Abdominoplasty, so much more than a tuck!
Dr Michael Kernohan
MBBS MRCS BDS FDSRCS MSC FRCS (PLAST) FRACS
Plastic and Reconstructive Surgery, Cosmetic Surgery
OK let’s be honest, most people think an abdominoplasty is a lifestyle choice! For many people it is a however, a game changer. Firstly, we tend to underestimate the psychological effect of redundant skin in the lower abdomen and its ability to constantly remind its presence. For those who have lost a large amount of weight through diet, exercise or bariatric surgery, the skin excess can be a big problem. They suffer from chronic rashes, discomfort and body image concerns that affect relationships, work, and so much more. There are Medicare codes for patients who hit the criteria of massive weight loss (5 BMI points), chronic intertrigo and issues with activities of daily living. With a Medicare code, insurers will normally support this surgery making it accessible to many. Until this year there was no Medicare code for post-partum patients who have not undergone massive weight loss but many of whom struggle with incontinence, and functional problems like low back pain, as a consequence of divaricated rectus abdominal muscles.
In 2019, Taylor et al, an Australian group, published a landmark multicentre study demonstrating significantly improved functional symptoms of reduced low back pain and incontinence, prompting Medicare to re deploy an item number to help these patients. As of 1st July 2022, item number 30175 is active and available.
New Medicare item number 30175
The new MBS item is available for radical abdominoplasty with repair of rectus diastasis (separation of the large abdominal muscles) where the patient has an abdominal wall defect because of pregnancy.
This new item will benefit some patients who have a rectus diastasis of at least 3cm measured by diagnostic imaging with moderate severity of pain or discomfort at the site of the diastasis in the abdominal wall during functional use and/or lower back pain or urinary symptoms and who have failed to respond to non-surgical conservative treatment, including physiotherapy
Consultation was undertaken with key stakeholders, clinical experts and providers, and consumer health representatives as part of the review process.
The Medicare Services Advisory Committee recommendation to create a new item was endorsed by the Australian Society of Plastic Surgeons and the National Association of Specialist Obstetricians & Gynaecologists.
What is involved?
The radical abdominoplasty with rectus repair is best performed under a general anaesthetic in an accredited hospital by a specialist surgeon. The operation usually takes two to three hours to complete. There are several options depending on the degree of redundant skin and the patient’s preferences. Ultimately, it is always a trade-off between scar and contour. The standard abdominoplasty involves a low scar from hip to hip anteriorly. In addition there is a scar around the newly placed umbilicus. More extensive variations include the “fleur de lys” abdominoplasty which also involves a vertical midline scar with the added benefit of control of lateral skin laxity. Extended abdominoplasty includes a 360 degree approach with the scar going all the way around the body – a powerful technique for recontouring the abdomen, buttocks and lateral thighs. Finally, the corset abdominoplasty is an extensive hybrid involving scars around the inframammary area in addition to low abdomen with a vertical midline scar joining them.
What are the risks?
The risks range from minor troubles with wound healing to major complications associated with most medium length operations. Expectation management is an important component of the informed consent process. All patients are counselled in depth, over multiple visits and are given advice documents to read and digest between appointment. Planning downtime is important as lifting needs to be avoided for 6 weeks post op.
https://plasticsurgery.org.au/information-for-patients/abdominoplasty-with-muscle-repair-after-pregnancy/
About Dr Michael Kernohan – Specialist Plastic Surgeon in Sydney and Southern Highlands NSW
Dr Michael Kernohan is a Plastic, Reconstructive and Cosmetic Surgeon providing a wide range of services from skin cancer to cosmetic surgery for the face, nose, breast and body.
He also offers complex reconstructive procedures following trauma and a range of cancer treatments using the most innovative and up-to-date treatment options.
Dr Kernohan is able to care for both public and private patients and currently has appointments in five Sydney hospitals and has an additional leadership role as Director of Surgical Specialities.
He consults and operates in the Southern Highlands and Southwest Sydney.
Please call on 1300 39 38 99 or visit www.drmichaelkernohan.com.au
Further Information about Item Number 30175
PDF version Factsheet New MBS item 30175 for abdominoplasty (PDF 207 KB)
Word version Factsheet New MBS item 30175 for abdominoplasty (Word 85 KB)
References Quoted
https://www.smh.com.au/politics/federal/surgery-for-women-with-birth-injuries-set-to-be-subsidised-again-20211007-p58y0v.html
https://plasticsurgery.org.au/information-for-patients/abdominoplasty-with-muscle-repair-after-pregnancy/
