Muscle Tightening and Tummy Tuck
It is rare that patients do not see some benefit from a muscle tightening procedure with a tummy tuck. Occasionally patients do not need it, but your history suggests that you might. If you don't need it intra-operatively, then over tightening just adds to post-op pain. That is a decision you need to discuss with your surgeon directly.
Best of luck,
Vincent Marin, MD
San Diego Plastic Surgeon
Muscle tightening during tummy tuck
The standard abdominoplasty or tummy tuck involves removal of the pannus, or overhanging abdominal tissue, tightening of the muscles in the midline and recreation of the belly button. In virtually all of the tummy tucks I've performed I could tell preoperatively if the muscles needed tightening. This is determined by the overall abdominal wall laxity at rest and with muscle contraction and the diastasis or distance between the muscles in the midline. However, I have had a few cases where I wasn't totally sure if the wall needed tightening or not until I visualized it. So if you trust your surgeon then allow him to make that "game time decision." Most of the pain associated with a tummy tuck is from the muscle tightening so if it isn't needed than that's good news for you.
Need for a muscle repair during a tummy tuck is a given for 100 pound weight loss
In concert with most of the other plastic surgeon respondents (but more forceful verbally), it would be essentially a zero percent possibility that with a nearly 100 pound weight loss and 2 pregnancies that you would not have laxity of your abdominal wall which would require a repair. I have never seen this and I would guess that none of these other plastic surgeons could recall such a case of their own.
It may be wise that before you proceed with surgery obtain one or more additional opinions from other board certified plastic surgeons. You may be happier in the long run that you did this.
Tightening of abdominal muscles with a TT
IIt is rare that I don't tighten the muscle during a TT. With your history I would anticipate a much better result if it were done. In fact, I have never seen a scenario like yours that didn't need it. At the very least ask your scheduled surgeon to do it for you. If he/she refuses I would seek the opinion of another board certified plastic surgeon. Unless you have another TT someday you won't get this chance again. Don't let it pass you by.
Muscle tightening during tummy tuck
After 2 pregnancies and an almost 100 pound weight loss, it is highly likely that you are going to require fascial plication ("muscle tightening"). Although relatively rare, the extent of your laxity may not become fully apparent until after your muscles are fully relaxed under general anesthesia. You may wish to emphasize to your surgeon that you expect the muscles to be tightened unless there is no laxity even after full muscle relaxation.,
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You should continue to see a board-certified plastic surgeon in order to receive formal evaluations and develop/maintain a doctor patient relationship.
When muscle tightening is needed
It is correct in that not all will need muscle tightening during a tummy tuck. It is hard to imagine though that after two pregnancies, and a near 100 pound weight loss, that a firm muscle plication and repair would not improve your tummy tuck result. Perhaps a second opinion would help set things straight.
Best of luck,
Should tightening muscles always be part of an abdominoplasty
There is not 100% agreement among board certified plastic surgeons on this. I feel that it there is good muscle tone and shape--which is possible even after pregnancies and weight loss--then suturing the muscles is not indicated and can cause problems particularly with bleeding into the muscles and longer recuperation. More is not necessarily better. But then I am an "If it isn't broken, don't fix it" person. Your surgeon is in the best position during surgery to judge the state of your abdominal wall. But you should discuss your concerns with him/her beforehand and you need to be comfortable with trusting the decision he/she makes. If not, you should probably seek a surgeon with whom you are comfortable.
Tightening Probably Necessary
Congratulations on the weight loss! In my experience, patients with weight loss of 100 pounds with a history of full term pregnancies will have some stretch of the muscles. I would agree that examination is very important and you may not need it, but I would plan to tighten as a rule. You can request that he /she plan on tightening and not perform only if you are in good position on the table. Good Luck!
Muscle repair is almost always used in tummy tucks following pregnancy
With your history of 2 full term pregnancies and a 100 pound weight loss it would be highly unusual for you not to need a muscle repair concurrent with your tummy-tuck. I cannot remember ever not performing a muscle repair with your kind of scenario. I would suggets that you get a second opinion by another Board Certified Plastic Surgeon. Good luck with your upcoming surgery.