Case-28856 Gallery

Before and after abdominoplasty revision in a 49 year old woman. She had previously had a Mommy Makeover procedure elsewhere and was told she had a fully tummy tuck, including rectus abdominis muscle repair. However, when she exercised, she still felt a large abdominal bulge and felt her abdominal muscles were not working well. She was also left with standing cone deformities of the ends of her lower abdominal scar, called “dog ears” by Plastic Surgeons.

A revision of her abdominal scar was planned together with a breast revision. Her lower abdominal scar was opened and dissection upwards revealed that her muscles had not been repaired. The second last image shows the muscle separation, which extended from her pubic bone below to the xiphoid process above. This degree of muscle separation, called “rectus diastasis”, is very common after several pregnancies as the muscles are stretched apart and the pressure of subsequent pregnancies limits their ability to rebound back together.

Muscle repair via “rectus fascial plication” is a vital component of a tummy tuck, as nothing else will bring these muscles back together once they are permanently separated. In the center of the muscle separation is the umbilical stalk, which is preserved on its own blood supply. It is protected when the muscles are repaired, and brought out through a new skin opening, like bringing a button through a buttonhole.

Her rectus abdominis muscles were repaired in two layers (shown by purple lines in the photo) from the outside in, and the abdominal skin was pulled tightly downward. This lessened the appearance of any remaining stretch marks that could not be removed during surgery. The dog ears were excised, and liposuction removed excess fat from her upper and lower abdomen, flanks, pubic region and inner and outer thighs. The last image shows the fat that was removed by the liposuction portion of surgery.

Follow up images are shown nine months after her redo tummy tuck procedure. Her scars are starting to fade, and she was so grateful that she finally got the tummy tuck that she wanted in the first place!