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Abdominal Contouring after Pregnancy

Stephen J. Ronan, M.D.

Pregnancy causes many changes in the body, especially in the abdomen. The ability of the abdomen to ėrebound' after childbirth decreases with each delivery. The typical patient that presents for abdominal contouring complains of extra skin, extra fat, a stretched or loose abdominal wall, stretch marks, and/or poor lower abdominal skin quality. Some patients complain that they can't see their belly button and others that their clothes don't fit properly. The abdominoplasty or tummy tuck procedure addresses all of these issues.

The abdominoplasty is completed through an incision made across the lower abdomen in an area that is usually covered by undergarments, typically at a level similar to a c-section scar. Through this incision, most of the abdominal wall is exposed. With pregnancy, the paired ėwashboard' or rectus abdominus muscles typically separate from each other (horizontal excess) and lengthen (vertical excess). Sit-ups and other exercises may strengthen the muscles but no amount of sit-ups can bring the abdominal wall back into its normal, unstretched postion. During the abdominoplasty operation, these muscles are plicated, or tightened, with sutures. The rectus muscles are visibly closer together and have better form. This achieves a flatter and tighter abdominal wall.

Next, the excess skin and fat is removed. Usually, this results in removal of all of the skin and fat between the belly button and the incision. This discarded skin tends to contain most or all of the stretch marks and often is inelastic and of poor quality. The upper abdominal skin, which is usually of better quality, more elastic and without stretch marks, is stretched to the lower incision. I like to contour the abdominal tissue to give the impression of a well toned abdominal wall. Finally, the belly button is recreated in ideal position.

Abdominoplasties are often combined with other procedures, such as liposuction of the lower back or thighs, or a breast lift/reduction. After abdominoplasty, my patients spend the night at the surgical facility which allows them to be cared for by our excellent nursing staff. Depending on the type of work, most patients are ready to return with 1-2 weeks.

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