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Despite diet and exercise, some changes to the abdomen don't fully recover on their own.
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Loose skin, stretched muscle fascia, and a weakened core.
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Why do people struggle with this area even when they're fit and healthy?
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Literally, it gets stripped apart.
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And that's something unique surgical intervention can restore.
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Once that's happened, exercise alone can't be correct.
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Bulging a bit and make the core support.
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Abdominal plastic restores the abdominal walls, integrity, and function.
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Patients notice huge functional improvements to big surgery so they understand that they're a trade-off.
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The tummy tuck, also known as an abdominoplasty.
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Despite diet and exercise, some changes to the abdomen don't fully recover on their own.
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Loose skin, stretched muscle fascia, and a weakened core can affect comfort, posture, and function, not just appearance.
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To explain what an abdominoplasty actually involves, who it's for, and what it can realistically achieve, I'm joined by specialist plastic and reconstructive surgeon, Dr.
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Adam Greenbaum.
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Adam, welcome.
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Nicola, hi.
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Adam, let's start with why the abdomen can be so resistant to recovery.
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Why do people struggle with this area even when they're fit and healthy?
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It helps to envisage the layers of the abdomen as a corset, I think.
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Particularly with pregnancy and weight changes, the corset gets stretched.
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And if the stretching is enough, some parts of that layered corset lose the elastic recall needed to spring back to how it once was before pregnancy or weight gain.
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The skin can lose elasticity, and the fascial layer holding the abdominal muscles in place separates.
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Literally, it gets stripped apart.
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And that happens down the midline.
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And so that's a condition called diastasis recti or rectus divarication.
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And that's something only surgical intervention can restore.
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Once that's happened, exercise alone can't correct it.
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People may feel strong overall, but still they'll notice persistent bulging of their tummy, poor core support, and loose skin that won't tighten and just hangs.
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And that's when abdominoplasty will help.
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So what exactly is a tummy tuck or abdominoplasty?
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Tummy tuck, abdominoplasty is a procedure that addresses those three key issues: the excess, loose abdominal skin, separation of the fascial support to the abdominal muscles, and during surgery, we tighten the abdominal muscles, remove excess skin and tissue, and reshape the abdomen to give a better uh support and contour.
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It's important to understand this isn't a weight loss procedure.
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It's about restoring structure and function once you're at your goal weight.
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It's really good to understand that difference.
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You mentioned muscle separation.
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Why is that such an important part of this surgery?
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If we go back to the corset analogy, the abdominal muscles act like a natural corset for the body, but they can only do this if the sheets of fascia, which is a strong connective tissue that's made of collagen, and that envelops the muscles.
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If that's intact, everything works.
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If that's not intact and it's stretched out of shape, then everything is lost.
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When those fascial layers separate, the muscle isn't supported.
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And so they can't contribute.
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What needs to happen, and you can end up with lower back pain, posture, and generally just difficulty engaging your core muscles when you need to.
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And so after pregnancy or significant weight loss, this can be a real problem for people.
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By repairing the fascial separation and repositioning those muscles appropriately, abdominal plasty then restores the abdominal walls, integrity, and function.
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And so done well, patients will notice huge functional improvements as well as changes in shape after the procedure.
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So are all tummy tucks the same?
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No, absolutely not.
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There are different types.
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Some patients benefit from a full abdominal plasty, which addresses the entire abdomen, and as I was explaining, those myofascial components which have separated.
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Others may be suitable for a much more limited procedure.
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It depends on the amount of excess skin and whether or not there's myofascial laxity.
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And that's why assessment is so important.
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The procedure needs to be tailored to an individual's anatomy and goals.
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That's really good to know.
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Scarring from a tummy tuck is something people worry about.
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What should patients
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expect?
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Tummy tuck does involve a scar.
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Typically it's a horizontal scar, low on the abdomen.
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Positioned, it can be hidden by underwear or swimwear, certainly.
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It's similar to and slightly longer than that you'd have after a cesarean section.
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So if you've had a C-section, I would reuse that scar and rework it.
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There's also a scar around the belly button because that's repositioned during surgery, but that's usually uh relatively imperceptible.
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Scars are notable initially, but they'll soften and fade over time.
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In any consultation, I'll discuss scar placement carefully with patients so they understand that there are trade-offs.
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So, what does surgery and recovery look like?
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Abdominoplasty would always be performed under a general anesthetic.
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Most patients would stay in hospital for at least one night, as this is a a large procedure, and it does require careful monitoring by nursing staff afterwards.
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After surgery, patients would feel tight through the abdomen.
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That's quite normal.
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Pain is quite well managed, but recovery requires some patience.
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I'd encourage patients to walk early on, but certainly that night if possible.
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And standing fully erect takes some time.
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Patients will be wearing a compression garment to support healing, and activity will gradually increase over several weeks.
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Full recovery can take time, but it's important not to rush it so that you get the best result you can.
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And when do people see the final result?
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You'll notice a change immediately.
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There will be swelling, as I've said, and that can take several months to settle.
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But the final result becomes clearer as healing progresses and the tissues soften.
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Between three and nine months, you'll be getting a very good idea.
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But results are long-lasting, and providing that you keep your weight stable, everything will look good forever.
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That's important though, not to be confused that if you get pregnant again or if your weight changes again, that will uh have an effect on that final outcome and result.
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And who is best suited for a tummy tap?
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People who are non-smokers who are at a stable weight are ideal.
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Again, ideally, you'd have completed uh all your pregnancies.
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It's good to be in good general health and quite fit.
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If you have loose skin and muscle and muscle fascial separation that hasn't improved with exercise, then you're an ideal candidate.
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An important thing to realize that this is big surgery, and so recovery takes time and you need to be committed to doing what we've um suggested.
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So, what defines cutting-edge plastic surgeries approach to tumuto surgery?
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Uh I take a careful approach.
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I base everything on this being a reconstructive procedure as well as to some degree an aesthetic procedure.
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I focus on the anatomy and the function uh to get the long-term outcomes.
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Pre-operative consultations are thorough and slow, and we discuss the pros and cons and the likely outcomes so that people have realistic expectations.
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Part of my training as a reconstructive plastic surgeon is to deal with both complex abdominal wall reconstruction and aesthetic balance.
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And this is uh a perfect fusion for this procedure.
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So to finish up, what are the key messages for our audience?
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Tummy tuck is about restoring structure, not about losing weight.
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But muscle and fascial repair is a key part of the procedure, so it is reconstructive.
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Recovery takes time, but results can be significant and long-lasting if things are taken appropriately and time is taken.
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If you think you've got problems with abdominal function, then this is a conversation you should have.
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An audience can learn more or book a consultation at CEPS.nz.
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Absolutely.
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Dr.
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Alan Greenband, thank you for joining us.