Modern Concepts in Abdominoplasty Article by Scott A. Spiro M.D. More women today than ever before are getting into shape after childbirth. They are combining proper nutrition with exercise. More women in their 30’s and 40’s are fitness conscience. It is okay now (over the last 10 years) for women after childbirth to take the time to improve their health. Women today are empowering themselves in the female fitness revolution. Moms want to look great. It has been said the 40’s are the new 30’s but I’d say the 40’s are the new 20’s. Problem: there are cosmetic and functional issues after childbirth, which are not treatable by proper nutrition/exercise: these are skin laxity issues and most importantly abdominal wall laxity issues. For years (the first 25 years) tummy tuck surgery focused on skin tightening and the “diastasis” or separation of muscles, an overall simplistic view of the complex dynamics of the female abdomen. I began exploring these concepts in combination fourteen years ago in my plastic surgery training. Through my long and extensive experience in breast reconstruction using abdominal tissue (TRAM flap) I developed unique methods of abdominal wall tightening, shaping, and strengthening using the fascia (the fibrous layer covering the muscles). I saw in patients (from elsewhere) abdominal residual laxities, tone inequality, and squared off shape as unaesthetic and unacceptable! It wasn’t enough to have tight skin if there was no feminine shaping. I developed a technique ten years ago that identified the functional and cosmetic issues before surgery and addressed them effectively in the operating room. I call this the “RETAF” procedure: Restoration and Equalization of Tone Across the Fascia of the abdominal wall. It is a powerful tool that creates incredible waist shaping and feminizes the torso. The principle is that the basic previous plastic surgery concept that abdomen muscles are the problem is incorrect. The muscles are fine. They must be recompartmentalized. Once the tension (or tone) of the fascia is restored over the muscles (rectus and oblique), these muscles can function appropriately. It’s not only position—it’s fascial tone—the recompartmentalization allows effective function. This is the key to core strength. Additionally, when this is done, there is even more skin excess to treat and further tightening (over the front of the hip-flankplasty- helps to create an amazing waist shape). My patients (more than many hundreds to date) come back to show me the ability to individually isolate and function each packet of rectus muscles, and they inform me that they have never had as great core control. They perform Pilates, Yoga, weight training, and cardiovascular training better than ever before. Some say it has helped them achieve unimaginable personal goals for youthful restoration of mind and body. Two patients in particular have informed me that they now compete in female fitness competitions regionally and nationally—fantastic! The surgery is performed in a hospital environment, under general anesthesia (for technical purposes). I ask patients to stay overnight so that they can be properly hydrated and given a sophisticated combination of both analgesic and muscle relaxant medications. This dramatically eases and speeds up recovery. Patients are seen weekly for the first three weeks. Then they are able to resume light exercise. At six weeks they should be approaching full workouts except for isolating core workouts, which we start at twelve weeks. After that—the sky is the limit. Ages range from 20’s to late 60’s and depend on pre-existing health considerations.