What is the difference between male and female rectus plication?
There is no difference between male and female tummy tucks or rectus plication. Both male and female patients will have to undergo a surgical procedure where weakened muscles are plicated as there will be a gap in the abdominal midline. There are many factors behind weakened abdominal muscles. These can be divided into genetics, natural ageing processes and weight gain. Many women will suffer some form of abdominal weakness after pregnancy, as weight gain and natural ballooning will continually stretch the tissues, causing a gap between the left and right abdominal muscles. If men were to experience weight gain around the abdominal region, they too would suffer the same problems. Although patients tend to lose weight or give birth, they will still experience some form of muscle diastisis and redundant skin. Male patients who exercise have increased chances of losing excess skin compared to females, as women tend to have more abdominal fat, with higher needs for redundant skin removals in addition to a rectus plication. Depending on severity, some patients will benefit from mini abdominoplasties while others with minimal redundant skin can solely opt for rectus plication without the need for skin excisions.
What are the types of abdominal surgeries, and would the procedures depend on how large the patients are?
We stage the different types of tummy tucks depending on how large patients are. If patients were extremely overweight and have drastically lost weight, they will need a procedure called a circumferential lift. This open surgery will call for a 360-degree incision not only along the tummy, but the back and lower back as well. We will have to make a circumferential cut because the patient has too much redundant skin. We will then lift the tissues, transpose the belly button and plicate the muscles as well. The second tummy tuck procedure is called an extended tummy tuck, where incisions are made from hip to hip. Appropriate for patients with increased excess skin only in the abdominal region, we will first excise redundant skin from the bikini line to the belly button, including the hips as well. We will also plicate the muscles and transpose the belly button. If patients have gained weight but have decreased excess skin, they would be the right candidate for a procedure called the mini tummy tuck. Even though we do remove some redundant skin in the lower stomach, surgeons will not be required to excise too much, move the tissues downward or create a new belly button. Because mini tummy tucks don’t require belly button transpositions, we will just cut small amounts of tissue in the lower abdomen and plicate the abdominal muscles. Mini tummy tucks can now be done endoscopically with a robotic system called the da Vinci. The da Vinci robotic tummy tuck is a scarless procedure and especially male appropriate because men with possible muscular laxity or umbilical hernias generally have reduced redundant skin. When we repair the rectus from the pubis upwards, it provides with a good, long lasting repair of the abdominal wall. Many patients opt for tummy tucks for cosmetic reasons, but rectus plication surgeries actually improve function as well. Not many know this, but the abdominal muscles play an important role in stabilising the spine and protecting it from hernias and slipped discs. I have treated patients who have previously undergone physiotherapy, Pilates and orthopedic surgery and what I found was that back problems actually stemmed from poor core abdominal muscles. Through rectus plication surgery, we will close the gaps between both the left and right abdominal muscles and in this way, both function and aesthetics will be restored.
Although abdominal muscles do weaken without exercise, it’s more the positioning that results in back pain. If patients have gaps in the abdominal midline, it’s not performing its normal function of holding the belly button inward. When this happens, your spine will be affected because core muscles are not in the correct position, which then constrains good posture. Weight gain can always be a factor, but ageing is another very common cause. Humans have two types of collagen in our bodies, and as we age, collagen type two decreases over time and hence, affects in tissue stretching. In certain people, collagen degeneration may happen more rapidly because of genetics but for others, deterioration could also be due to ageing and lack of exercise. From my experience, genetics and ageing amounts for 60 percent of poor abdominal muscles while poor lifestyle choices only count for 40 percent.
What are the advantages of robotic surgery?
In working with advanced technology, I have found that the future of surgery is in robotics. Robotic procedures are becoming the gold standard of minimally invasive surgery, not only in plastic surgery but many other surgical fields. In cases where the robotic da Vinci system is available, the tendency for laparoscopic surgery is being replaced by robotic-assisted surgery due to its many advantages. The robot’s high definition, three dimensional view and amplification of images give better depth sensation than the naked eye and 2-D endoscopic views. Laparoscopic instruments have limited motion range while the robot’s endo-wrist movement is comparable to the human wrist. The surgeon who is seated at the console in a comfortable ergonomic position controls the precise robot arm, surgical field and instruments. It’s amazing that there’s a growing trend for robotics that can perform procedures that almost eliminate scarring. Minimally invasive surgery has many advantages compared to open methods because it allows for fast recovery, reduced pain and lower risk of infection. Although robot-assisted surgery is a great tool, patient selection is key. For example, there would be no sense recommending this surgery type to patients with too much redundant skin. They would best benefit from open tummy tucks. This minimally invasive method is best suited to patients who have abdominal muscle laxity with little to no loose skin. Other patients who can take advantage of this surgical type would be patients who have a little excess skin, but who don’t want obvious scars.
Look out for: -
Part 2 of 4 with Laser? No, Vaser with Plastic Surgeon Dr. Colin Tham
Part 3 of 4 with Booby Trap with Plastic Surgeon Dr. Kuladeva Ratnam, and
Part 4 of 4 with Advanced Laparoscopic and Bariatric Surgeon, Dato’ Dr. Haron Ahmad