Q: Dr. Eppley, Do you do or work with an OB/GYN who will do both the tummy tuck and partial hysterectomy during the same operation.
A: It has been historically common to do a hysterectomy and a tummy tuck at the same time for the obvious convenience of patient recovery and the access that a tummy tuck incision provides for the hysterectomy procedure. I have done it numerous times with various Ob-Gyn surgeons. That is still done today although not quite as commonly due to economic considerations. Now that hospitals are very conscious and diligent about collecting complete fees for the elective tummy tuck portion of the combined procedure (OR and anesthesia costs of which you will be responsible not your insurance) it becomes critical to look at the cost differences of having these procedures done together or separately. Depending upon the facility (hospital) the combined costs may be relatively minor compared to doing them separately or could be thousands of dollars more if done together in a hospital compared to having them staged apart. (tummy tuck done in a private facility)
Having good experience combining these procedures, we do know what that differential can be based on our own private plastic surgery center. I will have my office pass along that cost differential to you so you can see of such a combined procedure makes good economic sense for you.
Dr. Barry Eppley
Q: Dr. Eppley, I have had lumbar spondylolisthesis from birth. I had gastric bypass to help with weight on my lower back. I didn’t lose the 100lbs requested to get tummy tuck but the lumbar pain is still horrible every day and night. Can insurance cover a tummy tuck as medically necessary ?
A: The only way to know whether insurance will cover any plastic surgery procedure is to send in a pre-determination letter with photos and wait to receive a written response. The size of your abdominal overhang must meet very specific physical criteria and documented medical symptoms to qualify for medical coverage. As a general rule, I would not be optimistic. Most insurances turn down every request for any form of an abdominoplasty no matter how big it is or what symptoms that it is associated with it.. Send me some pictures of your abdominal area and I’ll tell you what I think your chances are based on my experience.
Dr. Barry Eppley
Q: Hello, I have several questions regarding cosmetic surgery. First off I want to say I am a single mom of four wonderful children but they have destroyed my once nice looking tummy. But I HATE how I look. I have suffered an eating disorder since my first child being born, to the point I was approx. 90 lbs and I am 5′ 5″. I still do not eat right as I am petrified that I am going to gain weight and make my stomach even bigger. I am also a full time student so I know I cannot afford surgery. There is simply no way. Is there ANYTHING I can do? I hate the way I look, I hate to take showers, I hate to be seen by my fiance naked!!! I literally HATE my body. I currently weigh 135 lbs. So I have done very well maintaining weight. I am at a loss as to how can I rid myself of this awful belly? Please help!!
A: Unfortunately, the short answer is that only surgery can offer any help. After multiple pregnancies, your abdominal wall has been irreversibly changed. The abdominal muscles are no doubt separated along the midline and are lax which accounts for the protruding appearance of your belly despite being at a good body weight. In addition, the overlying skin has been stretched beyond its elastic limit as evidenced by stretch marks. All you can do with your weight is keep the fat layer thin but that will not change your skin and muscle of the abdominal wall. Perhaps one day you will be able to have the tummy tuck surgery that can provide the solution that you are looking for.
Dr. Barry Eppley
Q:I have had a c section with my son and I have no feeling toward the bottom of my belly. I have lost 52 pounds but still over weight. I am so frustrated but I think the only thing that will work is plastic surgery. Based on my readings, it looks like liposuction and a tummy tuck will do the trick. What has been your experience with the amount of improvement that thees two procedures can do?
A: Your question is a bit of a loaded one but the answer is in most cases very well. In fact so well for some people that it can be considered a ‘waistline’ miracle. This may seem a bit of an overstatement but for many tummy tuck patients it is not. The sheer removal of a full-thickness piece of skin and fat (either above or below the belly button) does something that no diet and exercise program ever could for someone who has lost a lot of weight. (50 lbs count as a lot!) When this skin and fat removal is combined with liposuction around the waistline and into the back, significant mid-trunk reshaping is done.
Already having a C-section scar (with numbness) and the extra skin created by your weight loss makes the consideration of a tummy tuck a fairly easy one as there are no viable alternatives. It is hard to predict how many inches may be lost around your waistline but it is fair to say at least 2 to 3 inches and maybe more. As impressive as the frontal change may be, I am always excited to help create the narrowing of the waistline by aggressive flank and back liposuction.
Dr. Barry Eppley
Q: I have a prominent ‘apron’ and it’s getting difficult to navigate. I had twin girls last year and would just like to have a lap to hold them in. I am not expecting to be a size six overnite but I just need to get rid of this extra baggage. I have read about the operation ‘abdominal panniculectomy’ and it sounds exactly like what I need. I would like to have that operation but just want to be sure it it safe since I have a young set of twins. What complications have you seen with this operation and how quickly does one recover?
A: The abdominal panniculectomy is essentially an amputation operation of the overhanging apron. It should not be confused with its cousin, an abdominoplasty or tummy tuck. While they are seemingly similar procedures as they do recontour the abdominal wall, how it is done and what the final result looks like is different. The goal of a panniculectomy is to get rid of the overhang, not to create a slim waist or flat stomach. That simply is not possible given the large anatomy of the abdominal pannus. Getting rid of the pannus will improve back and knee pain as well as skin hygiene underneath the skin flap. In most panniculectomies, it is best to eliminate the belly button (umbilicus) so there is less potential for wound healing problems after surgery.
The most common complications after abdominal panniculectomies are fluid collections (seromas) and wound healing problems of the incision. They are so common it is fair to say that 100% of panniculectomy patients will experience them. Most of them they don’t require further surgery to solve but sometimes they do. Major medical problems, such as blood clots, pneumonia or heart problems, are not common. But most panniculectomy patients are often overweight and may have other accompanying medical problems. This is why a good medical work-up before surgery with approved clearance by your doctor is very important.
It is best to think of complete recovery after a panniculectomy as taking up to four to six weeks.
Dr. Barry Eppley
Q: I have had 2 c-sections and they were emergency so they cut me the “old” way- and my abs have never recovered. So my main question would be, what areas will show the differences of before and after? It seems like I currently have 2 “tubes” around my belly. The top where my abs used to be (and even when I have lost a lot of weight still seemed to appear puffy) and then my belly button kind of creates a line that goes into the bottom innertube. The idea of a tummy tuck in my head will smooth everything down so I would not have these 2 rolls of fat around my waist as well as the fat that is on my back. Does that sound right?
A: I think you have hit the general concept right on the head. You are right for two specific reasons. First, to get rid of what is not desired between your belly button and the pubic region, it has to be cut out. That is the definition of a full tummy tuck, a horizontal excision of skin and fat that goes just above the belly button. Secondly, the only way to unravel the excess tissue around the belly button is to allow the skin and fat above it to be stretched down over it, again the definition of a full tummy tuck. The only concept you have in error is the rolls of fat along your waistline and into your back. A tummy tuck will not remove those, only liposuction will. That is why most tummy tucks incorporate liposuction into the flanks area as well to avoid the dreaded ‘muffin tops’ afterwards if it is not done.
Dr. Barry Eppley
Q: Hi, I am in the military and am unable to make tape or weigh ins. I had two c-sections and my stomach looks like I am still pregnant. I am also having trouble passing my sit ups. I will not be able to be promoted until I am able to make at least tape and pass my fitness test. I have tried everything to lose the weight from my tummy but I haven’t had any luck. Not even basic training has helped slim my tummy. I am desperate to do something and I think a tummy tuck may be the only answer. How long does it take to recover from this procedure?
A: This is a tummy story that I have heard quite often in my Indianapolis plastic surgery practice. Women often come in for a tummy tuck (abdominoplasty) when they have exhausted all of the conventional options for trying to make it look better. Most women do view a tummy tuck as a last ditch effort.
When you have suffered the ravages of pregnancy, no amount of dieting or exercise will improve stretch out loose skin and muscles. The protruding floppy stomach is not just a ‘fat’ problem. It is tissues that have been irreversibly damaged. While I think it is prudent to get in the best shape as possible before undergoing a tummy tuck, those efforts will not repair the tissue damage which exists.
While a tummy tuck is a wonderful body shaping operation, it should be considered major surgery. With major surgery comes a significant recovery. While recovery can be defined different ways, complete recovery that would allow one to perform strenuous activities will take six weeks for most people.
Dr. Barry Eppley
Q: I am interested in getting a tummy tuck. I have had two children and do not want any more. I can not get rid of this lower stomach pouch no matter what I do. A tummy tuck would do the trick but I am concerned about the scar. I am Hispanic and I am afraid I might scar badly. My c-section scar looks great so I seem to scar well. Will my tummy tuck scar look the same? I know it will be longer but will it look so fine and narrow?
A: While there are many factors that influence how a scar will ultimately look, one of the most important is that of tension. How tight is the wound on closure. A wound closed under tension will usually develop a scar that is somewhat wider than one that is not.
The concept of wound tension is what differentiates the c-section vs an abdominoplasty scar. C-sections are closed under absolutely no tension. They literally fall together loosely because of the expanded abdominal skin. This is why they usually look so good no matter how or by whom they were closed. A tummy tuck, however, is quite a different story. It is closed under considerable tension and requires the closure skills and training of a plastic surgeon to get a scar that may approximate that of a c-section. A good c-section scar is not necessarily a good predictor of what a tummy tuck may look like.
While scar outcomes are not always predictable, darker pigmented skin may widen and hyperpigment more than skin with less pigment. This is the risk of an abdominoplasty scar in one of Hispanic origin. Always remember that a tummy tuck is a trade-off, getting rid of that loose skin and fat with a better waistline for a scar. A scar is still an imperfection but, hopefully, one that is more tolerable.
Dr. Barry Eppley
Q : I have a stomach pouch that I just can’t stand. After my third child, I just could not get rid of this loose skin and fat that hangs below my belly button. Despite really watching what I eat and trying to exercise more, it won’t come off. It hasn’t budged at all in the past year. I think I may need some type of a tummy tuck. What is the difference between a mini- and a full tummy tuck?
A: Any form of a tummy tuck, also known as an abdominoplasty, removes skin and fat as well as tightens the rectus muscles. The removal of skin and the muscle tightening is what separates it from a liposuction procedure.
Most types of tummy tucks are horizontal full-thickness excisions of skin and fat down to the abdominal muscle wall. The difference between a mini- and a full tummy tuck is in the amount and location of this cut out. A mini-tummy tuck performs it below the belly button while a full tummy tuck goes above the belly button. As a result, the full tummy tuck has a longer final scar as well as a circumferential scar around the ‘new’ belly button. The mini-tummy tuck just has a less long low horizontal scar only.
A patient’s decision between a mini- and full tummy tuck must consider a variety of factors. How long a scar can one tolerate? How much loose skin and fat does one have? Is there loose and creapy skin around the belly button? Are there any rolls of skin above the belly button? How flat does one want the stomach area to be?
The simplistic answer to deciding between a mini- and full tummy tuck is what the stomach looks like above the belly button. Only a full tummy tuck can smooth out loose skin and fat above that central abdominal marker.
Dr. Barry Eppley