Open Book Tummy Tuck™ (Abdominoplasty)

What is a Tummy Tuck?

Before we discuss the Open Book Tummy Tuck (OBTT) any further, we need to understand what a Tummy Tuck (otherwise known as an “abdominoplasty”) truly means. To do so, one needs to understand the true meaning of the word reconstruction. The reason why this is important is to remove the widely held, albeit false, view by many that a tummy tuck is a purely cosmetic procedure. The definition of the word reconstruction is – to restore to a state (or create a state) that is normal for that person’s age, race, and gender.

We can further analyse this when we dissect the meaning of the word “normal”. With reference to the human form, normal is defined as something which is functional (or acceptable) to that individual. The spectrum of normal is extremely wide and as such, what is normal for one person may be abnormal if applied to another person. Just because a certain body issue (whatever that may be) is a common problem, does not equate to it being normal.

What does a Tummy Tuck fix?

When we review the abdominal wall, most would agree that a normal (or perhaps better described as undamaged) abdominal wall should contain:

• Good skin quality with no scars – whether that be stretch marks (which are in fact scars), surgical or traumatic scars.
• Good muscle alignment and tone – this ensures functionally sound core biomechanics and strength with a stable lower back and maximal bowel/bladder control.
• No skin excess and overhang with its associated functional and hygiene issues.
• Good pubic/mons position without droop and fullness and its potential functional problems.

With this basic understanding, all forms of tummy tucks are designed to address any problems with these areas – to restore to a state that is normal for that individual – and is hence by definition reconstructive surgery.

In other words, a tummy tuck is without question not a cosmetic procedure. Just because an operation makes something look better people will immediately label it cosmetic, however the primary purpose of an abdominoplasty is to reconstruct, and as a secondary bonus it will look better.

Different types of Tummy Tucks

The term Tummy Tuck is really a simple term that encompasses any operation that reconstructs the abdominal wall. This is because the degree of problems one has will dictate the type of abdominoplasty that is necessary.

The different names applied to the different tummy tucks typically relates to the surgical scars created. Common names include:

• Mini-tummy tuck
• Regular tummy tuck
• Extended tummy tuck
• Fleur-de-lis tummy tuck

Many variations exist within each type and the above is a very simplistic breakdown.

What is the Open Book Tummy Tuck?

Whilst these above tummy tuck options will be an ideal choice for most patients, with the ever-increasing number of people transforming their lives with life altering massive weight loss, better options were necessary to transform and reconstruct the bodies.

As such, the Open Book Tummy Tuck™ was an operation born out of necessity. Dr Dona developed this technique and coined the term “Open Book” based on how the abdominal wall appears halfway through the operation – the skin and fatty layers are opened like a book before being closed into its new form.

As is explained by Dr Dona, “when someone loses a massive amount of weight, they become, fitter, healthier and smaller – unfortunately the skin has a limited amount of elasticity and is unable to shrink-wrap around the smaller body.”

Dr Dona goes on to explain, “if you consider the skin to represent an old dress, then effectively you become a much smaller bodied individual walking around with a dress that is way too big for your body. My job is to make that dress fit your body.”

“The Open Book Tummy Tuck was developed to provide maximal contour improvement of the body with the skin tailored to precisely fit and showcase the smaller, fitter, healthier body hidden beneath.”

Of course, other areas of the body are also reconstructed as required, especially the abdominal wall muscles which usually require significant tightening. Furthermore, the OBTT is often combined with other contouring procedures such as Breast Reductions & Lifts, Total Body Lifts and/or Bra Lipectomies.

Applied to the correct patient, an Open Book Tummy Tuck™ is the gold standard in body contouring surgery after massive weight loss.

Surgery & scars

All surgery involves scars. Whenever a surgeon makes an incision, a scar will form. No magic exists to prevent a scar from forming or to make a scar disappear. The surgeons’ job is to ensure the scars are ideally positioned and have the best chance of healing well.

When it comes to body-contouring surgery, it is best to consider the entire procedure like dress making – the surgeon is the tailor and they need to tailor your skin to fit your smaller body. Dress-making involves removing material and running seams to create the best pattern/fit. In surgery, those seams are scars.

With respect to a tummy tuck procedure, the greater the contour improvement required, the greater the size and number of scars necessary. The OBTT is a surgical procedure typically utilised in those individuals who have experienced significant weight loss and therefore require significant contouring.

Most tummy tucks result in a single scar along the lower abdomen, which is nicely concealed within normal underwear line, and an additional scar around, or within, your belly button. However, sometimes additional scars are required to maximally contour the skin and provide optimal shape. A fleur-de-lis tummy tuck has a second additional scar along the entire midline of your abdomen up to you lower chest. In addition to the two scars of a fleur-de-lis tummy tuck, the OBTT has a third scar extending horizontally along the entire lower chest in the lower breast fold. The midline scar joins the lower abdominal and lower chest scars of the OBTT.

OBTT combined with other procedures

Massive weight loss affects every part of the body, with problematic excess skin issues often found in the arms, chest, back, buttocks and thighs. Therefore, surgery to reconstruct these areas is often required.

For some individuals, based on their unique circumstances, it may be possible to combine other procedures with an Open Book Tummy Tuck.

Further surgery – fine tuning

It’s not uncommon for any tummy tuck patient to require further surgery to “fine tune” the results.

As is often stated by Dr Dona, a tummy tuck is like dress making – the surgeon is the tailor, and they need to tailor your skin to fit your smaller body.

Just like dressmaking, often you need to have a second fitting to have some fine adjustments made to make it just right!

Tummy Tuck surgery is just the same but many times more complex. The skin and tissues are not static and rigid objects. They swell, they stretch, they shrink, they sag etc. In addition to this, the underlying body is also changing.

During surgery Dr Dona is crafting, sculpting, reshaping everything that’s 3D and not static, whilst at the same time making sure that he doesn’t push things too far and make it too tight – because that increases the risk of wounds not healing and breaking down.

With all this in mind, after everything settles and swelling starts to settle and things relax into position, it’s normal for things to be nowhere near as tight as they initially were. Therefore, it’s not uncommon for patients to require further surgery to fine tune the results, just like you would for a second fitting of a tailor-made dress. This is especially the case in quite large transformations such as an Open Book Tummy Tuck.

With this in mind, you should not undertake any surgery, especially these larger transformations, if you’re not prepared or willing to have further surgery, and the potential time off and costs involved.

Open Book Tummy Tuck – general potential complications

All surgical procedures carry the potential risk of wound healing complications – these complications include wound bleeding, infection, wound breakdown or even skin and tissue necrosis or loss. As a result, wound ulceration and wound breakdown can occur.  Wound complications can range in minor through to major concerns, that may warrant further surgical and hospital intervention.

With an OBTT, the wounds are obviously very large, so these risks are much greater compared to surgery with smaller wounds. Those patients at greatest risk of these potential complications are:

• Elderly
• Overweight
• Diabetics
• Smokers
• Immunosuppressed including those taking certain immunosuppressive medications

For most people without these risk factors, the chances of any significant wound healing problems are quite small.

An Open Book Tummy Tuck has very large wounds and therefore the risks of wound problems are much greater compared to a standard scar Tummy Tuck. The areas of greatest concern are located at the very bottom and top of the midline scar where it meets the relevant horizontal scar. These are the areas which have the greatest degree of tension and the poorest blood supply.

The general and specific complications for an OBTT are the same as noted on our Tummy Tuck page.