Dr. Dirk Lazarus
Plastic Surgeon

Tel: 021 424 1112
Fax: 021 424 1118

86 New Church St
Tamboerskloof
Cape Town, 8001
South Africa

Please note that as usual in my newsletters, opinions expressed are my own.

Tummy tucks vary according to each individual patient’s requirements. When I see a patient for a tummy tuck, I first assess their suitability for surgery and then try to decide on the most appropriate tummy tuck for that particular patient. Increasingly I am performing fewer classic (or full) tummy tucks and more mini (short scar) tummy tucks.

In assessing suitability for surgery I look at a number of factors. Individuals should be of relatively normal weight for height and have a body mass index of less than 30. [Body mass index (for the mathematically-minded amongst you) is (=) weight (in kilograms) over height (in meters) squared : BMI = wt(kg)/ht(m)2.] Patients who are overweight should be on an eating plan, preferably under the guidance of a dietician, and on an exercise program, preferably under the firm hand of a personal trainer. Overweight and obese patients are not suitable for tummy tucks.

Patients still considering another pregnancy are advised against a full tummy tuck. Part of the full tummy tuck operation is tightening of the muscles of the tummy and these may be disrupted by the expansion that occurs with pregnancy. Certain abdominal scars, especially the old fashioned open cholecystectomy (gall bladder removal) scar, can interfere with the blood supply of the tummy skin and performing a tummy tuck in a patient with such a scar would be ill-advised. The newer endoscopic or laparoscopic procedures leave smaller scars which still allow the tummy tuck to be done. Patients should also understand that a classic (full) tummy tuck is a major procedure and they should budget on three to six weeks or so of down time.

I assess patients who come to me for tummy tuck according to three important tissues: skin, fat and muscle:

Skin: excess skin, stretch marks, scars, etc. The only way to treat excess skin is to excise it (cut it out). I know of no cream, ointment, emollient or other remedy for stretch marks and again, the only treatment for stretchmarks that I know is to cut them out. Caesarian section scars are sometimes unsightly: raised and red; sometimes skew; or sometimes problematic in other respects. Again the treatment to neaten them up is to cut them out.

Fat: Excess fat can be removed by lifestyle changes such as diet and exercise, or by surgery. Surgery is good for lipodystrophy – fatty collections which do not respond to diet or exercise – and is the only way to permanently remove fat cells. Surgical removal of fat can be done in two ways: it can be excised (cut out) or liposucked away. Both techniques are used in tummy tuck, but in general a classic tummy tuck relies on excision, a mini tummy tuck more on liposuction.

Muscle: We each have two rectus abdominis muscles, one on the left and one on the right, running down from our chest cage to our pubic bones. Each muscle has three tendinous bands running across it and when we can see each muscle and tendinous band, then we can see the alluring and desirable six pack. Pregnancy, in particular, age and other factors cause the muscles to split apart, so called divarification of muscles. Divarification combined with poor muscle tone results in abdominal wall laxity. Most tummy tucks incorporate some form of muscle tightening – in a classic tummy tuck the muscle is sewed up (medical term: plicated) from top to bottom. In mini tucks the plication may only be below the belly the button.

Where patients have a marked skin excess, minimal fat excess and marked muscle divarification, I recommend a classic tummy tuck. This is typically the more mature patient who has had a number of pregnancies and whose skin has now lost a lot of elasticity.

A classic tummy tuck starts with a cut from hip to hip. This cut is a shallow U or W shape, skirting over or through the top of the pubic area. The cut is then carried in a curve up over the top of the belly the button. The excess skin and fat is removed. The belly button is left attached to the muscles like a mushroom as the skin is lifted up to the rib cage. The muscles above and below the belly button are tightened, but usually no or minimal liposuction is performed as liposuction can interfere with the blood supply to the skin. The skin is then re-draped – pulled down – and after making a hole for the belly button, sutured to form a low-lying scar. Finally the belly button is sutured in position, drains left in place, dressings applied and possibly a binder or some form of corset.

A classic tummy tuck of this nature is a big operation, usually requiring a couple of nights in hospital. The drain is left in for up to seven days. The tummy feels tight afterwards and you will need to be nursed in a bent position. It will take you a few weeks to straighten up fully.

Although the above, classic tummy tuck is a good operation, I have become dissatisfied with some elements of it:

1. It is such a big operation, usually requiring hospitalization for a few nights. Many of my patients want lesser surgery and in particular a shorter recovery period. I operate on a lot of medical tourists and these patients in particular need minimal down time and a quick, predictable recovery;

2. The ability to remove fat is limited. Although the fat below the belly button can be treated, the fat above the belly button cannot without possibly affecting the blood supply. Similarly the love handle area is often problematic;

3. Scar load – A full tummy tuck leaves a lot of scar. The scar from hip to hip, although it is well sited in a natural body line and usually positioned low and in the panty line, is still a long scar. The scar around the belly button is particularly unattractive. My ex professor used to say that you can judge the quality of a tummy tuck by the appearance of the belly button.

These days I more frequently leave no scar around the belly button. In addition I am able to perform most of my surgery as day case surgery with less down time and to remove more fat, especially in the difficult area above the belly button and below the rib cage. Most tummy tucks that I do these days are mini (short scar) tummy tucks.

A mini tummy tuck also involves an incision above the pubis, but usually the scar can be kept shorter than for a full a tummy tuck. A wedge of skin and fat is excised. No cut is made around the belly button, but the belly button is pulled down a little at the end. Most patients do not mind this and are happy with the vertically elongated belly button as opposed to their previous horizontally orientated belly button. I generally perform much more fat removal in my mini tummy tucks than in my full tummy tucks because I remove the fat with liposuction. Because the dissection is limited, liposuction can be performed relatively safely, without disrupting the blood supply. I can therefore remove up to 2kg of fat with dramatic results. When it comes to the muscle tightening, with the mini tummy tuck, I am usually limited to tightening the muscle only below the belly button. Occasionally I “float” the belly button which allows me to do more muscle tightening above (but not as much with a full tummy tuck), but at the expense of causing the belly button to be even lower at the end of the procedure.

The advantages of the mini tummy tuck are therefore that
1. it is a smaller procedure – I can do it as day case surgery
2. the recovery (down) time is less, about 2-3 weeks
3. the scar is shorter
4. no scar is left around the belly button
5. the belly button becomes more vertically orientated
6. more fat can be removed, especially from the upper part of the tummy
7. significantly less expensive

The disadvantages of the mini tummy tuck as compared to the classic are:
1. slightly less skin tightening
2. less muscle tightening

I currently perform about 80% of my tummy tucks as mini tummy tucks and only 20% as classics. I do, however individualize the surgery to fit the patient and not the other way round.

Comparative Summary:

For further before and after pictures, please email me.
Please note that prices may change from above.