Abdominoplasty can also involve liposuction for a contoured waist - as long as it is safe!

Karen M. Horton, MD answers:  

Can liposuction and tummy tuck be done at the same time?

Abdominoplasty has the goals of removing excess skin and fat from the lower abdomen, tightening the abdominal wall contour, and bringing the rectus abdominis muscles back together in the midline.

On the other hand, liposuction simply removes excess fat in areas where it is deposted in excess.  Sometimes, these two procedures are combined for the most aesthetic result. However, this must be done in the safest way possible, without creating additional risks.

I usually perform the abdominoplasty portion first.  This removes most of the lower abdominal and pubic area fat by direct excision, and liposuction is not needed for these regions.  I then evaluate whether there is any additional fat remaining that may be appropriate for liposuction - for instance in the flank and/or upper abdominal regions.

Of course, other areas of the body such as hips, inner or outer thighs are often addressed at the same time as an abdominoplasty, as complimentary procedures.

Next, if considering liposuction to enhance the abdominoplasty procedure, I will infiltrate the tumescent solution into the remaining abdominal regions.

Tumescent solution functions to temporarily constrict the blood vessels in the area and decreases the risk for bleeding and bruising with suctioning of fat. If any of the abdominal skin appears to have a compromised circulation, then I will stop here and not perform liposuction, to avoid the risk of wound healing problems.

However, if the abdominal skin appears to be healthy and pink, without any circulatory compromise, I may also perform a careful and limited amount of liposuction, usually to the flanks and possibly upper abdomen and/or pubic area at that time.

In Plastic Surgery, healing is based on having a good circulation to the tissues. It is always wise to do the safest procedure and avoid complications, rather than power ahead and risk "doing too much" at one time!  Safety first!

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.

Full "tummy tuck" closure with DIEP flap breast reconstruction... A good idea?

"It is possible to do rectus plication with DIEP flap donor site closure for a full abdominoplasty result"

Karen M. Horton, MD answers: Possible to do full tummy tuck while doing diep flap procedure?

I understand that the diep flap benefit of a real 'tummy tuck' is not covered by insurance. Is it reasonable to ask for the cost of a full tummy tuck (sewing together muscles, etc.) while the surgeon is performing a diep flap procedure? My surgeon seems very reluctant to even discuss outlying procedures such as abdominoplasty and liposuction, which I believe are both necessary to achieve the best final results. If I'm willing to pay for these procedures out of pocket, I don't know why my surgeon won't discuss them. Any insight appreciated.

By Karen M. Horton, MD - San Francisco Plastic Surgeon

When the DIEP flap (deep inferior epigastric artery perforator flap) is used for microsurgical breast reconstruction, usually a small split is made in the muscle fascia (thick layer of collagen over top of the rectus abdominis muscles) to dissect out the blood vessels used for transplantation of skin and fat from the tummy to the breast.

Usually, the fascial split is simply closed, and the overlying anterior abdominal wall (sheet of skin and fat over the muscles of the trunk) is pulled tighter and closed, resulting in a tummy tuck scar.

It IS possible to perform rectus fascial plication (corsetting of the rectus abdominis muscles of the abdominal wall towards each other in the midline AT THE TIME of DIEP flap donor site closure.
However, doing so may change the pressures inside the abdominal cavity (i.e. on the stomach, intestines, diaphragm, etc) and may increase the risk of complications to the flap circulation in the short term. The worst case scenario would be to perform cosmetic steps during surgery and to lose the flap altogether!

Performing a full tummy tuck closure with the DIEP flap is something I HAVE performed successfully on a number of occasions, but patients must be very carefully selected and we would all have to be willing to accept an increased risk for complications.

I am currently reviewing my results on this combined procedure and will be presenting my work at upcoming meetings and in the form of a scientific paper, to be published on my website.

Often, the best solution is the simplest. On the day of your DIEP flap, it is usually best to focus only on microsurgical success. "Touch-ups" can be done any time in the future, including liposuction contouring of the abdomen (done in most of my patients) together with their nipple and areolar reconstruction, and/or rectus fascial plication, if needed.

See the photographs below of an example of rectus fascial plication done either at the time of DIEP flap donor site closure.  Trust your Microsurgeon to make the best decision for you, and to ensure a SAFE and SUCCESSFUL breast reconstruction as the #1 goal!

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.
www.womensplasticsurgery.com