Are the risks associated with a fleur-de-lis tummy tuck significantly higher than the risks of a regular tummy tuck?

Question

I have been given two different opinions about which tummy tuck I need and I am trying to weigh the risks and make a decision. I am 63 years old and have a BMI of 35.

Ronald J. Edelson, MD · Answer

The down side of the fleur de lys type tummy tuck is the additional midline scar and possible wound healing problems.  I have never found it necesssry to perform the fleur de lys tummy tuck so I suspect a standard tummy tuck will work just fine.  I like to keep things simple.

William Bruno, MD · Answer

The risk of a traditional tummy tuck and fleur de lis tummy tuck are very similar. More than the type of tummy tuck is your elevated BMI as it relates to surgical risk. The risk of developing a DVT (blood clot) is higher in patients who are at higher BMIs. Consult with a few plastic surgeons to determine if you are a candidate for a tummy tuck. You may need to lose some weight prior to surgery to lower your risk profile.Best wishes,Dr.Bruno

Dean Trotter, MBBS, FRACS · Answer

The risks of a Fleur-de-lis (FDL) abdominoplasty are higher in terms of wound complications than a regular tummy tuck.  This is because there is an additional incision and where this vertical scar meets the horizontal one there is a common point of wound breakdown.The other operative risks are similar, albeit a little higher with FDL abdominoplasty since it is a slightly longer operation.  Bear in mind that it is usually only a good choice for patients with existing abdominal scars or massive weight loss - this patient group tends to have higher complications than other patients.Given you have a BMI of 35, I would advise you to lose more weight before making your final decision. A BMI less than 35 will likely mean less complications and a better overall outcome.  I suggest you discuss with your plastic surgeon your options and the pros and cons of each with respect to further weight loss.Kind regards,Dean

Mark Baldwin, MBBS · Answer

You need another opinion. I agree with other surgeon's answers that in general, either you do need a Fleur De Lis or you don't. Simple. So your third opinion needs to be from a surgeon who does plenty of both techniques. I see a lot of patients for a second opinion who have been informed they do not need, or should not have, a Fleur De Lis, invariably by surgeons who do not perform, or do not regularly perform, Fleur De Lis surgery.
I'd also be saying at 63yo, and BMI 35, if you're worried about the risks, you should concentrate on losing more weight before the procedure, which will have more impact on your safety than the technique.
Regards, Mark.

Andres Taleisnik, MD · Answer

Risks are somewhat higher with a fleur de Lis tummy tuck, since there are more incisions and blood flow to the skin is affected to a greater degree. This can affect healing. Most patients don’t need a fleur de Lis unless they’ve lost A LOT of weight, with skin so loose and redundant both horizontally and vertically. Visit at least two surgeons if you’re not reassured by your surgons’s explanations and recommendations. Your surgeon should be able to guide you. Good luck!

Curtis Wong, MD · Answer

but in my opinion and with my techniques (discontinuous undermining) blood supply is BETTER with the anchor abdominoplasty.  If you have tons of lax skin, such that occurs with major weight losses, those patients want their skin removed.  The anchor will do that whereas the traditional tuck will produce a much better contour but your skin will be much more jiggly... like the Pillsbury dough boy.  So if you have a lot of excess skin, the anchor is better.  If you don't, then the traditional would be better.  You must accept the vertical scar to have less skin and a flatter tummy.  Expect revisions.

Johnson C. Lee, MD · Answer

A fleur-de-lis tummy tuck adds the vertical incision to your tummy tuck. This will reduce the amount of blood supply to the lower central portion of your abdomen and will place you at higher risk of wound healing complications. The trade off however is that a fleur-de-lis gives the surgeon the ability to remove excess horizontal skin laxity which the standard tummy tuck cannot really do. This is why the fleur-de-lis is generally used on patients who have undergone significant weight loss and have a lot of loose skin both vertically and horizontally. Hope this helps!Johnson C. Lee, MD 
Board-Certified Plastic Surgeon
@drjohnsonlee

Tania Medina de Garcia, MD · Answer

Hello dear!!Thanks for the question and provided information as well. Both procederes can present risk and complications during and after surgery, however the most important is to chose a good plastic surgeon and to be in a good health. Your safety is the most important.  Good luck :)

Richard J. Brown, MD · Answer

First, the two different types are really for very different patients. You either need the Fleur-de-lis or you do not. If you need it then you more than likely have a lot of extra skin in the vertical and horizontal directions. Certainly with more incision there is more potential for wound healing problems. The Fleur-de-lis Abdominoplasty also elevates a bit more skin than the standard Abdominoplasty so there is more potential for blood supply issues. Being that said, I have done many Fleur-de-lis Abdominoplasty procedures and they healed well. The real question is do you really need it or not for the best result. If you do you should feel comfortable that it will more than likely heal well just like anyone else with just a little bit more risk than the standard abdominoplasty.

Michael Zarrabi, MD · Answer

thanks for your question. Photographs would be very helpful in this situation to get a better recommendation.  Generally the rest between the two types of procedures are about the same. Given your BMI, you are at increased risk of complications. Losing weight prior to surgery would be a great idea.  You have to consider whether having an extra scar from the breast bone down to the pubic bone would be beneficial.  If you really have a lot of excess skin, the extra scar maybe worth it

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