Abdominoplasty, concern about ideal figure before surgery
September 8, 2011 | 20,00 EUR | answered by Dr. med. Ralf Berg
Hello,
I have a surgical appointment in a week where an abdominoplasty with scar correction is supposed to be done. The good news is that I will be partially reimbursed for the surgery by my health insurance.
I know that without a picture, it might be difficult to say much about it, (even though the picture that was taken is already several weeks old) but here are some initial data: I am 158 cm tall, had 2 pregnancies, before the pregnancies I always weighed 50-51 kilos, so I was always slim and fit (especially my stomach had a six-pack) and I found the weight okay. After the pregnancies, I always weighed 47-48 kilos (for 8 years!), I have a rectus diastasis and even at my lowest weight of 46 kilos, my stomach visibly bulged. I have a 5cm long sunken vertical scar above the navel, the navel itself is very unsightly and completely distorted. I have been doing a lot of sports for years: mainly jogging 4-5 times a week + Pilates. Among other things, I have controlled my food intake for several years because I wanted to have a flat stomach as much as possible.
Negative aspects: I gained some weight again last winter. Possibly because I was no longer a housewife, but instead sat a lot in the office, didn't take care of my children at home as often, and was simply less mobile. So for the first time in years, I reached a weight of 51-52 kilos. I felt very uncomfortable! Because my stomach bulged even more noticeably, I often looked like I was 7 months pregnant, and I couldn't wear tight clothes anymore like in previous years. In late spring, I started to reduce my weight again, which happened very quickly, but with drastic measures: even more exercise, no more fat, no warm meals, almost no carbohydrates.
By the end of June, I had my figure back as it had been for the past years, but my stomach and buttocks felt very flabby and completely unstable, so even my gait was unstable, the skin hung down on the lower abdomen, many wrinkles formed. There were now wrinkles on the hips, which even hurt. Obviously, the abdominal wall was quite weakened. I then decided to have the surgery because I was advised to do so because of the rectus diastasis, the bulging, and the ugly scar.
Unfortunately, I didn't get a surgery date immediately, but only for September.
What worries me now: Especially in the last 3 weeks, I suddenly gained weight again because I developed depression! Since I was not in good shape, I couldn't maintain my level of exercise, and I couldn't maintain the relatively strict diet, I ate more carbohydrates again and drank too little water. Now I weigh 51 kg again. The fat must have been immediately stored in the folds
Dear questioner,
I'm afraid my answer will not please you. As you describe it, your concerns go beyond correcting a rectus diastasis, a type of "abdominal wall or scar hernia" for which the insurance covers the costs, but rather involve wanting to reshape your entire body. The criteria you are using are: 41 kg at 158 cm height (medically closer to underweight than normal weight) and still expecting to have the same tight, wrinkle-free skin at 37 years old as you did at 20.
Your fears are justified, as this type of "tummy tuck" will not be able to achieve that. It is physiological that body fat percentage increases with age, even in individuals of normal weight. Since fat is naturally not as firm as muscle, and the water content in connective tissue decreases over the years, wrinkles and folds form in the usual problem areas. It is also true that even if the tightening and fat removal on the abdomen is successful, the tendency to gain weight in other areas may persist or even worsen. You can see what else can happen in a question from a few weeks ago in this forum, where such a surgical correction not only did not achieve the desired smoothness of the abdomen, but the patient now has to deal with pain, constipation, and postural problems.
I strongly advise you to discuss all your wishes and justified fears with the surgeon again. My advice, even if you may not like to hear it, is to stay as fit as possible through exercise and nutrition, and to accept the inevitable aging and age-related changes in the body. Consider whether a few extra kilos, but distributed harmoniously, might give you a better figure than a flat stomach but saddlebag hips.
Ask your surgeon how many surgeries Uschi Glas had to undergo to achieve the image published in the magazines. It's like renovating a house: as soon as you renew one part, it no longer fits well with the neighboring part, and you have to make changes there too. This can become endless.
I think you would be wise to reconsider everything carefully and perhaps limit the surgery to what is necessary, namely correcting the rectus diastasis. This surgery is risky enough in terms of postoperative complaints. Even though it's a truism: wrinkles don't disappear with age, they come and form with age and are a natural part of the aging process.
From a distance, your goals seem too ambitious and unfortunately fundamentally unrealistic. Talk to people you like and trust about it. Compare your self-perception with how others perceive you. Take possible complications seriously, and remember that such surgery cannot simply be reversed, as the aforementioned questioner would prefer.
With many greetings,
Dr. R. Berg
