who wish to have subsequent pregnancies.

    • Individuals who wish to lose a large amount of weight following surgery.

    • Patients with unrealistic expectations (those who think the surgery will give them a “perfect” figure).

    • Those who are unable to deal with the post-surgical scars.

    • Patients who have had previous abdominal surgery.

    • Heavy smokers.

    Demographics

    According to the American Academy of Plastic Surgeons, in 2001 there were approximately 58,567 ab- dominoplasties performed in the United States, relating to 4% of all plastic surgery patients and less than 0.5%

    Enc of Surgery Vol. 1 - 1#1AB51 10/23/03 3:43 PM Page 8

  • (belly button). The vertical abdominal muscles may be tightened by stitching them closer together. The skin is then stretched back over the abdomen and excess skin and fat are cut away. Another incision will be made across the stretched skin through which the umbilicus will be located and stitched into position. A temporary drain may be placed to remove excess fluid from beneath the incision. All incisions are then stitched closed and covered with dressings.

    Individuals who have excess skin and fat limited to the lower abdomen (i.e., below the navel) may be candi- dates for partial abdominoplasty. During this procedure, the muscle wall is not tightened. Rather, the skin is stretched over a smaller incision made just above the pubic hairline and excess skin is cut away. The incision is then closed with stitches. The umbilicus is not reposi- tioned during a partial abdominoplasty; its shape, there- fore, may change as the skin is stretched downward.

    Additional procedures

    In some cases, additional procedures may be per- formed during or directly following abdominoplasty. Li- posuction, also called suction lipectomy or lipoplasty, is a technique that removes fat that cannot be removed by diet or exercise. During the procedure, which is generally performed in an outpatient surgical facility, the patient is anesthetized and a hollow tube called a cannula is insert- ed under the skin into a fat deposit. By physical manipu- lation, the fat deposit is loosened and sucked out of the body. Liposuction may be used during abdominoplasty to remove fat deposits from the torso, hips, or other areas. This may create a more desired body contour.

    Some patients may choose to undergo breast aug- mentation, reduction, or lift during abdominoplasty. Breast augmentation involves the insertion of a silicone- or saline-filled implant into the breast, most often behind the breast tissue or chest muscle wall. A breast reduc- tion may be performed on patients who have large breasts that cause an array of symptoms such as back and neck pain. Breast reduction removes excess breast skin and fat and moves the nipple and area around the nipple (called the areola) to a higher position. A breast lift, also called a mastopexy, is performed on women who have low, sagging breasts, often due to pregnancy, nursing, or aging. The surgical procedure is similar to a breast reduction, but only excess skin is removed; breast implants may also be inserted.

    Breast reconstruction

    A modified version of abdominoplasty may be used to reconstruct a breast in a patient who has undergone mastectomy (surgical removal of the breast, usually as a

    treatment for cancer). Transverse rectus abdominis my- ocutaneous (TRAM) flap reconstruction may be per- formed at the time of mastectomy or as a later, separate procedure. Good candidates for the surgery include women who have had or will have a large portion of breast tissue removed and al