Not All Tummy Tucks are Created Equal: Progressive Tension Suture Method for Better Outcomes

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So you’ve done your part: after having kids, or gaining weight around the middle for whatever reason, you got back to the gym and worked on your diet. But you’ve learned something that many still don’t appreciate, which is that no amount of exercise and no dietary breakthrough is going to tighten skin and erase stretchmarks. And there is no magic number of situps that will give you six-pack abs if the muscles have been separated by pregnancy, or reduce fat that is genetically programmed to park itself on the abdomen until famine conditions come along. Getting you old body back will mean a tummy tuck (abdominoplasty.)

Despite the innocent sounding terms like “tummy tuck” and “mommy makeover” this is a serious decision. Fortunately there have been some major improvements in technique over the years, resulting in faster recovery and superior results, but you still have to do your homework in order to find the right surgeon. The basic idea remains the same however with all versions of abdominoplasty: a football-shaped area of skin between the navel and the pubic area is removed, the navel is left where it is, and the skin of the upper abdomen is undermined and pulled down to be sewn to the lower skin edge. The navel is then brought out.

The most important considerations are what the scar will look like and where it will be, how much discomfort there will be after surgery, and of course your safety. For more than 10 years I have been using a technique known as the progressive tension suture (PTS) method, which contributes to an improved outcome by all of these measures. Let’s first consider the scar: by definition there needs to be a scar where it was all pulled together. Ideally, this scar should be located low, so that it can be concealed under a bikini bottom if desired, and as short as possible without compromising the degree of tightening achieved.

Recovery after surgery is another major issue, and because of the amount of undermining required, most often a drain tube is used. The sooner this can come out, the better, as far as most people are concerned. But if it comes out to soon, a fluid buildup called a seroma can result. Fortunately, the PTS method helps with this too.

I first started developed the PTS method as a way to get the scar low, and minimize tension at the wound which in turn makes for a finer, less obvious scar. Most abdominoplasties are done by pulling the skin down and closing it with several layers of stiches, but the resulting tension sometimes pulls the scar up or widens it. With PTS, there are stitches put into the undersurface of the undermined skin, each one taking up a little more slack, so that the skin can be pulled farther and there is virtually no tension at the edge. This gives complete control over the scar, as opposed to the “cross your fingers” and hope method or simply accepting that it has to be higher and more visible. A serendipitous finding with this technique was that fluid output in the drain tube was much less, and so it can usually be removed in a couple of days as opposed to a week or more. Since the drain tube is a major contributor to postop discomfort for some patients, getting it out earlier is a big advantage. And seromas have become a rare event.

These improvements were so dramatic in my practice that I published the technique and have lectured on it so that other plastic surgeons can offer it to their patients as well. There’s no question in my mind that using the PTS method results in better outcomes.