Tummy Tuck

Abdominoplasty (Tummy tuck)

Weight loss, pregnancy, and aging can leave stretch marks and extra skin that don’t go away despite being at a healthy weight and exercising. Losing the definition of your waistline and the tightness of your abdominal muscles is frustrating. A tummy tuck can remove the extra skin and fat, tighten the abdominal muscles, and shape the tummy. There are a few types of tummy tucks, depending on how much extra skin and fat you have. The right procedure also depends on your medical history, how many abdominal operations you’ve had, how much weight you have gained and lost, and your current weight. I’ll start by describing the “classic” abdominoplasty, which is most often performed and then address some other related procedures.

Who should not have abdominoplasty

If you are 20 or more pounds over your goal weight, you should wait until you have lost the weight. If you plan on future pregnancies, it is best to wait until you are through having children. After previous abdominal surgeries and after some hernia repairs, it may not be safe to lift up the skin all the way to the rib cage, and a smaller procedure might be safer. Smoking increases your risk of complications, so you should not have surgery unless you stop smoking for four weeks before and after surgery.

What happens during tummy tuck surgery

• Classic Abdominoplasty
• Mini tummy tuck
• Panniculectomy
• Circumferential body lift (Belt lipectomy)

Classic Abdominoplasty

All tummy tucks start with an incision above the pubic hair that goes from hip to hip. This will be a little shorter if there is not much skin and fat to remove, and it will be longer if there is more extra tissue. The skin and soft tissue is lifted up off your abdominal muscles all the way to your ribs (the skin is cut around your belly button so it stays attached to your muscles the whole time). Stitches are used to tighten and shape the abdominal muscles to narrow the waist and make the stomach flatter. Next, the skin is stretched back down and all of the extra tissue is removed. The final step is to make a new hole for the belly button.

Mini Tummy Tuck

If you have a very small amount of extra skin and just a small amount of muscle weakness below your belly button, the tummy tuck can be performed through a shorter incision. When there is not enough skin above the belly button to stretch back down, there will either be a small vertical incision just above the pubic hair (where the belly button was cut out) or there will not be an incision around the belly button, which will just be lower down as the skin is stretched out.

Panniculectomy

If you have a large amount of tissue that hangs over your pubic area and causes problems like rashes and repeated infections, your insurance company may pay for a procedure to remove the problematic tissue. It is important to understand that although panniculectomy does improve the appearance of the abdomen, it is not a cosmetic procedure. It is done primarily for relief of symptoms and for patients who are at high risk due to previous abdominal surgery, prior hernia repairs, or obesity. All the tissue on the lower abdomen that can be pinched together is removed without lifting up the tissues, tightening the abdominal muscles, or recreating the belly button.

Circumferential Body Lift (Belt Lipectomy)

This procedure rejuvenates and reshapes the tummy, lower back, buttocks, and outer thighs. The incision goes all the way around the waist like a belt. Commonly performed after weight loss over 50 pounds, up to 15 to 25 pounds of skin and fat can be removed during a belt lipectomy.

Risks of Abdominoplasty (Tummy Tuck) Surgery

Infection – This can vary from a small amount of redness on the skin, requiring antibiotics by mouth, to a pocket of infection that requires surgery and admission to the hospital for IV antibiotics. 

Bleeding – A small amount of bleeding may cause bruising and swelling. Rarely, bleeding is severe enough that you need another surgery to stop it.

Blood Clots – After surgery, blood clots can form in the veins in the legs. They can cause swelling, and they can potentially break off and travel to the lungs, where they can be fatal. Smoking, surgery time over 4-6 hours, and not moving around enough after surgery all increase the risk. This is a rare but serious risk of surgery, and I take precautions to ensure your safety.

Poor wound healing – This is more common with smokers and patients with medical conditions that affect wound healing like, diabetes, kidney disease, or obesity.  I also see this in patients with poor protein intake, which can occur with rapid weight loss or extreme dieting.

What to expect after Abdominplasty

After surgery, you will wake up with small drainage tubes placed under the skin. Your body produces fluid after surgery, and the tubes help drain this extra fluid and help the tissue stick back down. The longer your incisions, the more drains you will have (one for a mini tummy tuck and four or more for a belt lipectomy).

The drains stay in place as long as they are draining more than 20 to 30 ml a day (about 1/8 cup). There will also be a binder to reduce swelling and to help the tissue heal smoothly. Whether your surgery is done on an outpatient or inpatient basis will depend on the extent of surgery and your health risk factors. Either way, you should arrange for someone to drive you home after your surgery and to help you out for a day or two after you leave the hospital. 


For the first few days, your abdomen will be swollen and uncomfortable, which can be controlled by prescription pain medication. These medications can cause constipation, so I recommend you use over the counter stool softners to help prevent this. You should start walking the day of surgery to prevent blood clots even though you may not be able to comfortably stand up completely straight for about a week after surgery. 



 It may take you weeks or months to feel like your old self again. If you start out in good physical condition with strong abdominal muscles, recovery from abdominoplasty will be much faster. Some people return to work after two weeks for a job with minimal physical duties, while others take six to eight weeks to rest and recuperate.

 Your scars may actually appear to worsen during the first three to six months as they heal, but this is normal. Scars which are red and raised can take nine months to a year before they flatten out and lighten in color. While they'll never disappear completely, abdominal scars will not show under most clothing, and even under bathing suits and underwear.