Your Questions
Your Questions
Q: Dr. Eppley, my mother has a grade 5 abdominal pannus that covers her knees and below and 2 years ago developed a lymphedematous mass and hernia through the abdominal wall. It drains fluid off and on chronically and she has been taking antibiotics chronically off and on for years. She is on Medicare and they have denied coverage for the panniculectomy portion of the surgery, stating they will only do the hernia repair and not the panniculectomy which is coming out to 7000 dollars. Is there any advice you can give to help us appeal this? She has been on South Beach diet for 2.5 years, lost 44 pounds on the diet, and been at a stable weight for many years. She can no longer walk due to the herniated pannus. She has atrial fibrillation and a pacemaker and diabetes (although well controlled on oral hypoglycemics) I believe that leaving the pannus in place poses a significant risk to her to develop infection and a clot or other dangerous complications. I would appreciate any advice you can give. We need to fix the hernia and also want the panniculectomy so she can walk again and continue her diet and exercise program as weight loss may also help her atrial fibrillation problem as well. I cannot believe the insurance company considers this cosmetic in a 74 yr old woman. 🙁
A: It certainly sounds like your mother would benefit greatly by a combined abdominal panniculectomy and hernia repair. But I believe you may have a misconception about how Medicare works. Medicare, a federal program, does not preauthorize or preapprove any surgical procedure. They never have. A surgeon must do the procedure and then wait and see if Medicare will actually approve (pay) for the procedure. When it comes to an abdominal panniculectomy, no matter how medically indicated it might be (and your mother certainly fulfills that criteria), Medicare will almost certainly deny it after it is done. This leaves the patient with the benefit but the doctor will rarely ever get paid and if they do it is pennies on the dollar. An abdominal panniculectomy is a lot of work, risk and after care for little if any reimbursement. A patient may say that this is not their problem but the doctor’s…but it influences the options for many prospective patients. This is because very few plastic surgeons are willing anymore to do such procedures under Medicare. Thus the origin of the $7,000 fee to which you refer must be a cosmetic fee quote to do the procedure, allowing Medicare to pay for the hospital, operating room and anesthesia fess which they are obligated to do. Short of doing it under this fee for service basis, you will have to seek a plastic surgeon who accepts Medicare coverage.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am going through back problems at the moment but didn’t know if it was still ok to get breast enlargement and a tummy tuck. I am already on all kinds of medicines and have back pain but I think I am getting to the end of this, finally. I had worked out and walked four miles a day to loose weight and quit smoking then my back started acting up the tummy tuck and breast enlargement is something I have wanted since I had my three kids which I love dearly but ruined my body. I would like to know how long I should wait, I also have a hernia that they said unless it didn’t hurt all the time then don’t come back until it did . I’m sorry but I just feel like my life is on a complete hold while still wanting to look better and feel better about myself. I have to be at the mercy of all of these other problems before I can have my life back and have these things done to make me feel better about myself. Please reply with an honest answer all of what I am going through now is very heartbreaking so a reply soon would be greatly appreciated. Thank you.
A: While breast and abdominal reshaping can make some dramatic changes in any women who has been through three pregnancies, I have numerous concerns in your case if this is appropriate. Your history and ongoing back pain are concerns as well as what medications you are on. Breast augmentation and a tummy tuck are not a cure/treatment for back pain and may well make it worse in the short-term after surgery. I would imagine that some of the medications you are on are for pain relief, which would make any narcotics needed after a breast augmentation and a tummy tuck less effective. A detailed medical and medication history would have to be assessed to see if such body contouring would be advised. In addition, your hernia repair history is also significant for consideration for tummy tuck surgery. Your surgical records for this procedure(s) would need to be reviewed to determine what type of hernia repair was done and if there is any synthetic mesh in your abdominal wall.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 5’ 5” and weigh 172 lbs. I am considering a tummy tuck to get rid of my belly that is hanging over my pant line. I am not completely sure I am done having children but I want to go ahead and have a tummy tuck anyway. I am tired if carrying around this belly. My question is can I have a tummy tuck under local or something less than general anesthesia? Also if I should have another child in the future will I be able to get by without changing the look of the tummy tuck?
A: To get the best result from a tummy tuck, it really needs to be done under a general anesthetic. A tummy tuck is one cosmetic operation where the option of a local or IV sedation is just not practical and would not even be considered. Any pregnancy that goes to full-term is going to affect the results of any tummy tuck procedure. It is just a question to what degree will the tummy tuck change and how much loose abdominal skin will result. While it is likely that it will not create a complete return to the way you look now with a significant abdominal overhang, some new skin rolls will likely result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, is it possible during a tummy tuck to injure one’s bowels? I am afraid to have a tummy tuck because I don’t want to suffer a major medical problem just because I want a flatter stomach. How close are my bowels to where a tummy tuck is done?
A: While it is common to have some constipation after a tummy tuck, there is no risk of any long-term gastrointestinal tract issues. Only skin, fat and muscle is manipulated during a tummy tuck and there is no chance of inadvertent injury to the large or small intestines. The bowels lies on the opposite side of the abdominal muscles. Repairing a hernia at the time of a tummy tuck poses some risk for those concerns but it is no greater than any other hernia repair. Since pain medication will be needed after a tummy tuck, and that has a known slowing effect on gastrointestinal mobility, women should drink plenty of fluids during their recovery and take a daily stool softener starting a week before surgery as well as continue it afterwards. In short, a tummy tuck may require some significant recovery time but it is not a dangerous surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am going to deliver my third and final baby next month. I already have a c-section and will be getting another c-section for this final delivery. After the delivery of my second child, I saw how much loose skin and stretch marks I had and that never really went away afterwards. I am wondering if I can get a tummy tuck at the same time as my c-section. It just seems like a logical time to do it, kill two birds with one stone so to speak. Is the hardest part getting two doctors to do it at the same time or can my Ob-Gyn just do it?
A: While loose stomach skin can be removed at the same time as a c-section delivery, it is not the best time to do it. The uterus is swollen and prevents muscle tightening and there is still considerable water weight present. In addition, being under an epidural limits how much overall abdominal reshaping can be done. It is far better to wait six months after delivery and try to lose as much weight as possible before having a tummy tuck…the result will be so much better. While there is nothing wrong with having a little loose skin removed during the c-section but that shouldn’t be confused with a real tummy tuck.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am going to have a tummy tuck but I have a question about how the belly button is made. Where does it come from? Is made from skin thrown away from the tummy tuck or is it somehow carved out from the stomach wall? Can you explain it to me how you do it?
A: The belly button is nothing more than a remnant or stalk of scar tissue from the skin down to the abdominal wall. It is never removed during a tummy tuck but rather the skin around it is. The stalk of the belly button is always preserved, it is the loose skin around it and any extra length of oys stalk that is removed. The shortened stalk of the belly button is simply put back by bringing it through the abdominal skin that has been brought down and tightened over it. Reshaping of the belly button is almost always done whether it is shortened or not. The key to a good looking belly button result in a tummy tuck is to shorten it so that the outer skin dips in, the surrounding scar is on the inside, and it has more of a vertical rather than a round shape.It is always better to have a smaller belly button than a larger one as a result of a tummy tuck.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting maybe a mommy makeover. I have 2 kids, tubes are tied and I plan to have no more! I have a terrible big flabby stomach and my breasts are saggy :'( I got pregnant and thought it was a time to indulge. I wanted to have a chubby baby so I ate a lot. Gained almost 100lbs during my pregnancy. In the end my baby wasn’t chubby (weighing only 7lbs 11oz) but I was left with stubborn fat that won’t go nowhere. I don’t want bigger breasts though, my breasts are big enough, I would honestly maybe even like them a cup or more smaller but as long as they sit right on my chest they may just look better with possibly just a lift. I want my stomach flat again though. I am a thicker woman. 5’8″ 230lbs. I plan to lose some weight though (I’m working on it) prior to having these operations done. What would this cost? Could I pay like… $4000 then the rest in payments? Is that offered for operations, as these? How much weight do you think I should be before having this done? I don’t smoke or do any drugs, I drink occasionally but overall healthy, just overweight, or obese, I guess I should say… Please help me to feel better about myself again. PLEASE!
A: Thank you for your inquiry. While I will ultimately need to see some pictures of your body or see you in an actual consultation, let me provide you with a few thoughts/recommendations based on the description of your concerns.
From a breast standpoint, you are describing a classic full breast lift. This will leave most of your breast tissue but will significantly tighten and lift your breasts back up on your chest wall and center the nipple on the newly positioned breast mound.
From an abdominal standpoint, you most likely need some version of a full tummy tuck to get rid of any skin overhang and make your stomach flat again. Whether this is what we call a full tummy tuck or an extended tummy tuck awaits my visual assessment of your body.
Putting any form of breast and abdominal reshaping garners the moniker of a Mommy Makeover, changing what has been affected by pregnancy the most…one’s breasts and stomach area.
When it comes to weight loss before a Mommy Makeover, a general rule is that one should be between 15 to 25 lbs of their desired ‘realistic’ weight goal. Notice that I didn’t say your ideal body weight which for some patients is not a truly realistic goal.
I will defer cost estimates to my assistant. But cosmetic surgery is never paid in installments which is more typical in the banking and retail industries. We have no means to reclaim the surgical results if the patient defaults or fails to pay after the work is completed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 33 year-old female with three children, ages 9,7 and 4 years old. My last two deliveries were done by c-section. I love my c-section scar because it is low and very hard to see. I want to get rid of my abdominal pooch, loose skin and a belly button that sticks out. I want a mini tummy tuck because I would like the least scar possible and have it no bigger than my current c-section scar. I also want my muscles tightened because I have that pregnant looking pooch. I really don't want a scar around my belly button. Basically, will a mini tummy tuck accomplish all of my abdominal goals? Is this realistic?
A: The simple answer is no. You are asking out of a mini tummy tuck what a full tummy tuck does. What you want is a full tummy tuck result but only want the scar burden of a mini tummy tuck. I can’t blame you for having a lofty plastic surgery goal but it is not achievable. The reality is that one can not have both and you will have to choose which one of the two tummy tuck choices offers a trade-off that you can live with the best. In essence if the small scar of a mini-tummy tuck is the most important part of having the procedure then the trade-off will be that of incomplete correction, some remaining pooch and residual loose abdominal skin. Trying to keep the scar so small simply limits how much correction you are going to get. If the maximal amount of abdominal correction is what is most important, then the full tummy tuck should be done with the trade-off of a longer and higher final scar. (and a scar around the new belly button as well)
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I have had three c-sections, gained and lost over 100 lbs at least three times. ( after each pregnancy) I want to know if I need a tummy tuck or some type of pannus removal.
A: The difference between a tummy tuck and an abdominal panniculectomy is really one of magnitude. They are in many ways the same procedure with some different variations to them. A panniculectomy is nothing more than a ‘big’ tummy tuck. It involves a larger amount of abdominal skin and fat removal as a pannus means an apron or overhang of abdominal tissues across the waistline often onto the pubic areas or upper thighs. This means the horizontal incision and resultant scar may be longer and even extend into the back area from that of its smaller cousin, the more traditional tummy tuck. Given your description of recurrent weight loss of that magnitude and pregnancies, I would have no doubt that you have a pannus and your surgery would be a panniculectomy, often called an extended tummy tuck. The recovery from a tummy tuck or an abdominal panniculectomy would be the same. Longer incisions do not really mean a longer or more significant recovery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting a tummy tuck but have been told that I can’t due to my gall bladder scar. I have attached pictures and have highlighted my scars with a marker so that you can see them better. I am told that my appendix removal scar (30 yrs old) and c- section scar (9 years old) are no issue since they are below the belly button and would be removed. My gall bladder removal scar is 11 years old. I was told by one doctor that the skin below the scar would not survive if a tummy tuck was done. What technique for my tummy tuck would you recommend?
A: A long traditional gall bladder removal scar does place at risk for survival the triangle of skin that will ultimately result between the lower edge of the old gallbladder scar and the new horizontal tummy tuck scar. If done with care and looking out for several factors in the execution of the tummy tuck it can be done safely and without problems. The key factors are not to place the tummy tuck closure under too much tension (not too large of a horizontal excision), a limited central tunnel dissection of the upper abdominal skin flap and avoidance of any lateral abdominal wall liposuction. This will preserve the maximal amount of blood supply to the skin both above and particularly below the old gallbladder scar. This will allow the tummy tuck to heal uneventfully.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I had a tummy tuck three weeks. I had my drained pulled after 8 days and I developed a fluid collection right after. My doctor removed the fluid by needle twice and the third time today there was no longer any fluid. Since I had no fluid today and I don't have to come see my doctor until another six weeks can I go ahead and start exercising?
A: Given that you have an abdominal seroma after your tummy tuck, I would wait another week before you should start exercising again. Even though your recent tap was negative (empty), that does not mean you may still not build up a little fluid. The most assured way to make that happen is get very active. Strenuous activity increases lymphatic flow to the tummy tuck area which could cause more fluid to build up again. Give your body another week to heal and not show any evidence of further fluid buildup before ‘stressing’ the competency of the sealed lymphatics at the surgery site.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 35 years old and am 5’ 4” and weight 138 lbs. I had my last child one year ago and am back to my prepregnancy weight but can’t get rid of this loose tummy skin and fat. I went to a plastic surgery consultation and, in addition to a tummy tuck, was told that I needed liposuction as well. Do I really need to get liposuction on my love handles with my tummy tuck to get the best result? Since I am going for surgery I want the best result. I'm pretty happy with my general size, I just want to be firmer and smaller around my stomach.
A: It is a common misconception as to how far the effects of a tummy tuck reach. The main effect of a tummy tuck is seen between the hip points, it is essentially a 180 degree procedure of the trunk.. One must remember that waistline reshaping is closer to a 270 or 300 degree procedure. To extend the benefits of a tummy tuck, whose tissue excision and scar stops at the hips, fat removal by liposuction must be done to continue the narrowing benefit around the corner of the hips and into the back. This liposuction effects what most people call the love handles or the flanks. This not only flattens or indents the love handles but also decreases the risk of dogears or fullness at the ends of the tummy tuck incisions. I would estimate that about 2/3s of abdominal reshaping patients in my practice need the combined tummy tuck and flank liposuction procedures for the best result.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I have bad stretch marks on my stomach and a lot of skin hang over. I’m 5’2 and weigh 159lbs. I have lost 20 pounds and now I’m at a stand still. What can I do now and no amount of exercise seems to work?
A: The skin hangover to which you refer is known as a pannus, which is a fancy word meaning a skin apron. Even if you could lose more weight this abdominal pannus is not going to go away. It is excess skin that can not be lost by diet and exercise. It is excess skin created by pregnancies and weight loss. It is also skin that had lost any ability to shrink or contract as this is clearly demonstrated by the presence of stretch marks. Stretch marks are basically incomplete tears in the skin. This is like making little snips partially through a rubber band, it weakens its ability for elastic recoil. Most abdominal pannuses represent inches of skin (one foot or more) that has been stretched out.
You are correct in stating that exercise is not going to tighten skin nor will any more weight loss. (although there still may be some other medical benefits for more weight loss) This is a surgical problem that will require a large horizontal ellipse of skin and fat removal that will completely eliminate all loose skin over the central abdomen, a procedure otherwise known as a full tummy tuck.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need to remove excess skin from below my belly button and lift my breasts. I breast fed all four of my children and had a set of twins that stretched my stomach out tremendously. I have tried situps but they won’t take care of this loose skin.
A: Multiple pregnancies, particularly twins, push the skin past its elastic deformation limit. In essence, it snaps the rubber band nature of the abdominal skin forever relegating many women to loose and often floppy skin that is seen the most between the belly button and the pubic areas. The surest sign of permanently lost skin elasticity are stretch marks which represent incomplete tears in the skin. This is like making little snips partially through a rubber band, it weakens or eliminates its elasticity. You are correct in stating that exercise is not going to tighten skin, nor will weight loss. This is a surgical problem that will require skin excision and underlying muscle tightening, a perfect description for a tummy tuck. Whether your tummy tuck would be a partial (mini-) or a full tummy tuck I can not say without seeing pictures of you. But my guess would be that after four children, a full tummy tuck with maximal skin removal is likely in order.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am going through a divorce due to domestic violence. I have lost a little over 100 pounds since I left my abusive marriage with our son. I for so many years buried my head into food. Even though I have lost all of this weight I often look in the mirror and cry due to the way I look. I feel empty inside, I want to feel beautiful and content with myself. I want back all of that confidence that he took from me. I have a lot of extra skin from all of the weight I lost. I am only 30 years old but I dress like a 40 or 50 year-old due to my body’s look. I don’t want to feel like I am dying inside anymore, I want to feel alive again, confident, young, and beautiful. These are the goals I want to achieve. Most of all I want to be able to bring my son to a beach in a bikini he is so young I do not want him to miss out on things due to my insecurities, He has suffered so much due to this divorce and domestic Violence. I try to keep a positive outlook on everything. I have attached some pictures so you can see what you have to work with.
A: Thank you for sharing your very personal story and in losing in the weight. This is obviously a transitional period in your life and changing how your body looks would be a complementary component to it. The excess skin and fat represent both physical and emotional baggage. In looking at your pictures, I can see that you would get some good benefit out of the following procedures… a full tummy tuck, liposuction of the lower abdomen (prior to its removal) and flanks with transfer to the buttocks, and a breast lift. Together these would all make a significant improvement in the shape of your body and reverse some of the effects of your prior weight gain.. All those procedures could be done together with the tummy tuck as the foundation procedure which is the one that really involves any significant recovery. Breast lifts are relatively painless and fat injections to the buttocks only as minimal discomfort.
While all four procedures would provide the most benefit in terms of body changes, the most important one is the tummy tuck with flank liposuction. That is the foundational procedure that produces the best benefit out of all the potential body procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a tummy tuck six months ago and although I am happy with my lower abdomen I am not with my upper. It is still fairly thick and not as slim as the lower half. From the side view, the upper abdomen shows no difference unlike the lower. The only explanation that I can come up with is that my plastic surgeon refused to do liposuction of this area even though he did it to the sides of the tummy tuck. I can’t help but wonder if that had been done also it would look much better now. Can I get the upper abdominal area liposuctioned now and will it result in more loose skin afterwards?
A: Your question/concern of a tummy tuck result is a common one and one in which I review with every patient before surgery. Tummy tucks do their best work in the lower abdomen, where tissue is actually cut out, and offer more modest improvement in the upper abdomen. Your plastic surgeon was very prudent to not liposuction the upper abdomen during your tummy tuck as the risk of major healing problems can ensue at the central closure line . Thus many tummy tuck patients will have an upper abdominal fullness after their tummy tuck due to a persistently thick fat layer. This can be addressed after tummy tuck suction out extra fat and thin out its thickness. It will not cause any extra loose skin as that has been adequately tightened by the previous tummy tuck.
While we wish we could address the upper abdominal fat at the same time as the tummy tuck, it is wise to remember this basic motto in aesthetic surgery. It is far better to have two surgeries done safely than going for the perfect result and suffer a major wound healing complication which ca takes months to heal and leave a more devastating aesthetic problem than what one was initially trying to treat.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am having a tummy tuck and liposuction and am concerned about the risks of a deep vein thrombosis (DVT) and pulmonary embolism. (PE) Do you ever prescribe blood thinners in addition to sequential compression devices (scds) for the legs? I likely am being overly cautious but as a nurse who audits charts all day long I see DVTs and PEs as common problems in the hospital.
A: The prevention of DVTs is of utmost importance in any procedure but particularly in women who are having abdominal/pelvic surgery, which is a higher risk group. During any plastic surgery procedure and in recovery SCDs are used. After surgery early mobilization/ambulation is encouraged. A tummy tuck with or without liposuction is not a procedure one wants to lay around for any extended period of time. Fortunately, I have yet to have a DVT in a tummy tuck patient. Because of the increased risk of bleeding and hematomas, any form of blood thinner (such as heparin or lovenox) is not used unless the patient is a known risk with a prior history of DVT or a diagnosed abnormal blood hypercoagulopathy.
It is important to recognize that a hospitalized patient with a medical problem is a different situation than an otherwise healthy person having elective plastic surgery…so this would explain the dramatic difference in incidence of DVTs in these two populations. But they can happen in any surgery patient so SCDs and early ambulation are the established standard of care in tummy tuck patients.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am getting a tummy tuck and flank and thigh liposuction done in a few weeks. Honestly, I don’t have much of a pain tolerance so I am concerned most about that issue. I know I will be getting oral pain medication but my plastic surgeon didn’t mention a pain pump. Should those be used?
A: Pain pumps are a common method employed by some plastic surgeons for postoperative pain control after a tummy tuck. I have not found them particularly useful, however, in my experience because I infiltrate the muscle prior to closure. The main source of pain after a tummy tuck is due to the midline rectus muscle fascial plication, not what is done with the skin. I prefer to place 50cc of a Marcaine and epinephrine solution into the muscles during the procedure. This seems to be as effective as using a pain pump, saves the patient about $250 and avoids additional skin exit holes for the pain pump tubing. That being said, there is absolutely nothing wrong with using pain pumps also has an additional preventative measure of postoperative pain control.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I know a tummy tuck focuses on the abdomen below the belly button. However, I have two fat “dumplings” immediately above and to the left and right of my belly button. If this skin gets pulled down because the lower skin is excised, I was worried that these two fat “dumplings” would look like a new pannus. (if that makes sense).Is liposuction ever being performed on the area immediately above the belly button during a tummy tuck also?
A: In a tummy tuck, the excision of full-thickness skin and fat in the lower half of the abdomen results in an advancement or stretching of the undermined upper abdominal skin flap. This will ‘unravel’ much of the upper abdominal fullness and irregularities because this tissue unit must now stretch out and cover twice the surface area that it used to. Liposuction is never done on the upper abdominal skin flap during a tummy tuck because of blood supply and healing concerns. By doing so there is a very significant risk of causing skin necrosis and wound healing problems of the tummy tuck incisional closure. Once the upper abdominal skin flap is undermined to allow it to stretch out, the perforating vessels feeding the tissues are cut off from the underlying muscles. The skin is now surviving on the more superficial vessels near the skin that comes in from the sides. Liposuction will injure those vessels and make the central upper abdominal tissue have jeopardized vascular perfusion. The small increase in aesthetic improvement is not worth the risk of major tummy tuck wound healing problems. But those areas you are referring to above the belly button are not going to be carried lower as they now exist. They should be completely flattened out for the most part.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I’m having surgery in a few weeks consisting of a full tummy tuck and liposuction of the, flanks and outer thighs. How much fat did you estimate in inches that can be removed from each of these areas? Particularly with my outer thighs, I was hoping that whatever amount of fat was removed would be visibly noticeable to the eye.
A: While I don’t have the advantage of knowing what your body/thighs look like, there would be little purpose in having the procedure if the change was not noticeable. I never like to use inches as a circumferential measurement outcome for any liposuction-treated area or a tummy tuck because the visible change can be substantial but the circumferential measurement change can be less impressive. This, of course, highly depends on the body type and the size of the original problem. But you have to remember that only one section of the thigh (outer) is being treated not the circumferential thigh so that measurement will never be impressive as the outer profile or silhouette view. For a tummy tuck, only the front half of the body is being treated so the amount of ‘inches’ reduction will depend on the existing size of the frontal abdominal fullness and/or overhang.
While in many patients, inches do come off from a tummy tuck, that can be avery disappointing assessment criteria when looking at outer thigh liposuction…that is rarely an inchess off procedure.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, my first pregnancy was one very big baby for my little body. My stomach was completely stretched out like a big balloon. It got so big at the top of my stomach that it fractured the end of my sternum. It now sticks out and I am told it is called the xiphoid bone. Whatever it is called it now sticks out a little but but what is really bothersome is tht it moves around. and hurts when I stretch too much or bend over. I want to get a tummy tuck and was wondering if this could be fixed at the same time. However while researching the topic I couldn’t find anywhere that the two can be done together. You seem to be very creative and innovative so I was wondering if you could repair/remove it while performing a tummy tuck?
A: Fracturing of the xiphoid process from a large pregnancy is not a common problem but it certainly can happen. The xiphoid process is a small stick of bone that is attached to the end of the sternum which can become outwardly fractured with a consistent mass effect from below. Just because you did not find a simultaneous xiphoid process excision and tummy tuck on the internet does not mean that it is not done and I am certain many plastic surgeons have done them. It is easily done during a tummy tuck because at the upper end of the rectus fascial plication (muscle repair) sits the end of the sternum. So removal of the loose xiphoid process is easily done as it is right there. This does not lengthen the recovery or cause any prolonged pain after a tummy tuck.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 5’ 9” tall and fairly skinny. I have no extra fat but some loose skin from my three pregnancies. While I am not crazy about the loose skin, what bothers me the most are the many stretch marks that I have. They are around my belly button and lower as well as out onto my hips. The stretch marks on my hips are the worst, being wider, redder and more noticeable than those on my stomach. Therefore I would like to get rid of them the most.most noticeable, so I would love to get rid of those at least. I was hoping to get rid of most stretch marks and extra skin with a tummy tuck but I don’t want to go through with it if it does not provide a major improvement in my unsightly stretch marks.
A: The main benefits of tummy tuck surgery is the removal of extra skin and fat and the tightening effect of the stomach that it provides. Any improvement in associated stretch marks from pregnancy is a secondary benefit that is largely coincidental. The stretch marks that will be removed is what lies within the outline of the tummy tuck excisional pattern. Your surgeon can mark that out for you so you can see exactly what stretch marks will be removed. Stretch marks around the excisional pattern, particularly above the belly button, will shift position to a lower location below the new belly button for many of them. Stretch marks on the hip, which is largely outside the zone of the tummy tuck cutout will not be removed/improved.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m 38 years old and had 3 children by age 22 that I breastfed. I have small breasts which is cool with me, I just want them a little perkier. My tummy and love handles need to go. I can work on my legs in the gym and they have always been strong. Can my breasts, tummy and love handles all be done at the same time?
A: When you put breast and tummy reshaping together as a single procedure, that has become known as a Mommy Makeover. Most forms of breast reshaping include implants with some type of lift although breast lifting can be done alone. If volume is not an issue then breast lifts by themselves will be just fine. Tummy tucks, mini- or full versions, almost always include liposuction of the flanks. (aka love handles) Most people envision a near circumferential waistline reshaping and tummy tuck scars stop at the hips. So fat reduction beyond that needs to involve liposuction to extend the 180 degree effect of a tummy tuck into more of a 270 degree wrap around waistline effect. It would be very common and would have a more profound body change if what was affected by pregancies is reversed in a single operation. This explains the popularity and the effectiveness of the Mommy Makeover of which you desire.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been interested in maybe some breast implants with a lift, but also a tummy tuck. I am 46, with three c-sections and have had laparoscopies and I have a tendency to keloid. For many years, my belly button has developed keloids, and my Ob/Gyn would attempt to remove them permanently, this last time (2-3 years ago), gave me a “mini” tummy tuck during the revision surgery and all was paid for by insurance. The keloids came back, it frequently smells and oozes, and of course, is painful to the touch underneath all the bumpy skin. Do you think I could have this corrected and have some of it covered by insurance due to the ongoing medical issue of infection?
A: Without seeing some pictures of yoru abdominal concerns, I can not give a definite answer as to what may be the best treatment. But as a general concept about scars, tummy tucks and insurance, I can say that this is not a likely scenario to get it covered by insurance. It is understandable why you would think they should, and they may provide coverage for excision of the hypertrophic/keloid scars on their own, but it is not reasonable or ethical practice to expect to get some form of a tummy tuck as part of it. The tummy tuck is a cosmetic procedure and is not instrumental in solving the scar issues.The insurance industry views such physician behavior with one word…fraud. So this is not a practice that board-certified and reputable plastic surgeons would endorse or participate in.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in the lipodissolve or liposmart for underneath my chin and abdomen area. I have excess skin and fat due to having a child. I am still a thin female, but have insecurity in these areas and feel these procedures would benefit me the most in regards to my weight and issues I am having. Please email me with more info and pricing estimates if possible.
A: The best way to get an accurate price quote is to come in for a consultation so I can see what you really need. or send me some pictures. The under the chin area (submental) fat is going to need to be treated by liposuction (Smartlpo) not lipodissolve for a variety of good reasons, mainly a much better result in a single treatment session. The abdominal issue is less clear given that I have no idea what it looks like. When you use the words ‘excess skin and fat’, that may imply that liposuction may not be a good treatment approach because of the skin excess. No form of liposuction is going to shrink much loose skin, not even Smartlipo. If you have any stretch marks at all on this loose abdominal skin, there is no chance of shrinkage due to complete loss of elastic fibers/elasticity in the skin. Depending upon how much loose skin there is, this may put you more in need of some form of a tummy tuck.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had 3 C-sections, bowel obstruction surgery, hernia surgery and hysterectomy. I was wondering if getting a tummy tuck would be possible for me and would this be a feasible avenue to take? Also, would I be a viable candidate for the insurance to cover this procedure? Thanks for your assistance.
A: Thank you for your inquiry. It would be impossible for me to say whether you are a good candidate for a tummy tuck based on your complex abdominal surgical history alone. I have seen many patients with similar histories and they all were perfectly good candidates for tummy tuck surgery. So based on your information alone, I would assume until proven otherwise by actually seeing you that you would be a reasonable candidate. One of the very good benefits of a tummy tuck in patients with complex abdominal surgeries is that many of the abdominal scars as well as the loose skin and fat can be removed and traded off into one single horizontal scar placed low on the abdomen. Often, one gets a simultaneous pubic lift as well. Insurance does not cover nor do we attempt to process it for elective cosmetic tummy tucks. While you have a complex abdominal history and likely numerous contour deformities from them, these are still cosmetic and not functional issues.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was reviewing your Patriotic Program for plastic surgery. Honestly, I never in my wildest dreams thought I could receive a military discount for cosmetic surgery. I’m interested in having a consultation for an Tummy Tuck and liposuction around my knees. I have been waiting for close to 10 years to do this surgery. I think now is the time. My husband of almost 20 years is now serving in Afghanistan.
He should be home in the next two months. That being mentioned, I would like to be healed buy the time he comes home and look fantastic or at least as good as it gets. My husband has been telling me to go ahead and do it but I never do. I always find other ways to spend the money. I know I will feel so much better when my clothes fit nice and I don’t have to wear spanks…especially in a formal gown. Yep, I know I have at least 4 more formals to attend before retirement because of my four children. Thank you so much for taking your professional time to support our troops and their families using your gift.
A: Tummy tuck surgery can make a dramatic difference in your body shape and how you fit in clothes. Since you are done having children the results of a tummy tuck can last a lifetime and is one investment that cap pay dividends for decades.
We have offered military discounts for years for a wide variety of cosmetic surgery procedures. We are happy to do so and try to make a small contribution to those that serve or have served to protect the freedoms for what we have the opportunity
to choose to do every day.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have lost weight and have an apron of loose skin that hangs over, plus some fat at my waist that I would love to not have to look at anymore. I have looked at your gallery and have seen a couple of pictures that are very close to my condition, and like the after photos. I would be very happy to look like that. I am 60 years young and still have a lot of living to do. I am very healthy with only a thyroid condition that I take a small dosage of synthroid to correct.
A: Your age of 60 is certainly not a limiting factor in having tummy tuck surgery. As long as you are healthy and have no restrictive medical conditions, which it appears you are, there is no reason not to enjoy the outcome of removal of an overhanging abdominal pannus. Such a removal can be very liberating and improves not only your clothing options and hygiene but your self-image as well. Tummy tuck surgery is performed as an outpatient surgery under general anesthesia. The biggest issue in after surgery recovery is that you will have a drain for 7 to 10 days afterwards. This is more of a nuisance than anything else as you can move about and shower normally.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering what are the prices of your procedures I have been looking into mommy makeover for several years, (breast life/augmentation,tummy tuck, and some liposuction of the inner thighs and back flanks. I’m not looking to be a supermodel/size 6, I would be quite happy size 12 – 16. I just want a flatter tummy, non droopy boobs and thighs that don’t rub together. I have attached several pictures, could you please tell me what the cost would be, and if there is anyway to have our insurance company pay. I’m very depressed with the way I look, I just want my outside to reflect the way I feel on inside. I want to be that sexy person for my husband, and confident for myself. I hate trying to find clothes that hide my tire ring for a tummy, and replace pants because they got worn in the thigh area. I would also like to wear shirts without having my breast hang down to my tummy area. I need help, can you help me………..
A: Thank you for sending your pictures. I can not comment on your breasts since the pictures have a bra on but I will assume, for the sake of this discussion, that you need a full breast lift. Otherwise, you would benefit tremendously by having a full abdominoplasty to get rid of the overhanging pannus combined with liposuction of the flanks. This is the one procedure that will provide the greatest overall change. You do not have enough of an abdominal pannus to qualify for insurance coverage based on my experience. From a thigh standpoint, I don’t know that liposuction can ever take you to the point where your thighs don’t rub, that is not a realistic goal. Some improvement can be achieved in their fullness but to say they would not rub together would not be an accurate statement about the achievable result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to do something with my tummy area but am confused as to what to do. I have had several consultations and have been repeatedly told that I need a tummy tuck. However I don’t want to have a tummy tuck as I am scared of being cut like that and also fear the recovery. I lost 50lbs over the past two years and now weigh 140lbs and am 5’ 2” tall. If I just have liposuction will I be left with hanging skin and look worse?
A: It is clear based on your description of your body from weight loss and the recommendations of several plastic surgeons that a tummy tuck will produce a better result. But if you can not accept the excisional nature of the procedure and the resultant scar, then it is not a good operation for you. This is a common dilemma for many patients. Better result aside, liposuction is a more acceptable procedure for you and appears what you can accept at this time. The key to undergoing just liposuction is your acceptance that the result will not be as good as a tummy tuck. That is the price you pay for a procedure that does not ideally match the problem that you have. Always remember that you can always have a tummy tuck later if you find the deflated abdominal skin unacceptable. Based on your result from liposuction, you will either be glad that you choose just liposuction or will become convinced that a tummy tuck really is a good operation.
Dr. Barry Eppley
Indianapolis, Indiana