Abdominoplasty, commonly called a tummy tuck, is a procedure designed to tighten sagging abdominal muscles and give the stomach area a ﬂatter and smoother appearance. The procedure is most commonly done on women after they have had children. Many women are simply restoring their past ﬁgures from B.C. (Before Children). This isn’t vanity; it’s a reclaiming of self, or a healthy undoing of the past. Pregnancy can cause the lower abdominal muscles to stretch out, displace from the midline, and excess subcutaneous tissue may accumulate. The lower abdomen is often a fat storage area in women, probably designed by nature to protect them from famine. It’s like the hump on a camel and is extremely resistant to diet and exercise. Exercise will strengthen and ﬁrm the muscles, but all the sit-ups in the world won’t bring them back if your abdominal muscles have spread apart due to pregnancy.
Only four percent of patients undergoing tummy tucks are men, and most patients are of baby boomer age. Abdominoplasty can ﬂatten a protruding abdomen, but the trade-off is a scar running along the lower abdomen. This sometimes can be limited by endoscopic surgery. Additional scars may be around the belly button, and some may extend from hip to hip, depending on how much skin has to be removed. The scars are permanent.
Abdominoplasty is not a weight-loss procedure. It beneﬁts patients who are in relatively good shape but are plagued by an extensive fat deposit or loose abdominal skin unresponsive to diet or exercise. Some older patients who have lost skin elasticity and developed mild areas of fullness can also be helped.
Some patients store fat inside the abdomen around the intestines. They look like they have a beer belly, but there isn’t really a large amount of fat on the outer abdominal wall. These patients aren’t candidates for abdominoplasty. The large amount of inside tummy fat pushes out the entire abdominal wall. This overall protrusion can’t be corrected surgically because the muscles are stretched everywhere rather than simply separated in the middle, as is usually the case following pregnancies.
If you plan to lose weight, do your best to do so before abdominoplasty. Surgeons can obtain ﬂatter results by removing as much skin as possible. Women who plan on a future pregnancy should wait to have abdominoplasty because the vertical muscles running up and down the abdomen—that six-pack we hear so much about—will stretch during pregnancy, undoing surgical repairs. If someone is undecided about having a baby in the future or isn’t planning on a family for many years, I let them decide if the surgery is worth it. In general, plastic surgeons defer abdominoplasty until after a woman has ﬁnished with child bearing.
This is not a simple operation. Your surgeon will want to take a health history, determine the extent of fat deposits, and your skin and muscle tone. Be sure to tell your surgeon if you smoke, and report all medications and supplements you are taking. I will not operate on active smokers.
Tell your surgeon what changes to your appearance you expect to see. Based on your exam and a discussion with your surgeon, you may decide not to have the surgery at all. Ask your surgeon for a candid response about limitations based on your personal anatomy. Maybe liposuction alone could achieve a good result. Balance your expectations with a realistic goal. Review photos of prior patients with a preoperative anatomy similar to yours and compare their outcomes with what you want to see.
Regardless of which variation of abdominoplasty you and your surgeon choose, be certain the most revealing clothing you are likely to wear will cover the incision lines. It’s a good idea to wear a swimsuit the morning of surgery to use as a reference. I draw the incisions for my patients while they’re looking in a mirror, so they can verify their satisfaction with the incision placement.
Abdominoplasty is usually done as same-day surgery. Generally, surgeons do abdominoplasty under general anesthesia, so you’ll be completely asleep with a breathing tube. Other surgeons, depending on the extent of the procedure, choose local anesthesia with heavy intravenous sedation to keep you in a twilight sleep. You shouldn’t feel any pain but possibly could feel some pressure or tugging.
There are several different abdominoplasty procedures used, depending on the patient’s needs and anatomy. Discuss the procedure carefully with your surgeon to determine which one is right for you.
Endoscopic abdominoplasty is used in the rare cases where someone suffers from muscle relaxation but has good skin tone and needs little or no skin removed. In general, all abdominoplasty will begin with liposuction to smooth out unwanted fullness in certain areas. Then a one- to two-inch incision is made in a skin crease or an old surgical scar. The skin is elevated along the middle of the abdomen, sometimes all the way up to the lower end of the breastbone. Special endoscopy instruments are used to place strong muscle sutures to ﬂatten the middle of your abdomen. Additional small incisions may be made higher on your abdomen. The procedure lasts about two hours.
Modified or Limited Abdominoplasty – If a modiﬁed or limited tummy-tuck is indicated, following liposuction, the lower abdominal muscles on either side of the abdomen will be exposed through a crosswise incision along the upper pubic hairline. Incision length depends on your anatomy. Sutures will be placed in the midline to tighten your tummy. Additional sutures may be placed on the sides of your lower abdomen to tighten these areas.
Excess skin and some underlying fatty tissue are trimmed. Finally, additional liposuction contouring may be done before your incision is closed. A drainage tube usually is placed to prevent any accumulation of blood or serum during the ﬁrst few days after surgery. This procedure usually lasts between one and a half to two and a half hours.
Complete or Classic abdominoplasty generally requires an incision from hip to hip across the lower abdomen. The actual length of the incision depends on your anatomy. Your natural belly-button should be left attached to the underlying muscles. Abdominal muscles are tightened by pulling them into your midline and stitching them where they used to be. This ﬁrms up the abdominal wall. Additional sutures can be placed to narrow the waistline.
Skin and subcutaneous tissue are stretched and removed. A new opening is made for your navel through the overlying skin. One or two suction drains will be placed prior to suture closure. Usually butterﬂy skin tapes, sterile dressings, and an abdominal binder are applied. The surgery may last two to three hours. I always use compression boots during the procedure and into the recovery room to squeeze blood through the legs to prevent blood clots from forming.
Someone will need to drive you home when you are discharged and be around the house to help you for a few days. Pain from a full tummy-tuck can be about eight on a scale of one to 10, with 10 being a kidney stone and nine the delivery of a baby. Usually the abdomen is bruised for about three weeks and feels kind of numb and funny for several months, and in some cases to a slight degree for the rest of the patient’s life. This is not disabling, but the area doesn’t feel “quite right” when touched.
You will be discharged several hours after the procedure is done. You will have one or two drains. A drain is a small plastic tube connected to a light bulb shaped reservoir. The compressible reservoir creates gentle suction to remove excess ﬂuid from the surgical area. The recovery room nurse will teach you how to care for the drain prior to your discharge from the surgery center. You’ll receive pain pills and, possibly, a prophylactic antibiotic. I prefer to have my complete tummy tuck patients go home with bladder catheters, so they don’t have to get out of bed during the night to urinate. My patients wear elastic stockings to help prevent blood clots in the legs.
Road to Recovery
Tummy tuck patients at my cosmetic surgery office will need to avoid heavy lifting or vigorous exercise for six to eight weeks, so there is deﬁnitely a prolonged recovery period. Don’t try to lift anything heavier than about 10 pounds (the equivalent of a full grocery bag) during this time. Carefully lifting your children should be all right as long as you hold them close to yourself. Think of the operation as a hernia repair from “stem to stern,” and treat yourself gently.
I ask patients to walk hunched over for about a week to keep tension off the incision line. You can return to work in a week or two, if your job doesn’t involve heavy lifting. If you have a physically demanding job, you may need to return on light duty for a month. It may take a month or two before you feel like your old self. Studies show people who are in the best shape possible before surgery have the fastest recovery.
The incision will be pink for several months and then fade over the subsequent year. If your scar rises, becomes tender, or stays reddened, you may need additional treatment such as a cortisone injection. Mild depression is normal after surgery. It is a result of biochemical changes caused by the anesthesia and surgery, and should go away fairly quickly.
After I met with you for my initial consultation I knew you were the doctor I wanted to perform my surgery. Right away, you established a wonderful rapport with me. I felt very much at ease as you listened to my cares and concerns and answered all my questions without making me feel uncomfortable or rushed.
Risks and Complications
The problems I’ve had with tummy-tuck surgery tend to be the same as those for all cosmetic surgical procedures. Irregularity or asymmetry may persist, and touch-up surgery may be required. A number of patients develop ﬂuid collections after their drains are removed. Sometimes this requires draining, which is done with a needle in the clinic. Rare instances of permanent ﬂuid build-up have been reported. Treatment involves another operation to remove the tissue lining that is continuing to form abnormal ﬂuid.
Bad scarring is another possible complication. Infection is rare and usually is treated with antibiotics or surgical drainage. Excessive bleeding is unusual, and the drainage tubes are there to handle this. Geometrical problems like elevation of the pubic hairline or lack of central placement of the belly-button are potential risks. I curve the incision over the pubis and make precise preoperative measurements to prevent this from occurring.
Blood clots can be avoided by being active after your procedure. I use compressive stockings or mechanical devices on the operating table to squeeze the patient’s calves. Walking as soon as possible is helpful to maintain muscle strength and prevent blood clots. Surgeons may instruct patients to do ankle and foot exercises to improve blood circulation.