Abdominoplasty, commonly known as a tummy tuck, is a surgical procedure designed to create a flatter, more contoured abdomen by removing excess skin and fat and tightening underlying muscles. When the traditional approach is insufficient due to a greater volume of tissue or higher body mass, a specialized procedure called a plus size abdominoplasty is performed. This tailored operation addresses the unique anatomical needs of patients who have significant skin laxity, often resulting from substantial weight loss. The goal is a comprehensive reshaping of the midsection, requiring techniques that go beyond the typical horizontal incision, focusing on both aesthetic improvement and functional correction.
Defining the Plus Size Abdominoplasty
A plus size abdominoplasty is specifically designed for individuals who fall outside the conventional Body Mass Index (BMI) ranges preferred for a standard tummy tuck. While traditional abdominoplasty is reserved for patients near their ideal weight, this specialized procedure accommodates those with higher BMIs, sometimes up to 42, who are otherwise in good health. The definition centers on the volume of tissue being addressed, recognizing that surgical candidacy is not solely determined by the BMI number.
The primary objective of this procedure is to remove substantial amounts of skin and fat, often targeting a large apron of skin, medically known as a pannus. Removing this excess tissue provides functional benefits, such as alleviating chronic skin irritation, rashes, or hygiene issues that occur in the skin folds. The surgery is often viewed as a reconstructive effort that improves comfort and mobility, in addition to achieving a more balanced body contour. The extent of the tissue removal requires a more involved surgical plan to maximize skin tightening.
Specialized Surgical Techniques
To effectively address the massive tissue excess common in this patient population, surgeons employ techniques that extend beyond the single, low-horizontal incision of a standard tummy tuck. The most common specialized approach is the Fleur-de-lis (FDL) abdominoplasty, which combines the traditional horizontal incision with an additional vertical incision running down the midline of the abdomen. This distinctive inverted “T” or anchor-shaped incision allows for the removal of both horizontal and vertical skin laxity, which is necessary when the upper abdomen is severely loose.
The FDL technique permits a greater degree of circumferential tightening, resulting in a more contoured waistline than a standard procedure can offer. For patients with skin laxity extending around the sides and back, a surgeon may perform an extended abdominoplasty or a circumferential body lift (belt lipectomy). These comprehensive techniques involve incisions that wrap around the torso, ensuring that the lateral flanks and posterior rolls are addressed. This prevents the undesirable “dog-ear” skin folds that can occur at the ends of a limited incision.
Pre-Surgical Medical Considerations
The preparation phase for a plus size abdominoplasty is more rigorous and extended than for a standard tummy tuck due to the increased complexity and health factors associated with a higher body mass. Maintaining a stable weight for several months is a strict requirement, as significant weight loss following the surgery can negatively affect the final contour and may necessitate a revision procedure. Patients must undergo a comprehensive medical clearance, involving a thorough physical examination, blood work, and sometimes an electrocardiogram (EKG) to assess cardiovascular health.
Management of pre-existing co-morbidities is a priority; conditions such as uncontrolled diabetes or hypertension must be optimized before surgery to mitigate risks. High blood sugar levels, for instance, impair wound healing and increase the risk of infection, making strict control mandatory. Smoking cessation is non-negotiable; all nicotine products must be avoided for several weeks prior to surgery because nicotine compromises circulation necessary for healing the extensive incisions.
Recovery and Post-Operative Management
Recovery following a plus size or extended abdominoplasty is more involved and takes longer than recovery from a less extensive procedure. Patients should anticipate an extended initial recovery period, often requiring two to four weeks off from work and daily activities. The larger incision sites, especially those from the FDL or circumferential techniques, require careful management to prevent complications like wound separation or infection.
Temporary surgical drains are almost always placed to prevent the accumulation of fluid, known as a seroma, and these drains may remain in place longer than in a standard tummy tuck. Wearing a compression garment consistently is essential for minimizing swelling, supporting the newly tightened tissues, and promoting skin adherence. Due to the greater body mass and extent of the surgery, patients may experience increased mobility challenges initially, requiring adherence to physical limitations and extended rest periods for four to six weeks to ensure proper healing.