1. Deformities associated with the birthing of children, including stretched out skin and muscles, and fascial support to the abdominal wall.
2. Deformities resulting from marked obesity, with subsequent weight loss, or resulting large amounts of overhanging fat.
   
   The first group (Group 1) represents by far the largest number of patients requesting abdominoplasty. Although some people "bounce back" from childbearing with a nice taut abdomen and reasonably tight skin, many are not so lucky. Stretch marks may develop which are not only unsightly but can also add tremendous volume to the already excess skin in the region. These "striae" repre-sent "breaks" or fractures in the leather layer of the skin, a condition that most commonly occurs with pregnancy, but also develops in some normal people during puberty, during excessive weight gain, and certain hormonal abnormalities - be they naturally occurring or the result of hormone treatment.
   The other problem from childbearing is the stretch-ing out of the supporting structures on the abdominal wall, both the muscles and the ligaments or fascia. In some people these structures may actually rupture. Although exercise after childbirth helps restore normal muscle tone, in many (if not most) it is unsuccessful in restoring a normal "belly" wall. At this point a reconstruction is appropriate, and this is where the plastic surgeon "comes in".
   
   Although an abdominoplasty normally involves both reduction of skin excess and repairs the underlying support system, some patients may require only the part related to the skin and subcutaneous tissues. When the skin part occurs without the other surgery the patient may go home afterwards. However, hospitalization overnight is appropriate for tummy tuck and repair of the deeper structures.
   
   Sometimes abnormal fatty accumulations occur. These respond best to fat suction techniques. Sometimes however, the fat reduction leaves loose skin that needs to be reduced. Occasionally suction can be used in conjunction with abdominoplasty to further improve the result, but they are best separated to protect the blood supply to the abdominal skin. Sometimes, depending on the location of the fat, combined procedures are acceptable and practical.
   
   Usually the operation involves removing the skin from just above the umbilicus down to the area of the pubic hair (except in certain Orientals where pubic hair is very scant). The width of the skin removal is from hipbone to hipbone. Normally the umbilicus (belly button) is saved, and used to make a "new" belly button. The remaining skin is then lifted up over the abdomen, up over the lower rib cage, and then pulled down like a window shade to cover the entire abdominal wall. A small opening is made in the middle of this huge flap of skin, and the preserved umbilicus (belly button) delivered into this opening. We sculpt the fat at this time. Then we repair the incision and put the skin, fascia, and fat back together. This is all that is required in the simpler operation where the underlying repair is unnecessary.
   When the deeper abdominal wall requires repair, this must precede closing the skin. The supporting structures are repaired from "stem to stern", from the pubic bone to the xiphoid process (breast bone), taking up the laxity. This is like a huge hernia repair of the entire abdominal wall, but rarely enters the abdominal cavity. This reduces the post pregnancy expanded waistline.
   
   As with most plastic surgical operations, you give up some-thing to get something else. In this case the real price paid is a scar across the lower abdomen and around the umbilicus or "belly button". There may be an area of numbness and sensation loss in the lower mid abdomen. The pubic hair “triangle” may be higher than preoperatively because of tension from the huge amount of skin removed. The incision, which was designed low, is now located a bit higher. We make a major effort to keep the scars where they can be concealed by fashionable swimwear and lingerie.
   
   Scars always go through a thick and red phase for a period postoperatively ranging from a few months to 3 or more years. Faithful medicated tape application and applied pressure shorten the prominent scar period dramatically. Usually a few eventually shrink down to a small light line, but there is no guarantee. Some skin types keep the scar active, thick, and red for more months than others - during which time the scar may burn and itch as well. In rare instances true keloids form.