There are many changes that occur in the body with pregnancy and large weight shifts. As the abdomen expands, the two stomach muscles that normally hold everything in flat can stretch and separate. After weight loss or delivery, the muscles do not always return to their original positions, and can leave residual looseness. Despite intensive exercise, muscles that are separated may never completely flatten the stomach. Similarly, as the abdomen expands, the skin stretches. If this occurs rapidly, the skin can tear and create stretch marks. After weight loss or delivery, the excess skin cannot shrink due to a loss of elasticity, and the skin in the lower stomach often drops and sags.
The third component is fat, and there are two types; superficial fat is the substance you can feel when you pinch the skin. Deep fat can accumulate underneath the muscle when you are overweight. If your only problem is superficial fat, and the skin and muscles have good tone, liposuction is all that is required. If it is a deep fat problem, diet is a must. If you have loose skin or muscle, an abdominoplasty, or tummy tuck is often the best option.
At your consultation, Dr. Yager will do a physical exam to determine if your problem is skin, muscle, fat or a combination. We will look at before and after pictures, and create a plan to resolve your concerns. If it is a tummy tuck that you require, it is best done after your last child, as pregnancy with weight gain can cause the same stretching to occur again. If you do become pregnant after surgery, there is no danger to you or your child.
If you are considering weight loss, it is best done prior to surgery, as Dr. Yager will be able to maximize your result. Being five or ten pounds overweight is not a problem, but more than that can affect your result. All smoking must be stopped 3 weeks pre and post surgery, as nicotine can delay wound healing and even cause skin loss.
Dr. Yager performs a tremendous number of tummy tucks, and has presented his technique to the American Society of Aesthetic Plastic Surgery. The surgery is done through a bikini line incision marked to your particular style of panty. Dr. Yager uses an anesthetic technique that decreases your risk of nausea, and enables you to recover faster and go home the same day. The procedure takes 1-2 hours, and most of the stitches are under the skin and need not be removed. You will have to wear a girdle for 6 weeks after surgery, and will have a small drain that collects in a plastic reservoir for 4-7 days. Expect discomfort for the first 3 days. At one week, most patients feel quite well. We recommend 2 weeks off of work, as you need to feel comfortable. The only restrictions at 2 weeks are no heavy lifting or straining. By 6 weeks, you can do abdominal crunches. You will have several post-op visits the first week, as this is the crucial healing time, and quite a few more throughout the year. Staying bent at the waist during the first week is important to healing a fine line scar. Help in the house is often needed. You will need the prescribed pain medication and antibiotic.