Can I have a TT w MR full back and front lipo. (photo)

Question

I would like an extended TT w MR full back and flanks lipo also fat transfer to hips and bbl I am 41 yrs old 5'5 and 193 lbs my goal weight is 175-180 I have lost 32 lbs w diet n exercise I have diabetes type 1 I'm taking oral meds my sugar readings are between 92 and 116 in the mornings fasting but other than that I am healthy I have 4 children normal pregnancies I don't smoke, or do drugs, I don't drink I am realistic about my results just want to loose the apron and have a shape

Gary Lawton, MD, FACS · Answer

Abdominoplasty treats the skin excess and muscle weakness of the abdomen, as well as any fat that is between the belly button and the pubic hairline. Liposuction treats only fat. It can be used to thin out the abdomen, but the skin must be in good condition with no excess, and there should not be muscle weakness. I do not like to combine abdominoplasty with liposuction because of the added risks of fluid collection under the skin, VTE and wound healing problems.

Aggressive liposuction with tummy tuck is dangerous.  A full tummy tuck with liposuction at the same time will certainly put you at a high risk for fluid under the tummy tuck skin (seroma). A full tummy tuck with aggressive liposuction at the same time will also certainly put you at an unacceptably high risk for a potentially fatal pulmonary embolism (PE), venous thromboembolic event (VTE). The literature is complete with this information. The science is the science. This is a risky combination.

The incidence of seroma formation is about 16.0 percent in the abdominoplasty-alone group and 31.2 percent in the abdominoplasty with liposuction group.

The combination of abdominoplasty and liposuction procedures can still overwhelm the body's ability to resist these shear forces by the fact that more surface area is available to “shear” and thus produce seroma fluid. Not so much as an additive effect but synergistically, such that the seroma fluid from the flanks flows into the adjacent abdominal space and resists the ability of the upper abdominal flap to close over the abdominal wall. Patients must be counseled about their risk for seroma formation and treatments aimed at resolving them including frequent postoperative visits for needle drainage and the rare case requiring operative drainage in the face of a persistent seroma.

Robert M. Tornambe, MD · Answer

I do not recommend doing both procedures at once because after BBL, you must sleep on your stomach to avoid pressure on the grafted fat in your butt. A painful and difficult thing to do right after a Tummytuck ! I usually do the BBL first to obtain as much fat as possible from the stomach and back regions, and 4-6 weeks later, perform the Tummytuck. Be sure to consult with a board certified plastic surgeon. Good luck!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you are a great candidate for a tummy tuck with liposuction. 
This can be done through a low and short incision, all completely below the
bikini line.  Your muscles can also be
plicated resulting in a flat abdomen.  BBL can be performed at the same time.  Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results.  The
most important aspect is to find a surgeon you are comfortable with. I
recommend that you seek consultation with a qualified board-certified plastic
surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Harry T. Haramis, MD, FACS · Answer

I do not perform these together, especially with your medical history- you are increased risk for blood clots and post op positioning is very difficult if both are done at the same time. We have an internist in our practice to medically clear all of our pre and post op patients as well.Rather, these should be staged- Vaser ultrasound liposuction to flanks, back, abdomen with fat grafting. Then, several weeks later when up to it, tummy tuck. The order can be reversed depending upon how much fat is needed for grafting.An exam and consultation with a plastic surgeon who performs these procedures is recommended to confirm you are a candidate as well as discuss your options and expectations.

John Paul Tutela, MD · Answer

Thanks for reaching out. You are absolutely a candidate.  I would however continue in you diet and exercise program and continue to loose weight first.  Your results will be far superior.  It is always best to operate once you are at a stable weight for a little while.  Any weight gain or weight loss after surgery can alter the outcome.I hope this helps :)

Aramis Vega, MD · Answer

It's my pleasure to answer your question.You are a candidate for liposculpture and tummy tuck surgery if your general health condition is ok.Sincerely,Dr. Aramis Vega

William B. Rosenblatt, MD · Answer

You need to get your BMI below 30 - for a better result. Also as a diabetic, you need medical clearance and should think of doing less at once. A tummy tuck with muscle repair and some flank lipo would be fine. But for more lipo you should stage the surgery as diabetics have a greater risk of post op problelms. Also You would not have a short incision , not with the amount of skin and fat you have to remove. -- but the scar can b e kept within the bikini lines.

Brooke R. Seckel, MD, FACS (retired) · Answer

Congratulations on your weight loss.  You will have a much better result from your tummy tuck if you can first finish losing weight and get closer to your ideal body weight.  The combination of an extended tummy tuck and liposuction of the back and flanks can be a lengthy an complex operation.  If you are considering fat transfer to your hips and buttocks I would suggest that you consider a second operation for the liposuction and fat transfer.  It is important for you to know that fat transfer to the buttocks does carry some risk.  There have been 22 reported deficit from this operation do to fat embolization to the lungs.

James Fernau, MD, FACS - Account Suspended · Answer

Thank you for your question and photographs.I would recommend once you reach your goal weight, as long as you are in the BMI range of 30 or below, to maintain that weight for at least 3-6 months before having your surgery performed. If your BMI is higher than 30 you put yourself at a higher health risk and if your weight fluctuates too much after your surgery it can affect your results. So I would wait until you reach a healthy weight that you are satisfied with then have your surgery performed. It is important to remember to continue to live a healthy balanced lifestyle though diet and exercise even after surgery to maintain your results. I generally stage these procedures simply because you will have to refrain from sitting/applying pressure on your buttocks for at least 2 weeks after a BBL which means you would need to sleep on your stomach, which may not be optimal when just having a tummy tuck. This reduces complications and provides for a more comfortable post-operative recovery.It would be best for you to schedule a consultation with a board certified plastic surgeon once you have reached a stable goal weight, so they can perform a physical examination and determine whether you are a candidate for these procedures. Best of luck!Sincerely,

James Fernau, MD, FACSBoard Certified ENTBoard Certified Plastic SurgeryMember of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

James Fernau, MD, FACSBoard Certified ENTBoard Certified Plastic SurgeryMember of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

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