Extended Tummy Tuck (Abdominoplasty)

When it comes to the different types of body contouring surgical procedures, the main surgery that comes to mind is the abdominoplasty, more commonly known as a tummy tuck.

However, there are numerous types of tummy tuck procedures, including:

• Mini Tummy Tuck
• Standard Tummy Tuck
• Extended Tummy Tuck
• Fleur De Lis Tummy Tuck
• Open Book Tummy Tuck™

In this article, we will explore the Extended Tummy Tuck, and how it differs from a standard Tummy Tuck. We will also cover the healing process, potential risks, and how to select a qualified surgeon who can treat you. By shedding light on the surgical components such as incisions and muscle tightening, we can better appreciate the complexity and potential benefits of this reconstructive surgery.

What is an Extended Tummy Tuck?

An extended tummy tuck is a variant of the standard tummy tuck (abdominoplasty) that targets the abdominal region to remove excess skin, tighten the abdominal muscles, and reduce skin laxity typically after massive weight loss or following pregnancy. Unlike the standard tummy tuck, this surgical procedure includes a longer horizontal incision that extends beyond the hips, towards the back, allowing for a more extensive removal of loose skin and a greater degree of reconstruction.

Ideal candidates maintain a stable weight and understand the commitment to recovery time, which restricts strenuous activities for six weeks post-surgery to ensure proper healing.

This reconstructive surgery demands a thorough consultation with a plastic surgeon to ensure the optimal approach to achieving desired results.

What is the purpose of any Tummy Tuck?

A tummy tuck is a body contouring procedure aimed at addressing a number of issues, including:

• Excess abdominal wall skin
• Fatty abdominal wall apron
• Rectus divarication (muscle damage)
• Ptotic (droopy) mons region
• Small umbilical and abdominal wall hernias

These issues are common following massive weight loss or pregnancy.

The purpose of this surgical procedure is to address these issues and thus reconstruct the abdominal wall. The primary goals include:

• Restoration/reconstruction of the natural contours and tighter appearance of the abdomen.

• Improved comfort and aesthetic outcome, particularly in cases where skin laxity interferes with daily activities or clothing choices.

• Reinforcement of weakened or separated abdominal muscles, resulting in a more toned and functional abdominal wall.

In order to achieve these results, then scars will be necessary. Furthermore, the results should not be compromised for the sake of making the scar smaller/shorter. Greater contour improvements typically require more (longer) scars.

At the same time, the scars need to be placed as low as possible to be easily concealed within normal pants and underwear.

Patients seeking a tummy tuck should be at a stable weight, as weight fluctuations can affect the long-term results of the surgery. The healing process requires a significant recovery time, with a gradual return to physical activity and strenuous activities. It is critical for patients to follow post-surgery guidelines closely to ensure optimal healing and to maintain the results of their tummy tuck surgery.

Differences between a Standard Tummy Tuck and an Extended Tummy Tuck

The main difference is the length of the scar. A standard tummy tuck typically involves a scar from hip to hip and low down at the pubic level.

In contrast, as its name implies an extended tummy tuck has a scar which extends further out towards the hips and flanks. This is designed to remove more excess skin and to ensure a smoother contour and no ‘dog ears.

By having a longer scar Dr Dona can achieve several key goals:

• Ensures the scar can be placed as low as possible.
• Ensures as much excess skin from the upper abdominal wall can be removed.
• Ensures maximal amount of excess skin can be removed from the sides (other than performing a Belt Lipectomy).
• This ensures a smoother lateral hip and lower abdominal wall contour.
• All of the above measures ensure he does not give a patient a dreadful ‘dog ear’, which is often a sign of poor surgical planning.

In light of this, as far as Dr Dona is concerned, most patients having a tummy tuck should be having some form of an extended tummy tuck. Too often he will see a patient that has been treated elsewhere where the surgeon has tried to create a short standard tummy tuck scar, and the result has been that the scar is too high and/or the patient has terrible contours with dog ears.

Other key differences:

• Scope: Extended tummy tucks target a larger area of the abdominal wall and often include the flanks and sides, providing a more comprehensive body contouring outcome.

• Recovery Time: Both surgeries require significant recovery time, minimising physical activity and avoiding strenuous activities for weeks after surgery.

• Aesthetic Outcome: Patients can expect a more extensive aesthetic change with an extended tummy tuck, particularly if they have loose skin around the hips.

In summary, extended abdominoplasties provides a more dramatic aesthetic and functional result than standard tummy tucks, ideal for individuals with significant excess skin following substantial weight changes.

What are ‘dog ears’?

Dog ears is the name given to an abnormal protrusion that can be found at the end of a scar. They would typically arise when a surgeon has removed an ellipse of skin, and when the wound has closed, one or both ends of the scar can point out, or protrude, and thus create an unsightly contour.

To understand why these would occur is to consider then consider a piece of cloth that you need to tailor for an outfit. If you were to remove a slither of that material and then sew it closed, if the angle of the segment is too great, then as you bring the edges together it will start to protrude.

Therefore, to minimise the abnormal contour, you need to ensure the angle at the apex of the segment of material you remove is minimal, so that when it is closed the surface remains as smooth as possible.

In a tummy tuck, if you try to make the scar short in length, but at the same time want the scar as low as possible and to remove as much vertical skin as possible, then you will have a problem when you remove that lower abdominal wedge of skin. Specifically, the angle of the defect you create at the hip level is so great that when you close the wound you will almost certainly end up with an unsightly dog ear. So, you have given the patient a short scar, but the contours are terrible.

Therefore, to avoid this problem you need to extend the scar beyond the hip level, as far as needed to ensure you can remove more skin and create a very acute tapered angle of your segment of skin you remove so as to avoid a dog ear.

An extended tummy tuck provided by Dr Dona thus achieves our key objectives:

• Ensures the scar can be placed as low as possible.
• Ensures as much excess skin from the upper abdominal wall can be removed.
• Ensures a smoother lateral hip and lower abdominal wall contour.
• All of the above measures ensure he does not give a patient a dreadful ‘dog ear’, which is often a sign of poor surgical planning.

Who are the ideal candidates for this procedure?

Ideal candidates for an extended tummy tuck are individuals seeking significant body contouring in the abdominal region due to the presence of excess skin and laxity that often results from massive weight loss or post-pregnancy changes. To undergo this surgical procedure, one must have a stable weight, as weight fluctuations can affect the aesthetic outcome and potentially compromise the results.

Candidates should have:

• A positive outlook and realistic expectations.

• Good physical health, with no underlying conditions that impair healing.

• Excess abdominal skin that extends around the hips.

• Loose skin and weakened abdominal muscles that require tightening.

• A commitment to maintaining a healthy lifestyle post-surgery.

It’s important for candidates to understand the recovery time, which will involve weeks of limited activity and the necessity of temporary drainage tubes to aid the healing process. The procedure is not a substitute for weight loss or an appropriate exercise program and is typically recommended for those who have already reached a stable weight and are not planning significant weight changes, including future pregnancies, which could undo the results of the tummy tuck surgery.

What are the key components of the surgery?

An extended tummy tuck surgery is comprised of several critical components to ensure a successful outcome. Initially, a comprehensive evaluation of the abdominal region is performed to determine the extent of skin laxity and the condition of the abdominal muscles. During the surgery, the key steps are:

1. Incision: A long, curved horizontal incision is made, extending from one hip bone to the other, often reaching around to the flanks and lateral buttock region. It is extended as far as necessary with the patient laying on their back to ensure that the scar can be placed as low as possible and create a smooth contour.

1. Skin and Fat Removal: Through this incision, Dr Dona is able to remove excess skin and fat, to maximally recontour the abdominal wall.

1. Muscle Tightening: The underlying weakened abdominal muscles are sutured together, tightening them and providing and thus providing significant functional benefits.

1. ‘Repositioning’ the Belly Button: Because of the extensive skin removal, the belly button is repositioned (more correctly it is re-inset into the abdominal wall skin) to maintain a natural look.

1. Drainage Tubes: Typically, drainage tubes are placed to collect excess fluid and aid the healing process.

1. Closing the Incision: Dr Dona closes the incision with three layers on internal sutures, ensuring the scar is as discreet as possible, following the natural contours of the body.

Post-operative care is also a critical component, involving specific guidelines to reduce the risk of complications and optimise the healing process. 

Pre-operative consultations

Prior to undergoing any surgical procedure, including an extended tummy tuck, pre-operative consultations are a critical component of the process. During these consultations, patients and surgeons discuss the procedure in detail, setting realistic expectations and ensuring that the individual is well-informed.

• Medical Evaluation: Assessing the patient’s medical history to ensure they are a good candidate for surgery, discussing any potential risks and complications.

• Expectation Setting: Aligning the patient’s aesthetic goals with what is surgically feasible, and ensuring they have realistic expectations regarding the results and recovery time.

• Instruction Provision: Advising the patient on pre-surgery preparations, such as achieving a stable weight, cessation of smoking and avoiding certain medications, which can affect the surgery and recovery process.

• Discussion of Recovery: Providing information on the post-surgery healing process, including how to care for incisions, manage pain, and recognising the limitations on physical activity during recovery.

It’s crucial for patients to be thoroughly informed and prepared, contributing significantly to the success of the surgery and satisfaction with the outcomes.

Types of Anesthesia used

General Anaesthesia: all patients of Dr Dona undergoing any form of tummy tuck will have a general anaesthetic. Basically, this means that you are looked after by a specialist anaesthetic doctor who puts you fully asleep before the surgery starts and are only woken up after the surgery is completed. The specialist anaesthetist will also look after all your pain management ensuring you are kept as comfortable as possible throughout the recovery process.

Detailed surgical procedure

The extended tummy tuck is a complex body contouring procedure designed to address significant skin laxity and weak abdominal muscles typically following massive weight loss or prolonged weight fluctuations.

Prior to the surgery, patients must have achieved a stable weight to ensure optimal aesthetic outcomes and minimise the risk of complications. It’s essential that individuals have realistic expectations and understand that while the extended tummy tuck can dramatically improve body shape, it is not a substitute for weight loss or a healthy lifestyle.

During the pre-surgery consultation, Dr Dona will explain the procedure, recovery time, potential risks, and post-surgery care. It’s also the ideal moment for patients to ask questions and voice any concerns they may have. The surgical plan is tailored to the individual’s specific needs and goals to enhance both functionality and aesthetics.

Patients should prepare for a significant healing process, which includes a period of limited physical activity and diligent wound care.

Incisions and technique

An extended tummy tuck surgery involves a horizontal incision low down at the pubic level that extends beyond the hips, typically from one side of the hip bone to the other, and sometimes around the sides. The length and shape of the incision can vary based on the amount of excess skin and the desired outcome.

A second incision around the belly button is necessary to reposition it appropriately after the removal of excess abdominal skin. This is a critical step to maintain the natural appearance of the abdomen post-surgery.

Dr Dona will utilise specialised techniques to minimise scarring and to contour the body strategically. The incision sites are carefully closed with three layers of internal dissolving sutures.

Dr Dona may employ liposuction as part of the extended abdominoplasty to enhance the contouring effects along the upper flank region.

 Removal of excess skin and fat

The primary goal of the extended tummy tuck is to remove excess skin and fat in the abdominal region and flanks. After making the incisions, Dr Dona separates the skin and fatty tissue layer from the underlying abdominal wall muscles. He will then determine how much excess skin can be safely removed to ensure a minimal tension, and thus safe, wound closure.

In conjunction with skin removal, targeted fat pockets may also be removed or reshaped via liposuction. This process ensures a more contoured profile and can assist in defining the waistline.

 Tightening of abdominal muscles

For the majority of patients, the extended tummy tuck also involves the tightening of stretched and damaged abdominal muscles. This condition, known as diastasis recti, is common after pregnancy or substantial weight gain and loss. Dr Dona will maximally tighten and repair the abdominal muscles along the midline, restoring their original positioning and functionality.

This muscle tightening is a crucial component of the procedure, as it provides structural support to the abdominal wall and further defines the waist. The surgical correction not only enhances the aesthetic outcome but also can improve core stability and reduce lower back pain caused by muscle weakness.

Following the tightening, all incisions are closed, dressings are applied, and proper post-operative care is initiated to support the healing process. Recovery time varies between individuals, but most are advised to refrain from strenuous activities for six weeks after surgery to ensure a safe and successful recovery. 

What are the potential risks and complications?

A detailed list of potential complications can be found here: https://www.drdonaplasticsurgery.com.au/body/tummy-tuck/#potential-complications

While an extended tummy tuck can significantly improve the appearance of the abdominal region by removing excess skin and tightening the abdominal muscles, it is important to be aware that it is a major surgical procedure that comes with potential risks and complications.

Some of the common risks associated with an extended tummy tuck, also known as extended abdominoplasties, include scarring, infection, and anesthesia-related complications. Additionally, issues such as bleeding, formation of blood clots, fluid accumulation, poor wound healing, numbness or changes in skin sensation, and dissatisfaction with the aesthetic outcome can occur. Weight fluctuations post-surgery can also impact the longevity of the results.

Understanding these risks and strictly following the surgeon’s post-surgery guidelines are essential steps for promoting a smoother healing process and minimising potential complications.

Scarring

An unavoidable consequence of tummy tuck surgery is scarring. A long horizontal incision is made across the lower abdomen, typically extending from hip to hip, which means the resulting scar will be quite extensive. The appearance of the scar varies from person to person, depending on individual healing processes and genetic predispositions to scarring. Compression garments and various post-operative treatments will help to minimise scar visibility. Patients must also follow their surgeon’s specific instructions on wound care to ensure optimal healing and scar formation. Scars take at least 12-24 months to fully mature, but they never disappear.

Infection

Post-operative infection is a risk associated with any surgery, including extended tummy tucks. Symptoms of infection may include excessive redness, warmth, swelling, or drainage at the incision site, and can be accompanied by fever. Infections can usually be managed with antibiotics, but in some cases, additional surgery to remove infected tissue may be necessary. To minimise this risk, Dr Dona takes precautionary measures such as administering antibiotics before and after surgery. Furthermore, adherence to proper post-surgery wound care and hygiene is crucial for patients to prevent infections.

Anaesthesia-related risks

Anaesthesia enables patients to undergo a tummy tuck without feeling pain during the procedure. However, it also poses its own set of potential risks and complications. These include but are not limited to allergic reactions, respiratory issues, blood pressure fluctuations, and in rare cases, cardiac events. A thorough pre-surgery review of the patient’s medical history and close monitoring during the procedure play a vital role in minimising these risks. It is imperative that patients disclose their full medical history, including any history of adverse reactions to anaesthesia, to the surgical team prior to the procedure.

Patients considering an extended tummy tuck must carefully consider these potential risks and complications and weigh them against the benefits they expect to derive from the surgery. As per any medical treatment, a risks versus benefits assessment needs to be undertaken to determine is this surgery is the right choice for you. 

Recovery process

All patients are provided with detailed verbal and written pre-and postoperative instructions. It is vital that you adhere to these guidelines to maximise the chance of an excellent surgical outcome.

The recovery process after an extended tummy tuck – a more extensive variation of the standard tummy tuck surgery – demands patience and adherence to post-surgical instructions to ensure optimal healing and aesthetic outcome. Following this body contouring procedure, patients can expect a recovery time that spans several weeks. The immediate days after surgery involve rest and limited movement to allow the body to begin the healing process. Drainage tubes will be placed to eliminate excess fluid, and they are usually removed before being discharged from hospital.

It’s common to experience discomfort, swelling, and bruising during the initial post-operative phase. Pain is manageable with prescribed medications, and swelling will gradually subside over time. To support the abdominal region and minimise swelling, patients are required to wear a compression garment for six weeks after surgery. Patients should plan to take time off from work and arrange for assistance with daily activities.

Around the fourth to sixth week, patients usually start feeling more themselves, but complete internal healing may take several months. It’s crucial for patients to maintain full compliance with all post-operative instructions and appointments with Dr Dona and his team to monitor the healing process and to optimise your outcome.

Post-operative care guidelines

Post-operative care is an essential component of the extended tummy tuck process. Patients will be given specific guidelines to ensure proper healing and to reduce the risk of complications. These typically include:

• Wound Care: Keep the incision area clean and inspect it regularly for signs of infection.

• Medications: Take all prescribed medications, including antibiotics and pain relief, as directed.

• Garments: Wear the compression garment as advised to decrease swelling and support the newly contoured abdominal area.

• Hygiene: Gently shower as instructed, avoiding direct water pressure on the incision site.

Adherence to these care guidelines is critical for reducing the risk of infection and promoting a smooth recovery. 

Activity restrictions

Some general guidelines to follow:

Walking – Walking is encouraged to promote circulation but should be kept light and brief. Gradually increase walking as guided by your body comfort levels.

Driving – You should not consider driving for the first 2 weeks after surgery. After this time, you should only drive if you feel safe doing so.

Returning to work – You will be able to return to a light office or desk work environment at 3 weeks post-op. Light hospitality work may be possible at 4 weeks. Any employment that involves heavy lifting or straining must be avoided for 6 weeks.

Returning to normal – At 6 weeks post-surgery you can gradually return to normal training and physical activities.

Consider the first 6 weeks after surgery as RECOVERY, and after 6 weeks consider all activities as REHABILITATION. Undertake any physical activities that you wish to do and be guided by your comfort and strength which will slowly improve.

Back to Normal – It will take at least 6 months before you are feeling “normal” and able to do all the things you could before surgery.

When to seek medical advice

Post-surgery, it’s essential to recognise signs that warrant medical advice. Patients should contact their surgeon if they experience:

• Signs of infection (increased redness, warmth, worsening pain, or discharge from the incisions).

• Persistent high fever over 38.5°C.

• Sudden swelling or pain, which may indicate a blood clot.

• Unusual or foul-smelling discharge from the incision or drainage tubes.

• Difficulty breathing or chest pain.

Immediate medical attention can mitigate serious complications and ensure the safety and success of your recovery after an extended tummy tuck.

Expected results and benefits

An extended tummy tuck is a plastic surgery procedure designed to transform the abdominal region by removing excess skin, tightening abdominal muscles, and eliminating stubborn fat deposits.

Results from an extended tummy tuck:

• Enhanced Comfort and Functionality: Reduces discomfort caused by excess skin, like rashes or chafing, and can improve posture.

• Tightened Muscles – Improved Functionality: Specifically aids in repairing and tightening the abdominal wall, beneficial after childbirth or significant weight loss.

• Excess Skin Removal: Effectively removes hanging skin that is often unaffected by exercise and diet. This is both an aesthetic and functional benefit.

• Improved Body Contour: Creates a more aesthetically pleasing profile.

• Long-lasting Results: By maintaining a stable weight and adhering to a healthy lifestyle, the results can be enduring.

Long-term outcomes and maintenance

Long-term outcomes and maintenance post-extended tummy tuck are contingent upon several critical factors. Individuals who maintain a stable weight without significant weight fluctuations tend to preserve the aesthetic outcomes of their body contouring procedure. The repositioning or reconstruction of the belly button during the surgical procedure remains intact if patients keep a consistent weight. Adhering to a healthy lifestyle with regular physical activity can enhance and prolong the results.

Post-surgery, patients should follow Dr Dona’s post-operative instructions to ensure proper healing of the abdominal muscles and skin. It is essential to allow sufficient recovery time and avoid strenuous activities for the recommended period after surgery. Typically, full healing might take several months.

Loose skin or skin laxity due to aging or subsequent massive weight loss after an extended tummy tuck might necessitate additional surgery.

How to choose a qualified Plastic Surgeon

When selecting a qualified surgeon for an extended tummy tuck or any other plastic surgery, it is imperative to follow stringent criteria to ensure a safe procedure and satisfactory results. Here’s how you can choose the right surgeon:

1. Specialist Qualifications:
   Ensure the surgeon is a Specialist Plastic Surgeon
2. Experience and Skills:
   Look for a surgeon whose practice focus is largely body contouring surgery and has a long-standing track record of tummy tuck surgeries.
3. Before and After Gallery:
   Review their gallery of before and after photos to assess some of the results they have been able to achieve and ensure they provide surgery to many different body types and offer custom body contouring surgery procedures.
4. Consultation:
   During your consultation, evaluate their approach to maximal contour enhancement and scar minimisation, and inquire about the surgical techniques they employ for optimal healing and the least visible scar.

A surgeon’s expertise directly influences the healing process, the final functional and aesthetic enhancement, along with the appearance of scars. Do diligent research and choose wisely for the best tummy tuck results.

Also, the right surgeon should not only have the necessary qualifications but should also make you feel heard and reassured throughout your surgical process.