I would like to get the best results possible I know this increases the chances of necrosis but what percent of patients do you see that end up with necrosis?
What Are The Risks With Upper Abdominal Liposuction with Tummy Tuck?
Doctor Answers (20)
Different techniques of liposuction with a tummy tuck.
To answer this question, a bit of knowledge on the technical aspects is necessary. In a traditional abdominoplasty where the entire skin flap is elevated off the abdominal, the main blood vessels to the central and upper skin flap are divided. If you were to liposuction this area of the flap, the skin is put at risk as the remaining blood supply can be damaged. However, in a technique known as "discontinuous undermining", the flap is separated from the abdominal wall primarily using liposuction before any incision is made. Once the liposuction is complete, the incision is made and care is taken to preserve the blood vessels which run along the central flap. The liposuction prior to skin elevation allows for improved preservation of blood supply and debulking of the abdominal skin flap. This is a safer method of liposuction during a tummy tuck than the traditional approach. However, the downside is the longer operating time required. Regardless of technique, not all tummy tucks require liposuction and care must be taken either way.
Tummy tuck and liposuction
for years (ten) i never did liposuction on my tummy tucks, then for another ten years I did it routinely. today i select which cases do I combine and which cases I stage. good judgment comes from experience, experience comes from bad judgment. see a board certified plastic surgeon and discuss your concerns. Safety is Important, but the two can be combined; in most patients.
Lipo and Tummy Tuck
I routinely perform liposuction of the upper abdomen with tummy tuck surgery and because I limit the undermining of the abdomen above the belly button to a small tunnel to correct muscle laxity, I have not found there to be any increased skin necrosis. One of the biggest causes of necrosis is smoking which must be stopped prior to surgery. In selected patients I will perform circumferential liposuction of the trunk with a tummy tuck.
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Upper abdominal lipo should be avoided during a tummy tuck
This is a topic which always seems to be discussed at plastic surgery meetings and conferences. Basically if you liposuction the upper abdomen during a tummy tuck you risk injuring the blood supply to the abdominal skin which can lead to skin death (necrosis). I can not give you an accurate percentage, but we do know this carries a risk which can easily be avoided by not doing liposuction. It is a risk that most plastic surgeons are not willing to take because of the potential disastrous consequences. Some of the fat can be carefully trimmed (with a scissor or scalpel) which is much more precise than liposuction, therefore preserving the blood vessels.
Consult with a board certified plastic surgeon in person for a complete evaluation and explanation.
Abdominoplasty and liposuction
If you are not smoker and do not have other medical conditions which increases the chances of having complications ( Diabetes,cardiovascular diseases,etc...), and if you do not have any incisions (deep cuts) above your belly button, you are not at significant higher risk of loosing your skin flap. Of course your plastic surgeon should be competent/experienced enough to perform the operation with just adequet underminings and gentle liposuction, not to compromise blood supply of the abdominal skin flap. It is helpful to ask your plastic surgeon about his/her experience of performing these combined procedures. I have performed this type of operations may times without loosing any skin.
Abdominoplasty and liposuction of the abdomen
There are techniques were liposuction of the abdomen with abdominoplasty can be done safely with a minimal risk of necrosis.
These techniques are relatively newer ideas and the difference from a traditional abdominoplasty is that these newer techniques may have minimal undermining of the supra umbilical area of the abdomen. What cannot be done is to liposuction the same area that is undermined. If you do not undermine the flap than liposuction of the abdominal flap can be done safely.
There are some instances that I have used this technique in a patient I would be afraid to do a traditional abdominoplasty on because of the risk of necrosis. An obese patient is an example of a patient who this limited undermining technique may be a safer technique than traditional abdominoplasty.
If you look at my profile one of the patients who wrote a recommendation was actually a patient who had a limited undermining abdominoplasty with extensive liposuction of the abdomen.
Liposuction along with Tummy Tuck
Many surgeons perform some liposuction during the tummy tuck procedure. Safety should ALWAYS be the first priority. We need to limit the amount of liposuction performed during the tummy tuck procedure so that there is no compromise with the recovery process. It is ideal to meet with a couple of board certified plastic surgeon's who have experience with abdominoplasty surgery and get their advice.
Lipo upper abdomen with tummy tuck
Liposuction of the upper abdomen can safely be done during a tummy tuck as long as the tummy tuck does not jeopardize the upper abdominal blood flow too extensively. The upper part of the tummy tuck dissection should be more central and conservatively done and this will allow the upper abdomen to be safely liposuctioned.
I perform these 2 procedures at the same time very frequently and I have not seen any skin necrosis problems due to it, of course you have to be in good health and a non smoker.
Generally not recommended to do liposuction at same time as tummy tuck
Generally, I do not recommend doing liposuction at the same time as the tummy tuck because of the chance of necrosis of the abdominal flap. Conservative liposuction to the hip areas are okay.
Liposuction During Abdominoplasty
Liposuction is commonly performed with a tummy tuck, but not commonly on the upper abdomen where the tissues are "elevated." This puts the tissues at risk for loss and what is commonly termed "necrosis." This isn't commonly done, but the consequences are significant if it happens and most surgeons aren't willing to take that risk of an avoidable complication. A second procedure to address this area can easily be done later, but if you loose tissue, that cannot ever come back. Frequently this is addressed by dressing changes and daily wound care.
The other option is to lose the necessary weight before surgery to alleviate the need to do any upper abdominal contouring procedures.
Best of luck
Vincent Marin, MD
San Diego Plastic Surgeon