Aesthetic (cosmetic) surgery describes procedures that improve personal appearance. Abdominoplasty, or “tummy tuck” reverses degenerative changes some women experience with aging and after pregnancy, such as loose sagging skin and a stretched abdominal wall. The goal is to restore a youthful, alluring, “hourglass” silhouette, a narrow waist, and flat abdomen between breasts and hips. The scar resulting from abdominoplasty is a non-cosmetic attribute of the procedure, and a distinct disadvantage.
Techniques have been proposed to reposition the scar, to shorten it, or to avoid it altogether, such as “reverse” abdominoplasty, “mini” abdominoplasty, and “endoscopic” abdominoplasty. Most moms however, are much better served by traditional abdominoplasty. Skin stretched by pregnancy spreads across the lower abdomen and around the umbilicus (“belly button”). To remove this skin most effectively and most cosmetically, a scar placed horizontally across the lower abdomen is necessary, along with a smaller scar around the belly button.
How can plastic surgeons justify this scar for a cosmetic procedure, and why should patients accept this scar? For each woman having tummy tuck, cosmetic improvement expected from abdominoplasty must be worth the price of the procedure, the recovery time, the associated risks, and a permanent scar across the lower abdomen. The amount of excess skin and striae (“stretch marks”) to be removed, the bulging or abdominal weakness, the shapeless form, and the woman’s desire for improvement must be significant enough that she agrees to the necessary scar. Because the goal of tummy tuck is a sexy, feminine appearance, and because a bad scar will sabotage this, doctor and patient should participate together in the effort to minimize visibility of tummy tuck scars.
Strategies to diminish the scar burden begin before surgery. Position, length, and character of the scar are important features to manage. Tobacco smoke impairs healing and can worsen scarring. Smokers should stop completely before considering tummy tuck. On the day of surgery, women should wear the style of bottoms they prefer. The operation should be planned for scar placement behind the straps and fabric. Anticipated scar position is drawn in the mirror, so patients know what to expect. Women with a naturally high belly button can still have a low scar, but may need a small vertical component above the pubis. This usually hidden extension allows lower swimsuit bottoms and intimate wear than higher placement of the entire horizontal scar that women with a high belly button have endured in the past. The scar must be as short as possible horizontally. In surgery, pleating the abdominoplasty flap closure facilitates scar shortening. To prevent a wide scar, tension upon the closure must be minimized. Carefully planned skin removal, “Progressive tension” sutures, and a multiple layer plastic closure are important in this regard. Uncomplicated wound healing minimizes scarring. Blood supply to the abdominal skin must be preserved. The surgeon has incomplete control over this aspect of the procedure.
Post-surgical scar reduction demands patient participation. Helpful measures include specialized tape across the scar to minimize tension during healing, a slow and gradual return to normal activity, use of an abdominal binder or pressure garment, and application of an adhesive silicone sheet for several months. Skin scars are hidden by anything near the scar that diverts attention, including bright colored clothing, jewelry (belly button), and ornamental body tattoo. Still, for whatever reason, an objectionable scar may develop. Rather than lifelong embarrassment and concealment, women and their surgeons must be willing to revise the scar, usually an office procedure, for the best possible outcome.