Extended Tummy Tuck (Abdominoplasty)
Tue 1st Oct 2024
If you’ve lost a large amount of weight and have been left with excessive loose skin and tissue around your middle, you may be interested in learning about surgical options that can help address these issues.
An Extended Tummy Tuck is a type of Abdominoplasty that is, as the name suggests, more extensive than the standard Tummy Tuck (Abdominoplasty). This procedure is reserved almost exclusively for patients who’ve lost a significant amount of weight and need reconstructive surgery to remove excess skin, tighten the abdominal muscles and reduce skin laxity.
In this article, we discuss all aspects of this procedure, including suitable candidates, surgery details, the recovery process, potential risks and complications, and even how to choose the right surgeon.
What is a Tummy Tuck (Abdominoplasty)?
First, let’s be clear on what an Abdominoplasty is. A Tummy Tuck (Abdominoplasty) is a surgical Body Contouring procedure aimed at addressing several issues, including:
- Excessive abdominal wall skin
- Fatty abdominal wall apron
- Rectus divarication (stomach muscle damage)
- Ptotic (droopy) mons region
- Small umbilical and abdominal wall hernias
These issues are common following extreme weight loss or pregnancy. However, the needs of every individual differ. Some require more extensive surgery than others, so there are different types of Abdominoplasties available.
They include:
- Mini Tummy Tuck (Abdominoplasty)
- Standard Tummy Tuck (Abdominoplasty)
- Fleur De Lis Tummy Tuck (Abdominoplasty)
- Open Book Tummy Tuck(Abdominoplasty)
The Extended Tummy Tuck (Abdominoplasty) is a variant of the Standard Tummy Tuck (Abdominoplasty).
Difference Between a Standard Tummy Tuck & an Extended Tummy Tuck
The Standard Tummy Tuck has a horizontal incision that runs from hip to hip, just above the pubic region. Typically, the scar appears under the bikini line and can be easily concealed by regular underwear. A small incision is also made around the navel to free it from the skin and fatty layer.
The Extended Tummy Tuck, however, has a long horizontal incision that extends beyond the hips towards the back. This allows for more extensive removal of loose skin and more reconstruction.
The Extended Tummy Tuck aims to address the issues listed above (such as removing excess skin and tightening muscles) and essentially reconstruct the abdominal wall.
The primary goals of the Extended Tummy Tuck (Abdominoplasty) include:
- To improve comfort, particularly in cases where skin laxity interferes with daily activities or clothing choices.
- To reinforce weakened or separated muscles, resulting in a more toned and functional abdominal wall.
- To restore the natural contours with a tighter appearance of the abdomen.
Benefits Of A Longer Scar
To achieve good results, the surgeon must create scars. And importantly, the results should not be compromised for the sake of making the scar shorter. Typically, greater contour improvements are achieved with longer incisions. This incision will be placed as low as possible. However, it will be easily concealed within regular pants and underwear.
By creating a longer scar, Dr Dona can achieve several key goals:
- Ensure the scar can be placed as low as possible
- Ensure as much excess skin from the upper abdominal wall can be removed
- Ensure a maximal amount of excess skin can be removed from the sides (other than performing a Belt Lipectomy)
- Ensure a smoother lateral hip and lower abdominal wall contour
- All of the above measures ensure that he does not give a patient a ‘dog ear’, which is often a sign of poor surgical planning (and results in abnormal skin protrusion at the end of the scar). More info below.
Given the numerous benefits, Dr Dona’s opinion is that most patients who have a Tummy Tuck should have some form of an Extended Tummy Tuck (Abdominoplasty). Too often, he will see a patient who has been treated elsewhere with unsatisfactory results. In these cases, the surgeon has tried to create a short, standard Tummy Tuck scar, resulting in a scar that is too high and/or leaves the patient with undesirable contours and ‘dog ears’.
An Extended Tummy Tuck targets a large area of the abdominal wall, often including the flanks and sides. This gives a more comprehensive Body Contouring and a more extensive aesthetic outcome.
In summary, extended Abdominoplasties provide a more dramatic aesthetic and functional result than the standard Tummy Tucks (Abdominoplasties). They are ideal for individuals with significant excess skin following substantial weight changes.
What Are ‘Dog Ears’?
‘Dog ears’ is a colloquial term that describes an abnormal protrusion that can be found at the end of a scar. They typically arise when a surgeon removes an ellipse of skin, and when the wound is closed, one or both ends of the scar can protrude, creating an unwanted contour.
To understand why this may occur, it’s easier to consider a piece of cloth being tailored for an outfit. Suppose you are to remove a sliver of the material, then sew it closed. Then, if the segment is too large, as you bring the edges together, the fabric starts to protrude.
To minimise any protrusion, the tailor must ensure the angle at the apex of the segment is as small as possible so that, when closed, the surface remains as smooth as possible.
Therefore, when considering a Tummy Tuck (Abdominoplasty), if the scar is too short (but placed as low as possible and endeavours to remove as much vertical skin as possible), the angle of the wound becomes too large. Consequently, a ‘dog ear’ is formed.
To avoid this unwanted contour, it is best to extend the scar beyond the hip level, as far as needed to ensure the surgeon can remove more skin and tissue and create an extremely acute angle in your segment of skin.
Ideal Candidates For An Extended Tummy Tuck (Abdominoplasty)
An ideal candidate for an Extended Tummy Tuck (Abdominoplasty) is someone seeking significant Body Contouring of the abdominal region. They have excess skin and skin laxity, often seen in patients who have experienced massive weight loss. Candidates should have:
- maintained (and be able to maintain) a stable weight
- loose skin and weakened abdominal muscles that require tightening
- excess abdominal skin that extends around the hips
- a commitment to maintain a healthy lifestyle after surgery
- good physical health with no underlying conditions that impair healing
- a positive outlook and realistic expectations.
It’s also essential that candidates for this procedure understand the recovery time. Recovery involves weeks of limited activity and time off work.
You must also understand that the procedure is not a substitute for weight loss or an appropriate exercise program. It is typically recommended for individuals who have already reached a stable weight and are not planning significant weight changes. This includes future pregnancies, which could undo the results of the Tummy Tuck (Abdominoplasty) surgery.
Your Consultation With Dr Dona
The first step to determine whether an Extended Tummy Tuck (Abdominoplasty) is appropriate for you is an initial consultation with Dr Dona. All patients will have at least two consultations before potentially proceeding with surgery.
During these consultations, Dr Dona will cover the following:
- Medical evaluation: Assessing the patient’s medical history to ensure they are a good candidate for surgery, discussing any potential risks and complications.
- Expectations: Aligning the patient’s aesthetic goals with what is surgically feasible and ensuring realistic expectations for results and recovery time.
- Instructions: Advising the patient on pre-surgery preparations, such as achieving a stable weight, quitting smoking and avoiding certain medications that can affect the surgery and recovery.
- Discuss recovery: Providing information on the post-surgery healing process, including how to care for incisions, manage pain and recognise the limitations on physical activity during recovery.
It’s essential that patients are thoroughly informed and prepared for their procedure, as this contributes significantly to the success of the surgery and patient satisfaction with outcomes.
The Extended Tummy Tuck (Abdominoplasty) Procedure
The Extended Tummy Tuck (Abdominoplasty) is performed in a private hospital under general anaesthesia. Before surgery, Dr Dona comprehensively examines the patient’s abdominal region to determine the extent of the skin laxity and the condition of the abdominal muscles.
During surgery, the key steps are as follows:
- Incision: A long, curved horizontal incision is made, extending from one hipbone to the other, often reaching around to the flanks and lateral buttock region. It is extended as far as necessary, with the patient lying on their back, to ensure the scar can be placed as low as possible and create a smooth contour.
- Skin & fat removal: Through the incision, Dr Dona can remove excess skin and fat to optimally contour the abdominal wall.
- Muscle tightening: The underlying weakened and damaged abdominal muscles are sutured together, tightening them and providing significant functional benefits.
- ‘Repositioning’ the belly button: Due to the extensive skin removal, the belly button is repositioned (re-set into the abdominal wall skin) to maintain a natural look.
- Drainage tubes: Typically, drainage tubes are placed to collect excess fluid and support healing.
- Closing the incision: Dr Dona closes the incision with three layers of internal sutures, ensuring the scar is as discreet as possible and follows the natural contours of the body.
Potential Risks & Complications
All surgical procedures carry the potential for risks and complications. Please visit this webpage to see a detailed list of potential complications.
Additionally, the following specific risks and complications are related to an extended Tummy Tuck (Abdominoplasty).
- Asymmetry – The two sides of your body may not look exactly the same, and the skin can appear uneven.
- Swelling – Swelling is expected after an Extended Tummy Tuck (Abdominoplasty). Most settle within the first few weeks, though it can take several months to resolve fully.
- Changes in Sensation – Numbness around the scars, especially across the lower abdomen, is common. Some feeling may return over time, but certain areas may remain permanently numb.
- Scarring – Scars often look more noticeable in the first six months. Over 12–18 months, they typically fade to fine white lines, but in some cases, they may become raised, thick or darker (hypertrophic or keloid).
- Skin Healing – In rare cases, reduced circulation can affect healing. This may lead to minor wounds that require dressings or, occasionally, additional surgery.
- Fluid Build-up (Seromas) – Fluid may sometimes collect under the skin. If it does, it may need to be drained with a needle.
- Further Surgery – Some patients later choose an additional procedure to refine or ‘fine-tune’ their results.
Your Recovery
All patients are given detailed verbal and written pre-and post-operative instructions. You must adhere to these guidelines to maximise your chance of an excellent surgical outcome.
You must be patient after surgery, and understand that the recovery process spans several weeks. You’ll need to arrange time off from work, and if living alone or unsupported, arrange for someone to help with daily activities.
Immediately after surgery, you must rest and limit movements to allow the body to begin the healing process. In your initial post-operative phase, you can expect to feel discomfort, swelling and bruising. However, your pain will be managed with prescription medication, and all swelling will gradually subside.
To support the abdominal region and minimise swelling, you’ll be required to wear a compression garment for the first six weeks.
Activity Restrictions
As mentioned, it will take you several weeks to recover, and all activities must be eased into over time. Here are some general guidelines to follow:
- Walking: Walking is encouraged to promote circulation, but should be kept light and brief. You can gradually increase walking, guided by your comfort levels.
- Driving: Do not drive for the first two weeks after surgery. After this time, you should only drive if you feel safe doing so.
- Returning to work: You’ll be able to return to light office or desk work approximately three weeks after surgery. Light hospitality work may be possible after four weeks. Any work that involves heavy lifting or straining must be avoided for six weeks.
- Returning to regular fitness activities: After six weeks, you can gradually resume regular gym training and physical activities.
Consider the first six weeks after surgery as recovery, then all time after as rehabilitation. Only perform activities that you want to do and be guided by your comfort and strength. Be prepared to wait a good six months before you feel fully back to ‘normal’ again.
Results And Benefits
Undergoing any surgical procedure is a big decision, but the rewards can certainly be worth the effort. Patients who have undergone an Extended Tummy Tuck (Abdominoplasty) can experience the following results:
Enhanced Comfort: The procedure reduces discomfort caused by excess skin, such as rashes or chafing, and can improve posture.
Tightened Muscles & Improved Function: By tightening and repairing the abdominal wall, patients can benefit from increased core stability and improved function.
Excess Skin Removal: The procedure effectively removes hanging skin (that cannot be improved by diet and exercise), providing both aesthetic and functional benefits.
Improved Body Contour: An Extended Tummy Tuck (Abdominoplasty) creates a more aesthetically pleasing profile.
Long-lasting Results: The results can be enduring, provided patients maintain a stable weight and adhere to a healthy lifestyle.
How To Choose A Qualified Plastic Surgeon
It’s always important not to rush any decisions regarding surgery. Do your research and take the time to find the right plastic surgeon for you and your objectives. The right surgeon should not only have the necessary qualifications but should also make you feel heard and reassured throughout your surgical process.
Further, a surgeon’s expertise directly influences the healing process, your functionality, aesthetic enhancements and the appearance of scars. This is why you must find the right surgeon. The following guidelines will help you do so:
- Specialist Qualifications: Ensure your surgeon is a Specialist Plastic Surgeon
- Experience & Skills: Look for a surgeon whose practice focuses primarily on Body Contouring surgery and who has a long-standing track record of Tummy Tuck (Abdominoplasty) surgeries.
- Before & After Gallery: Review the surgeon’s before-and-after photos to assess some of the results they have achieved. These images will also help you determine whether the surgeon has operated on various body types and performs other customised Body Contouring surgical procedures.
- Your Consultation: During your initial consultation, evaluate your surgeon’s approach to maximal contour enhancement and scar minimisation. Also, ask them about the surgical techniques they use to promote optimal healing and achieve the least visible scar.
