This is why your belly still sticks out after kids [Shannon O'Brien, MD, Portland]

Eva Sheie (00:00):
You're listening to Where Before Meets After. Can you tell us what are the different types of tummy tuck surgery?

Dr. O'Brien (00:07):
There are a few types of tummy tucks. Most commonly people talk about a standard abdominoplasty, a mini abdominoplasty, sometimes people will talk about a fleur de lis abdominoplasty. And all of those sort of refer to incision length or position and how much work behind the scenes is being done as well. And incision length is really decided based on how much extra skin there is. So with a standard abdominoplasty, you've got an incision that goes across the lower abdomen, kind of just above the hairline, where it goes outside the hip bone to outside the hip bone across, and then there's an incision around the belly button as well. With a mini tummy tuck, for the most part, that incision stays between the hip bones and there's no incision around the belly button. And then with a fluoride deli, which is the least common or less common, you have an incision that goes kind of from the breast bone down the middle of the belly.

(01:11):
And then you have that longer incision, more like the standard abdominoplasty incision from outside the hip bone to outside the hip bone. And that is sometimes utilized after pregnancy alone or for mommy makeovers, but is more commonly utilized in ladies or men who've lost significant amount of weight.

Eva Sheie (01:29):
Are those scars all hidden by clothing? They're not visible after you've had surgery?

Dr. O'Brien (01:35):
For a standard abdominoplasty or a mini abdominoplasty, the incisions stay low. So typically in a swimsuit or a underwear, certainly with jeans or pants, those longer incisions are covered up by clothing. The incision around the belly button would be visible if you were in a two-piece swimsuit or if you had a crop top, you might see an incision from a standard abdominoplasty, just around the belly button. With a fleur de lis where you have that longer vertical incision that would be visible, not through clothing, but if you had a two-piece swimsuit on, you'd see that vertical incision.

Eva Sheie (02:16):
What other questions do you get asked about tummy tucks when people come to see you?

Dr. O'Brien (02:20):
Everybody wants to know do tummy tucks hurt and how much? And

Eva Sheie (02:24):
Of course.

Dr. O'Brien (02:25):
I tend to, for ladies who've had C-sections, I have some people say that they hurt kind of on par with C-sections. Some will think one hurt more than the other. And there are different things happening certainly between the two procedures, but it leads to probably a similar recovery and pain from what I understand.

Eva Sheie (02:51):
Without the newborn.

Dr. O'Brien (02:52):
Without the newborn and with better sleep. Yes. Yes. So you don't have to pick anything up and you can sleep through your nights a lot better with the tummy tuck. Because I do tighten the muscles in most standard abdominoplasties or regular tummy tuck, that feels tight. And I think that's where some of that similarity to the C-section discomfort kind of comes. But that tightness is what really is worth it because it really flattens the belly and it gives you that great shape and it really brings the muscles back to the midline. So you get a nice straight sort of shape along the outer edges of the muscle. And then when that extra skin is kind of pulled out and it's nice and I get rid of that, then you have this great muscular foundation and a nice smooth, flat skin overlying it.

Eva Sheie (03:45):
If you have old C-section scars or any other kinds of scars, like I have a really unsightly appendicitis scar from the olden days back when they actually made a long incision, right?

Dr. O'Brien (04:03):
Yeah. Yeah.

Eva Sheie (04:04):
I guess they don't do that anymore.

Dr. O'Brien (04:06):
They try not to, but some people still get appendectomy scars in that area. But I take out as many scars as I can so that a patient just has one line, if at all possible. It really does smooth out the contour. Oftentimes with old scars, there's tethering, so people will get a little indentation around a scar. And so when that scar is gone or just with the releasing of the skin and sort of advancing everything, even scars that I can't get out oftentimes are smoother and contour because the skin's not kind of falling over an old scar tether and they tend to ... Everything looks a little better once it's smoothed out.

Eva Sheie (04:52):
Is liposuction usually included in mommy makeover or tummy tuck surgery? Is that something that is commonly included?

Dr. O'Brien (05:02):
Oftentimes I'll sort of look at somebody all the way around their torso as we're having a conversation about a tummy tuck, just to kind of incorporate anything that might suddenly become more visible once the tummy is flat. So if somebody has fuller hips or fullness in their flanks or their back or what have you, suddenly when their belly is flat, you may see that kind of bulging from the sides or now their tummy is nice and flat, but they feel like in a t-shirt, maybe their back isn't the contour they'd like to have. And so oftentimes doing liposuction in those areas is important to give that good 360 degree improved contour and really make you feel like the front and the back match.

Eva Sheie (05:56):
There we are with the matching again.

Dr. O'Brien (05:57):
The matching. Symmetry and matching.

Eva Sheie (06:01):
A lot of women suffer from diastasis recti after having even just one child, but I think it can get worse after you've had several.

Dr. O'Brien (06:12):
For sure.

Eva Sheie (06:13):
How do you detect it and then how do you correct it?

Dr. O'Brien (06:17):
Diastasis recti is basically a gap between the rectus abdominis muscles. And so when you see somebody who has a six pack, their muscles sit very close along the middle and they have kind of a little groove between those muscles. And that is the area that gets stretched out during pregnancy. And it can happen after one. Women tend to show earlier in their second or subsequent pregnancies because those tissues have already softened a little bit and they just relax faster and they just lose the ability to snap back because the fascia, which is what gets stretched out, doesn't have much ability to contract back. The muscles contract back just fine, but they're now in kind of a looser sheath. And so basically the idea is to re-tighten that fascial layer in order to bring the muscles back to the midline so that mechanically they hold everything back nice and tight.

(07:14):
As far as diagnosing it, usually just by having somebody either lay down flat and lift and either feeling their belly or have them lift their head up, you can see a bulge in the middle or sometimes if it's significant enough with the patient standing, you can kind of feel the inner edges of the muscle and feel a finger or multiple finger gap between them.

Eva Sheie (07:38):
In a really severe case, I think you can kind of see, it might even look like they have a belly that shouldn't be there, right?

Dr. O'Brien (07:46):
I tend to tell ladies that when the muscles are brought back to midline after repair during a tummy tuck, it takes away that relaxing bulge that happens when somebody stops kind of sucking it in or just intentionally holding a little bit of muscle tone to their belly. It's that, and I tend to say that little boop when you relax your belly and it just sort of falls out a little bit, that goes away because now the muscle tone, even when you're relaxed, just the resting tone is enough to hold everything back the way it did before pregnancy.

Eva Sheie (08:25):
Are there reasons for wanting diastasis recti corrected even if they're not aesthetic? Does that make sense?

Dr. O'Brien (08:34):
It does. Some people come in and they just feel like when they are trying to work out that their workouts aren't as efficient as they had been. They don't feel like they have the ability to strengthen their core. They feel a little bit lax through there. It's hard to say whether it affects back pain, although some people wonder if it does. I'm not sure one way or another, but it does bring those muscles back so that they have the ability to pull straight from the ribcage down to the pubic bone without having to compensate for the laxity of the tissues that are supporting them. And so I do think it makes people feel more solid and stronger just because everything's back in its natural position.

Eva Sheie (09:18):
That's a good enough reason.

Dr. O'Brien (09:20):
Yeah, right.

Eva Sheie (09:21):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wearbeforemeetsafter.com. Where Before Meets After is a production of The Axis.