Is Liposuction Necessary when Having Tummy Tuck?

Question

I have had several consultations with different plastic surgeons about having a Tummy Tuck done.  Two of the plastic surgeons told me that they would just do the Tummy Tuck, without Liposuction as it can be dangerous if done at the same time.  Two other plastic surgeons said that they would do Liposuction to the flanks, and also right under my rib cage, above my belly button.  I am really confused!  I am going back to the one ps who said he would do both at the same time and ask him more questions about it.  I just want to be safe.  Is Liposuction really necessary? Or can some area already be tightened with just Tummy Tuck?

Jeffrey E. Schreiber, MD, FACS · Answer

This is a very interesting topic. Textbooks have stated that it is risky to perform abdominal liposuction at the same time as a tummy tuck, but recent plastic surgery articles have discounted this. In my practice, I'll liposuction the flanks only with a tummy tuck to help preserve the blood supply to the abdominal skin. The feeling is that extensive liposuction above the belly button could disrupt the blood supply to the skin flap. A little liposuction would probably be fine, but I would be hesitant to perform aggressive liposuction above the belly button at the same time as a tummy tuck. You can always go back later (3-6) months for liposuction after the blood supply has been re-established to the abdominal skin after your tummy tuck.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding whether liposuction is necessary when having a tummy tuck. It’s excellent that you are gathering information to make a well-informed decision.

Liposuction in combination with a tummy tuck must be approached with caution to avoid compromising the blood supply to the operated areas. This is crucial for ensuring proper healing and optimal results. I typically restrict liposuction to the love handles when performing it alongside a tummy tuck. This approach helps in enhancing the contour of the waist while maintaining the safety and integrity of the abdominal skin flap.

The confusion you're experiencing is understandable since practices vary among surgeons. Some may feel comfortable performing liposuction in areas like right under the rib cage and above the belly button, while others might avoid it to minimize risks.

Liposuction can be an effective adjunct to a tummy tuck for removing stubborn fat deposits and refining the body’s contour. However, it is not always necessary. The tummy tuck alone can significantly tighten abdominal muscles and remove excess skin, which might be sufficient depending on your goals and existing body shape.

It's important to discuss your aesthetic goals and any concerns with your plastic surgeon. Asking about their specific techniques and the reasoning behind them, as you plan to do, is a great strategy. Always ensure your surgeon is board-certified and experienced in performing these combined procedures.

Sincerely,
Dr. Katzen

Otto Joseph Placik, MD · Answer

There are many issues here which are too complex to answer completely in this format but I will try to simplify.

Some physcians have concerns with any combination of the procedures and feel that there is an elevated risk of deep venous thrombosis. This, at one time in the past, let the Florida State Health officials to limit performing these combinations to hospitals or surgery centers only; this moratorium has since been lifted.
Many physicians are reluctant to perform liposuction on areas that are lifted during the surgery especially the central and upper portions of the belly. This can cause a compromise of the blood supply and lead to healing problems. Less controversial is liposuction of the flanks (an area that is not lifted). Liposuction of the thighs, arms etc. is generally considered acceptable but does vary among surgeons and may depend on the extent of the abdominoplasty.
Liposuction is generally considered an integral part of mini-abdominoplasty in which the upper and central parts of the abdomen are not lifted up.

This is extremely oversimplified and is essentially a summary of the most relevant points in my opinion. I hope it helps.

Scott Tucker, MD · Answer

There is some controversy about lipo at the time of abdominoplasty. If done with caution and not to and undermined flap I feel as if it can be done safely. Whether or not it is neccessary depends upon where you have fatty excesses. In some cases if they are not addressed at your initial surgery you might need to have it done later to maximize your result.
Just address your concerns with the plastic surgeon that you like the best and I'm sure he/she can put your mind at ease.
Good Luck!

Darrick E. Antell, MD, FACS · Answer

Every case is different and each surgeon has their own preferences for performing a particular operation. In some cases liposuction may not be necessary at all and in others it may enhance the result.
When performed at the same time as a tummy tuck, one needs to be aware of a variety of issues pertaining to the blood supply and the surgeon you met with can discuss this with you in greater detail. Most of my cases are performed in combination with some degree of liposuction.

Michael M. Omidi, MD, FACS · Answer

Thank you for the question. Tummy tuck and liposuction address different needs so it would help to conduct an in-person exam to give you an individualized answer. Keep in mind, however, that tummy tuck does not necessarily involve liposuction. These are two different procedures.
A tummy tuck offers the most effective way to correct loose skin and muscle separation in addition to eliminating excess fat. Liposuction will also remove fat, but it can't address flabby, hanging skin that typically persists after weight loss. For this reason, many patients who have experienced a massive weight loss or recent pregnancy tend to opt for a tummy tuck. This procedure can also be combined with liposuction for maximum effect. 
As for discomfort, you will not experience any pain during the procedure itself since your plastic surgeon will use anesthesia. A tummy tuck will involve more bruising and a more prolonged recovery since it's a more invasive procedure. If you pick a qualified surgeon and carefully follow the post-op instructions, however, you should not experience any complications. 
The bottom line is a full tummy tuck will not only remove excess fatty tissue, but also eliminate excess skin and correct abdominal muscles that have been separated and weakened by lack of physical activity or pregnancy. 
An in-person exam with a board certified plastic surgeon is always the best way to fully assess your needs and address your concerns. Best of luck!

Tom J. Pousti, MD · Answer

Thank you for the question.Liposuction is a tool that is often used during the time of tummy tuck surgery. Different plastic surgeons utilize this tool differently;  some are more “aggressive” than others.  In my practice, I frequently utilize this tool to treat adipose tissue of the flanks and pubic areas during the tummy tuck procedures.It will not hurt to discuss the pros/cons of liposuctioning with your plastic surgeon;  simply ask for his rationale why feels it would be potentially helpful treating the areas you are concerned about.   Best wishes.

Vijay K. Bindingnavele, MD, FACS · Answer

Abdominoplasty can be performed without liposuction but liposuction may be necessary to obtain optimal results.  While abdominoplasty removes excess skin and the underlying fat, it does not take care of surrounding fat which can be removed by liposuction.  An evaluation will allow the surgeon to determine if liposuction needs to be performed with an abdominoplasty for optimal results.

Christopher L. Hess, MD · Answer

I consider myself a conservative and safe surgeon.  Yes,  liposuction can be performed on that abdominal flap in the superior abdomen at the time of abdominoplasty.  However, this does run the risk of injuring the blood supply to the flap and thus increasing the risk of wound healing problems.  In addition if the lower part of the flap is not or cannot be defatted than the result is more fullness in the lower abdomen which can give the appearance of an unfinished surgery.
However, liposuction of the flanks is totally safe and has no bearing on the blood supply of the abdominal flap.  I aggressive remove the fat from this area which results in a very pleasing waist line.

Marcus L. Peterson, MD · Answer

I like to do liposuction at the same time as a tummy tuck because it helps the skin advance and makes you look thinner.  I have to be careful not to do much in the area above the umbilicus because this is the area of maximum stress.  The waist area and front part of the hips are a good place to contour the tummy tuck for a nice results.
The tummy tuck will tighten the skin and the liposuction will improve the contour and transition areas. 
Best Wishes
Dr. Peterson