Tummy Tuck (Abdominoplasty)

50 year old woman with a tummy tuck.  During her tummy tuck she had 1465g of skin and fat removed, 3200cc of fat liposuctioned from the upper abdomen and love handles, and her muscles which were streteched out by her prior pregnancies have been repaired.  After photo taken at 3 months.

Check out this vlog by one of our patients who went through the Tummy Tuck experience with Dr. Jugenburg

Drain-Free Tummy Tuck Fees

• Mini Tummy Tuck $6800
• Full Tummy Tuck $9500+
• Extended or Fleur de Lis (Vertical) Tummy Tuck $12,200

• (additional liposuction: $1500-4000+ per additional area to be liposuctioned – please note liposuction fees differ greatly depending on the area and and expected volume of liposuction)

Are You A Candidate for A Drain-Free Tummy Tuck?

If you have an abundance of loose or excess skin on your abdomen, or have an excessive amount of external abdominal fat (fat that you can grab and pinch with your hands), you may be a candidate for tummy tuck surgery. In addition, most mothers have some amount of abdominal muscle stretching or muscle laxity due to childbirth. If you find you have one of these issues, or all three, a tummy tuck is the ideal way to correct these problems.

To be considered a good candidate for a tummy tuck procedure, you should:

• Be physically healthy
• Be at a stable weight (BMI under 30)
• Be a non-smoker
• Have realistic expectations as to what the procedure can do for your appearance

If you can pinch a large section of loose, sagging skin on your stomach, or you are are constantly bothered by the feeling that your stomach is too large, a tummy tuck may be the appropriate procedure for you.However, if you only have minimal excess skin and little weakness in the abdominal wall, you may be a candidate for a “mini” tummy tuck. Dr. Jugenburg will determine which procedure is best for you during your initial consultation.

The patient on the left has a lot of loose skin that can be easily pinched and grabbed.  That is an ideal candidate for a tummy tuck.

The patient on the right has a large belly that feels full and tight.  It protrudes out a lot.  If you try to push into it, it feels relatively hard.  There is not a lot of loose skin you can grab, as you can in the other photo.  This person is NOT a candidate for a tummy tuck and must lose weight before being considered.  If a tummy tuck is done at this stage, it will do little to improve the appearance of that belly.

This is another patient with higher BMI who has a significant amount of internal fat.  A tummy tuck removed the excess skin hanging off her abdomen, but it cannot flatten the belly or make her ‘thinner'.  Internal fat (fat within the abdominal cavity, visceral fat) is removed only via diet and exercise.

For a lay person, it may be impossible to differentiate internal and external fat when looking at a human body.  Two people may look similar, may appear to have same bulging belly and love handles.  But because of their different fat distribution, they would get two very different results after a body contouring plastic surgery.

So what exactly is Internal Fat and why can I not remove it?  Internal fat is the fat within the abdominal cavity.  A ‘beer belly’ would be the most extreme example of this, where a large belly is very protruding, feels very hard, and all the fat (visible volume) is internal.

Because this internal fat is closely wrapped around the digestive organs, any attempt at liposuctioning or cutting it out would damage these organs and lead to death.  For this reason, internal fat is not removed.  If you have a large amount of internal fat, the only way to remove it is via diet and exercise.  For morbidly obese patients, bariatric surgery such as gastric bypass, gastric sleeve, lap band, or other procedures that limit you ability to intake calories may lead to weight loss.
External fat is the fat that is under your skin.  It is not wrapped around any vital organs, so liposuction and cutting it out is possible.  This is the ONLY type of fat that a Plastic Surgeon can sculpt, shape, or remove.

So how can you determine if your fat is internal or external?

Pinch it.  If you can pinch it, you can treat it with plastic surgery.  When you do pinch, however, realize that you are pinching a layer of fat that is folded over (see the video on this page) therefore in effect the real fat thickness is half of the pinch thickness.

Weight Loss Before Your Tummy Tuck

Some patients may have excessive amount of internal fat which cannot be corrected by Plastic Surgery.  If your BMI is over 30 or Dr. Jugenburg determines you have excess internal fat and would benefit from weight loss prior to your tummy tuck, you will be asked to lose a certain amount of weight before we can proceed with your surgery.  As you can see in the above photo, our patient underwent weight loss prior to her surgery and her final result is beautiful.  This would not have been possible without her losing excess intra-abdominal fat (via diet and exercise).

Muscle repair

Muscle repair (repair of rectus diastasis) that takes place during a tummy tuck repositions separated abdominal muscles which were stretched and separated during a pregnancy.  In mild cases of rectus diastasis, abdominal workouts and physio may be helpful.  However for many of the women we see, no amount of sit ups, physio, diet or exercise will correct the separation.  In such patients, muscle repair (diastasis repair) is the only effective treatment.

Abdominal rectus muscles have been stretched during her pregnancy, and a tummy tuck was used to tighten her abdominal muscles, skin and flatten the belly.

Another example of a muscle repair and removal of some excess skin left after a pregnancy.  No amount of sit-ups can repair this damage, unfortunately.

What Happens During a Consultation?

Choosing a cosmetic surgery procedure is always an important decision that should never be rushed. That is why Dr. Jugenburg always takes the time to get to know his patients and their reasons for wanting a Tummy Tuck during a consultation. During this meeting, you will have a general health check and discuss all the implications and outcomes of Tummy Tuck surgery to ensure that you are fully informed and prepared to enter the operating theatre. This is also a time when you can ask any questions that you might have about Tummy Tuck surgery in a private, but friendly clinic environment.

What Can You Expect With Tummy Tuck Surgery

The best way to determine if a tummy tuck (and/or a panniculectomy) is the right procedure for you is to have an initial consultation with Dr. Jugenburg. You will have an opportunity to discuss your goals and expectations with the doctor, and ask any relevant questions you have about the surgery.

During your initial consultation, Dr. Jugenburg will:

• Review your medical history and any medications you are taking
• Discuss the part of your body that you would like treated
• Provide recommendations based on you needs and your goals

Dr. Jugenburg will listen to your needs, expectations, and your desired outcome from the surgery. Dr. Jugenburg will review all the surgical options that are available to you, and you will be able to tour our state-of-the-art facility and meet with our caring staff that will be part of your team.

There are actually several different types of abdominoplasty, and Dr. Jugenburg will determine which option is best for you. This is based on the amount of loose skin, excess fat and the laxity of the stomach muscles. The options include:

• Review your medical history and any medications you are taking
• Discuss the part of your body that you would like treated
• Provide recommendations based on you needs and your goals

Dr. Jugenburg will listen to your needs, expectations, and your desired outcome from the surgery. Dr. Jugenburg will review all the surgical options that are available to you, and you will be able totour our state-of-the-art facility and meet with our caring staff that will be part of your team.

There are actually several different types of abdominoplasty, and Dr. Jugenburg will determine which option is best for you. This is based on the amount of loose skin, excess fat and the laxity of the stomach muscles. The options include:

1. Tummy Tuck (Complete Abdominoplasty): in this procedure, an incision is made above the pubic hairline, another is made around the belly button, and the muscles that run vertically on each side of the stomach’s front wall are tightened. The skin removal and the muscle tightening are the most critical steps in improving the contour of the stomach. Liposuction may be performed along with the complete tummy tuck, depending on the amount of fat that needs to be removed.
2. Mini Tummy Tuck (Partial Abdominoplasty): a mini tummy tuck is done for patients who have mild to moderate stomach contour changes and have minimal excess skin and little weakness in the abdominal wall.
3. Circumferential Abdominoplasty: if there is a large amount of excess skin and fat in the back and hip area as well as the abdomen, circumferential abdominoplasty is performed. This helps to improve the body’s contour in three dimensions.

The tummy tuck surgery will be performed in our certified and state of the art medical facility located inside the luxurious Royal York Hotel., Tummy tucks generally take anywhere from 1 to 3 hours. The length of your surgery will depend on your body type and the amount of work that is required.

Tummy Tuck Scars

A full tummy tuck involves a scar that typically runs from hip to hip.  We make every effort to keep the scar as low as possible so that when you wear your pants or a bikini, the scar is hidden.  There is also a scar around the belly button.  A mini tummy tuck does not have a belly button scar.

These scars take several months to fade, and a fully healed after one year.

Can the scar be shorter?

The tummy tuck scar length varies in length from patient to patient.  The length is determined by your existing fold.  If you look in a mirror and see the fold where your skin folds over, this determines the extent of your scar.  If you try to cheat and make it shorter, you will end up un-natural looking folds/lumps on the sides.  If you are unsure about how long your scar would be, you can always send us your picture for an assessment.

Differences Between A Mini Tummy Tuck and A Tummy Tuck

There are many differences between a mini tummy tuck and a full tummy tuck. The main differences is that with a mini tummy tuck the area at and above the navel is not treated, so there is no scar or repositioning of the ravel. Other differences include:

Reasons to Consider Abdominoplasty

A large amount of weight loss and the resulting sagging skin is only one reason to consider a tummy tuck. Other causes of excess, loose and sagging skin include:

• Aging
• Heredity
• Previous pregnancy
• Prior surgery

It is perfectly normal to want to have sagging skin or a protruding belly corrected. In addition to wanting to remove the loose skin around the midsection, patients may also want to consider a tummy tuck to:

• Correct a protruding stomach that is not consistent with the body’s proportions
• Improve tone in the abdominal and stomach muscles
• Eliminate skin problems in the skin fold under the abdomen
• Remove those areas of fat that simply won’t respond to exercise or dieting
• Correct prominent C-section scarring and stretch marks
• Repair diastasis recti
• Repair abdominal muscles that are overly stretched out

Tummy Tuck: Surgery Details

The procedure begins with general anesthesia. You will be completely asleep during the surgery.

In a traditional tummy tuck, an incision is made horizontally in the area between the public hairline and the belly button. The amount of excess skin will determine the length of the incision.

The skin will be dissected up toward the rib cage, the muscles are tightened and the belly button is repositioned while excess skin is removed.This helps to dramatically improve the appearance and strength of the abdominal area. Dr. Jugenburg may recommend having liposuction along with the tummy tuck to provide optimal results.

After the excess fat and skin are removed, the remaining skin from the upper abdomen is released and pulled down over the open area to close it. Skin is tightened, muscles are tightened as required, and the belly is flatter. Once the procedure is completed, the incision will be sutured and bandaged. You may be given an elastic bandage or compression garment to wear in order to minimize swelling to support the abdomen as it heals.

Following your surgery you will recover in one of the beautiful Fairmont Royal York Hotel rooms. You will receive a care package from us and our staff is available to you while you stay with us. Should you desire, full room service is available to you.

You will see Dr. Jugenburg’s nurses the day after your surgery and at specified intervals during the weeks following your surgery. This is done so that the doctor and his team can personally monitor your recovery process, and to ensure that you have the best results possible.

Recovery From Your Procedure

The tummy tuck surgery will leave your abdomen bruised and swollen, which will diminish over a period of one to two weeks. Because patients retain some water following the procedure, there will be some temporary weight gain. This is normal, and will dissipate quickly.

Recovery from tummy tuck surgery requires rest and taking it easy. The first two days following the surgery are usually the most uncomfortable.  After the first two days you’ll notice a dramatic improvement in how you feel. Because of the innovative surgical techniques used by Dr. Jugenburg, your discomfort will be easily controlled with prescription medication only.

During your recovery you should avoid strenuous physical activity; this is especially important if your abdominal muscles have been repaired from diastasis recti. You may need to limit your physical activity from four to six weeks.

After your tummy tuck procedure, you will have a flatter, firmer abdominal contour that is proportionate with your individual body type and weight. The actual results will be hidden due to swelling at first, but you will begin to see your new slimmer profile within one to two weeks after surgery. Depending on the surgery, it may take anywhere from several weeks or months to see the final results.

During recovery it is critical that you refrain from smoking. Smoking deprives your body of oxygen, which increases the risk of wound breakdown and infection following the surgery.

The goal of a tummy tuck is to provide you with a tighter, smoother and more attractive abdomen. Your love handles will be smaller, and you will look more fit, youthful and healthier.

A Panniculectomy

While the tummy tuck, or abdominoplasty, is designed to create an abdominal profile that is smoother and firmer, an alternative procedure is a panniculectomy.  This is NOT a tummy tuck, this is an ‘amputation’ of the loose skin in patients who have lost >100lb and have medical problems due to the excessive skin.  This is NOT a cosmetic procedure and the results are not pretty.  This procedure can be performed alone or in combination with a tummy tuck, and is done to remove the skin hanging on the abdomen, called the “pannus” or apron. It runs from below the belly button, and is usually a result of losing significant amounts of weight – approximately 100 pounds or more.  It is often done at the same time as the tummy tuck.

While the tummy tuck tightens the underlying stomach muscles, the paniculectomy only removes the excess skin and fat required for medical reasons.

After losing a significant amount of weight, the patient is left with heavy, loose folds of skin around the abdomen, which end up sagging and losing their elasticity because they have been stretched over a long period of time. This can lead to ongoing problems, including:

• Difficulty performing daily hygiene
• Yeast infections or cysts in the folds of the skin
• Lower back pain
• Inability to comfortably wear clothing
• Rashes above the pubic area along the groin and hips

Patients requiring panniculectomy have overcome obesity and have recently lost a significant amount of weight. They also may have post-pregnancy problems with excessive fat that is situated below the belly button. Depending on the amount of excess skin you have and the condition of your abdomen, Dr. Jugenburg will determine the best procedure or procedures to meet your specific needs.

Patients are considered candidates for panniculectomy if they have:

• Excessive fat that presents health problems, like skin rashes, ulcers or other skin disorders
• Weight that’s been stabilized for at least one year
• An ongoing diet and exercise plan
• An approval from OHIP is require prior to considering this surgery

Avoid any vigorous exercise, heavy lift, or gym for 6 weeks after the surgery. Failure to do so will lead to loss of muscle repair, and abdominal bulging (throughout the entire abdomen, around the belly button, or in the upper or lower abdominal area),

Although complications following Abdominoplasty are infrequent; the following may occur:

1. Bleeding, which in rare instances could require hospitalization and blood transfusion. Blood clots may form under the skin and require drainage.
2. Skin irregularities, lumpiness, hardness and dimpling may result; some problems disappear with time and from massage, but skin irregularities, hardness, lumps, dimpling or other problems may persist and additional treatments may be necessary
3. Infection is rare but may occur and treatment with antibiotics and/or drainage may be required. In rare instances surgery may be required for severe infection (such as necrotizing fasciitis.)
4. Wound dehiscence (wound opening) may occur and is generally allowed to heal on its own.
5. Outpatient nursing may be required to assist with the wound care. You may be required to travel to a local clinic for daily wound care.
6. Hernia may be found during the surgery and they may require surgical repair, which may be associated with potential injury to the bowel. Numbness of the skin over treated areas is common and can persist for months. In rare cases it may be permanent.
7. Abnormal scarring or scar position is rare but is possible.
8. Dizziness may occur during the first week following Abdominoplasty surgery particularly upon rising from a lying or sitting position. If this occurs, extreme caution may be exercised while walking. Do not drive a car if dizziness is present.
9. Deep Venous Thrombosis, Pulmonary Embolism and Fat Embolism may occur.
10. Abdominal perforation may also occur in rare instances.

The risk of these specific complications is increased in patients with increased BMI and previous abdominal surgeries. If left untreated these complications may be fatal.

Potential Complications

One of the possible complications after a tummy tuck is skin necrosis in the midline, as that has the poorest blood perfusion after a tummy tuck.  If this happens, the management is to allow the area to heal and once fully healed, Dr. Jugenburg will then come back and peform a reconstruction using a tissue expander.  This will be used to stretch the normal uninjured skin to allow for the reconstruction