It’s not unusual to have a patient come in to my office with a protruding abdomen and ask how much improvement can be obtained with surgery. The answer is, “It Depends!” If the patient is a middle-aged male who has a prominent abdomen with minimal fat that can be pinched, not much surgical improvement can be expected. Weight loss is the answer since the problem is the internal fat around the abdominal organs that must be lost to flatten out the abdomen. Liposuction can only remove fat that is just beneath the skin, not the fat around the abdominal organs. On the other hand, most women and some men with a prominent abdomen can expect improvement with surgery. The degree of improvement depends on three things:
• Is there loose skin? Weight loss, pregnancy, and advancing age with loss of skin elasticity and flattening of the discs in your back are all causes for loose skin. A tummy tuck, with or without muscle tightening, will remove the skin and leave a scar that is usually well-concealed with underwear.
• What is the condition of the muscle? If you lie down and lift your feet off the floor while keeping your legs straight, you can get a sense of what is going on with the muscles of the abdomen. Women who have had children will frequently be able to feel a muscle separation in the center of the tummy, termed a diastasis. This is caused by separation of the two large muscles that give strength to the abdomen. A tummy tuck will allow for sewing of these muscles back together. Another test to check is if you stand upright and tense the abdominal musculature. There should be a firm feel to the abdomen and, if not, surgically tightening the muscles may be of benefit.
• Is there significant fat internally? Generally a BMI of 30 or above indicates that weight loss is needed to maximally flatten the abdomen. To calculate your BMI, go to http://nhlbisupport.com/bmi/bminojs.htm. Many patients who undergo a tummy tuck or liposuction have a BMI over 30. They can expect improvement with surgery, but will usually have some bulging of the abdomen that reflects excess internal abdominal fat that will not flatten with muscle tightening. Many of these patients go on to lose this excess weight after surgery, encouraged to see how much better they look when surgery is completed.
What if a hernia is present? This can produce a bulge that can be repaired at the same time as a tummy tuck. Hernias typically occur around the belly button or in the upper portion of the tummy. If the muscle is being tightened, this muscle repair adds a reinforcing layer to the hernia repair, making the use of surgical mesh unnecessary except in cases of recurrent hernias or very large hernias.
Should you have further questions, please contact my office.
George Sanders, M.D.
