Tummy Tuck and Hysterectomy—Is It Safe to Combine These Two Procedures?

A recently published study has suggested that combining tummy tuck, a cosmetic surgery that removes the sagging skin and fats in the abdomen; and hysterectomy or the removal of uterus is relatively safe.

While the study is quite small—only involving 65 women who had both procedures at the same time—the researchers believe it is enough to demonstrate its reasonable safety despite that their findings have shown the rate of minor complications was about 32 percent.

However, no major complications were seen in 65 women who had tummy tuck and hysterectomy at the same time.

But not everyone agrees.  Some doctors said that “minor complications” are sometimes interpreted in many ways.

Hysterectomy is currently the second most commonly performed surgery performed on women, behind Caesarian, according to data released by the US Office on Women’s Health.

The procedure is conducted to treat cancer, abnormal bleeding, pelvic pain, benign tumors in the uterus, and endometriosis (uterine cells grow in other areas of the body).  While it is possible to remove the uterus through the vagina, most doctors prefer using an incision made across the abdomen.

Because hysterectomy and tummy tuck have the same incision site, some doctors have come up with the idea of combining these two procedures, which they believe offer potential benefits including decreased time spent in hospital, reduced risks associated with general anesthesia, less surgical expenses, and reduced overall healing time.

But due to increased surgical trauma and longer operating time (which may increase the risk of complications), many doctors still prefer to conduct tummy tuck and hysterectomy months apart. 

Liposuction, Tummy Tuck Improve Self-Esteem—Study

Liposuction and tummy tuck, two cosmetic procedures that can improve the appearance of the abdomen, can lead to higher self-esteem, according to a study published by the Plastic Reconstructive Surgery magazine (April issue).

Dr. Eric Swanson, lead author of the study, evaluated the quality of life in 360 patients who had liposuction surgery (removing the excess fats through a suction probe) and/or tummy tuck (excising the hanging skin and reshaping the underlying tissue within the abdomen).

According to result, satisfaction rate was particularly high among patients who had liposuction combined with tummy tuck (or abdominoplasty surgery), although they also scored higher in terms of pain and have experienced longer recovery period.

About 60 percent of patients had liposuction, 5 percent had abdominoplasty, and 35 percent had a combination of both.  The evaluation was conducted an average of four months following plasticsurgery.

Meanwhile, their average age was 42 and approximately 85 percent of the respondents were women.  But aside from tummy tuck and liposuction, around 35 percent of patients had other cosmetic surgeries (e.g., breast augmentation or facelift) at the same time.

Patients who had tummy tuck alone rated their cosmetic results higher than others—an average score of 9 out of 10—compared with the score of 8 with those who had liposuction surgery.

However, patients who both had liposuction and tummy tuck scored the highest in terms of satisfaction over the result—around 99 percent.  Surprisingly, the level of pain with this approach has no difference between “combined procedures” and abominoplasty alone.

Aside from high satisfaction, patients who had liposuction and tummy tuck at the same time said they would undergo the procedure again, while 99 percent said they would recommend it to others.

Approximately 70 percent of patients reported improved quality of life, although this is particularly higher among individuals who had liposuction and abdominoplasty performed at the same time.  And overall, 86 percent of the respondents reported improvements in their self-esteem after surgery.

Because many people still perceive cosmetic plastic surgery as “superfluous,” studies which assess its impact on the patients’ quality of life and self-esteem after the procedure are important as experts believe it is the “best way to gauge its success.”

Since cosmetic plastic surgery is elective and not medically necessary, its cost is usually not included in health insurance, although a growing number of doctors offer payment options to help patients finance the procedure. 

Recovering from Lower Body Lift Surgery

Shedding the extra pounds can have a significant impact to a person’s health, however, one downside is the formation of excess skin especially around the midsection, upper arms, and bra line.  This problem is particularly common for those who have lost 100 lbs. of excess weight or more.

Because the redundant skin is quite common among massive weight loss patients especially in the midsection, lower body lift is one of the most recommended plastic surgeries for them.  With this procedure, surgeons can target the excess skin along the abdomen (just like in a tummy tuck), and lift the sagging thighs and buttocks.

With this procedure, it would be like receiving tummy tuck, thigh lift, and butt lift all at the same time.  But one downside is the relatively long and painful recovery which is common with any invasive plastic surgery.

Lower body lift requires the use of a circumferential incision that results to a belt-like scar that fades over time.  This will cover the hips, back, and abdomen of a patient, allowing plastic surgeons to excise the redundant skin, lift the sagging buttocks and thighs, and contour the midsection of the body.  

Because the surgery is conducted under general anesthesia which puts a person to sleep, nausea and vomiting are quite common especially during the first to second day of recovery.  Meanwhile, some doctors recommend IV medications to control such symptoms particularly vomiting as it can put stress on the surgical incisions.

While some body contouring surgeries such as liposuction and tummy tuck are usually considered an outpatient procedure, this is not the case with lower body lift due to its invasive nature.  In fact, most plastic surgeons would likely recommend several days or weeks of hospital stay so the patients can receive immediate care in case a complication occurs.

In most cases, patients are only discharged from the hospital once they are already comfortable with oral pain medications.  But still, they should avoid strenuous activities and heavy lifting for several days to prevent wound reopening and promote faster recovery.

Despite some discomfort, patients are advised to take a short, gentle walk and/or perform light activities to prevent blood clotting and encourage their body to heal faster.

To minimize swelling and promote quicker recovery, plastic surgeons require their patients to wear compression garments that provide not just support but also encourage the skin to heal closer to the body, further defining the midsection.

Tummy Tuck as a Mommy Makeover Surgery

Tummy tuck or abdominoplasty is one of the most common “mommy makeover” surgeries.  In this procedure, plastic surgeons create a horizontally-oriented incision below the navel to get rid of the hanging, loose skin across the abdomen; and if needed, they also tighten the underlying muscle to further achieve a toner and slimmer appearance.

The procedure is more commonly performed on women than men because they experience pregnancy that often results to loose skin and stretched/weakened abdominal muscles.  By contrast, male patients only need this surgery after losing a significant amount of weight that left them with pannus, which is an apron-shaped skin in their abdomen.

Traditional tummy tuck involves a horizontal incision placed just within or above the pubic region.  The length of the surgical cut depends on the amount of skin to be removed, overall structure of the abdomen, and sometimes even the style of bathing suit or undergarments a patient prefers to wear.

Plastic surgeons will make every effort to keep the incision within the undergarment or bathing suit lines; however, this may not always be possible particularly those with excessive flap of skin and fats that reach and cover the pubic area.

In addition to the horizontal incision within or above the pubic region, doctors also create another one to free the navel in order to pull down the redundant skin above it, and remove any excess tissue.  The position of the belly button remains unchanged.

For some patients, the abdominal wall must be tightened and sutured to further address the sagging appearance.  This approach is particularly necessary for women who had previous pregnancies.

Because some of the skin is removed, the stretch marks in the area may be eliminated as well.  Any remaining purplish or whitish lines may become less apparent, although patients should not expect a dramatic change in their appearance.

The result of tummy tuck is supposed to last a lifetime, unless a person gains or loses a significant amount of weight.  The post-surgical outcome may also be reversed by pregnancy; for this reason, it is best to postpone the surgery if a woman is planning to have children in the future.

As with any body contouring surgery, there is really no point of having tummy tuck if one is not willing to maintain a stable weight through healthy diet and regular exercise.  It is important to note that while touch-ups are fairly common with this procedure, it results to more scarring.

Importance of Skin Removal After Major Weight Loss

Plastic surgery, particular body lift, plays an important role in helping previously obese patients live a more normal life.  In this procedure, surgeons remove the “redundant” skin which commonly occurs around the midsection—particularly the abdomen—,upper arms, back or “bra-line” for women, and thighs.

The skin and tissue laxity also results to sagging breasts and deflated-looking buttocks.

Because of the extreme disfigurement experienced by previously obese patients (they either lost weight through bariatric surgery or natural methods), body lift is seen not as a mere cosmetic procedure but as an important surgery that can make the body appear as normal as possible.

In fact, many insurance companies consider some forms of body lift as a reconstructive surgery and cover some of the surgical costs.  By contrast, they do not provide coverage for any cosmetic surgery which is elective in nature.

To be considered a reconstructive surgery, a body lift should be performed not just to correct or at least improve the appearance of the disfigured body; but primarily, it should be used to address skin irritation, foul odor and poor hygiene caused by the trapped sweat, and chronic back pain because of the extra weight of the hanging skin.

Tummy tuck and lower body lift, if performed to MWL patients who are experiencing the symptoms mentioned above, are generally covered by health insurance.  But unfortunately, other forms of body lift, particularly those targeting the upper arms, breasts, thighs, and buttocks are usually not included in the coverage. 

Even when multiple body lift procedures are performed, about 5 to 15 percent of MWL patients will need postoperative revisions, although most of these are minor “touch-ups” to correct residual deformities and other complications.  It is important to note that complication rates are not equivalent to failure rates.

Despite the risk of scarring and the need for postoperative revisions (in some cases), majority of MWL patients are satisfied with the result; in fact, several studies have found that most people who had body lift enjoyed better performance in physical exercise, professional and sexual integration, sexual life, and behavioral improvements.

The good thing about having body lift after major weight loss is the result can last a lifetime—as long as the patients will maintain a normal weight through proper diet and regular exercise.

Because food has been a source of comfort for previously obese people at some point in their lives, some plastic surgeons work closely with psychologists or behaviorists to help patients stick to a healthy lifestyle and maintain the result of body lift.

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