Why Do Some Surgeons Prefer Not to Do Lipo of the Upper Belly when Having a Tummy Tuck?

Doctor Answers 11

Can liposuction and TT be done at the same time?

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To answer your question I need to make a distinction in the type of TT done.  A full TT elevates the skin from the lower abdomen up to the rib margins.  This separates the abdominal skin from a part of its normal blood supply which comes up through the rectus muscles (the sit up muscles). The flap stays alive from blood vessels which run within the abdominal skin flap and usually does so very well.  However, if in addition to full elevation of the abdominal skin flap, a surgeon runs a liposuction cannula into the abdominal skin flap to thin it, the blood supply to the part of the flap closest to the incision may lose some of its blood supply and die.  This is why surgeons avoid liposuction of the upper mid part of the abdomen during a full TT.

There is a slightly different type of abdominoplasty where the skin is not completely separated from the underlying rectus muscles all the way up to the rib margin but this area is liposuctioned instead.  Some blood supply from the rectus muscles is still feeding the flap so the liposuction can be done to thin the upper part of the flap safely and then the lower abdomen excess skin is trimmed off and the abdomen is flatter and tighter.  This is called a Lipoabdominoplasty and gives excellent results in the proper patients.  Contact a surgeon certified by the American Board of Plastic Surgery and get more details.

Tummy Tuck With and Without Upper Abdominal Liposuction

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Liposuction is not done in the central upper abdomen at the time of a tummy tuck by many plastic surgeons in an effort to a avoid wound healing complications. While it may be viewed as a 'homerun' effort and offers more complete abdominal contouring, should a necrotic skin flap develop below the belly button (no matter how small) it will make you wish it had been omitted from the procedure. It is much better to have a tummy tuck that heals well. You can always undergo a secondary upper abdominal liposuction procedure later which is a much more tolerable 'problem' than to go through the time and tremendous inconvenience of a long healing process of an open wound...not to mention the ugly scar which will result.  

Avoiding liposuction in the upper abdomen

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I tend to agree with all the answers here with regard to the increased risk of wound problems and skin flap death when aggressively liposuctioning this area.  I would add that if your surgeon is telling you that he or she does not want to add risk to the procedure, I would take this advice to heart.  Your safety as a patient should be one of the top three priorities that any board-certified plastic surgeon should be concerned with.  Conversely, if you feel that you cannot have confidence or trust in your surgeon, then it can be helpful to get a second opinion.

My preference is to not liposuction in that area to lessen the chance for complications.  However, I will perform some liposuction in that area in select cases depending on the degree of contour deformity and the amount of lateral undermining of the flaps.  Thank you for your question.

Tito Vasquez, MD, FACS
Southport Plastic Surgeon
4.7 out of 5 stars 17 reviews

Lipo of the central abdomen

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I prefer not to liposuction the central abdomen at the same time as a tummy tuck because it may jeopardize the viability of the central lower skin especially if there was full undermining of the upper abdominal flap.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Liposuction during abdominoplasty (tummy tuck)

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For a "regular" abdominoplasty liposuction in the central upper abdominal area is generally a recipe for skin healing problems at the lower abdomen.  We need to divide some of the "normal" circulation to the skin flap that gets raised up during the procedure, and in so doing we ask the skin to "live" on an altered blood flow pattern, through the skin.  If you then liposuction this area you create swelling and trauma to that area and the blood cannot flow properly through it, so the skin below it dies.  No fun for anyone.  For "minI" abdominoplasties often there is no interruption of the normal circulation so it is OK to liposuction the abdomen at the same time.  All that having been said, I often liposuction the lower sides of the abdomen and sometimes the abdominal areas below the breasts and I have not run into any problems doing that. 

If it were easy anybody could do it!

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This is one of the many controversies  in abdominoplasty and serves to reinforce the need to be evaluated by someone who has a good deal of experience in the procedure. 

I have used liposuction for nearly every abdominoplasty I have performed for many years now. I do lipo the superior flap above the umbilicus because it allows me to do less complete undermining of the flap. The blood supply remains intact. I have not seed an increase in wound healing problems.

One caveat is that neither liposuction nor abdominoplasty should be used as a weight loss measure. My liposuction volume is modest and really only used to mobilize the tissue and aid in closure of the wound.

Thomas R. Walek, MD
Providence Plastic Surgeon

Liposuction of the upper abdomen during tummy tuck can increase complications

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Many will use liposuction over the hip or flank to improve the contours during a tummy tuck, though some surgeons will not suction the upper abdomen. If the upper abdominal skin is suctioned and thinned there is a risk that the circulation to the skin may be compromised and increase the risk of healing complications after.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Liposuction and tummy tuck

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A tummy tuck involves elevation of the skin and fat of the abdomen to your breast bone.  This can be good and bad.  By elevating the skin flap, your surgeon is able to remove the excess skin and tighten your abdomen.  The bad part is that it can stress out the blood supply to your skin and fat at the lower abdominal incision.  We know that if we do liposuction to the upper central abdomen at the same time, it will further stress the blood supply to the lower abdomen.  Both of these issues combined can lead to wound healing complications, so many surgeons will not do both at the same time.  Hope that this helps!

Anureet K. Bajaj, MD
Oklahoma City Plastic Surgeon
5.0 out of 5 stars 21 reviews

Is liposuction of the upper abdomen necessary during a tummy tuck?

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Medicine is more of an art than people realize. Plastic surgeons develop routines and habits based on their personal experiences. Although I personally will judiciously liposuction the upper abdomen for an abdominoplasty, this area is essential for the blood supply of the abdominal flap and too much surgery could result in a skin loss. Surgeons, me included, will typically alter their abdominoplasty technique to bolster the blood supply to this area and increase safety. 


The data is clear

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Adding liposuction to tummy tucks does not increase risks of wound healing problems or scaring.   Extended undermining does...........

Read the literature.  It is safe to lipo the flaps above the umbilicus and the entire world does it. Stay deep and limit undermining of the flap.  

The data is clear.

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 152 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.