Abdominoplasty, the medical term for what is commonly called a "tummy tuck", involves surgically removing excess skin and fat from the middle and lower part of the abdomen and sometimes tightening the abdominal muscles. The result is a flatter abdomen, and sometimes, a smaller waist, because the procedure corrects loose, sagging skin and excess fat. Any scars are usually located below the line of a swimsuit or underwear.

Patients considering a tummy tuck should have realistic expectations about the procedures and have an initial consultation with an experienced physician who explains the risks as well as benefits of the procedure. A person's type of skin, overall health, weight and age can affect the outcome.

Both men and women get tummy tucks. The procedure is especially useful for women whose skin has stretched after more than one pregnancy. For people whose fat deposits are just on the lower part of the abdomen, a partial abdominoplasty or mini-tummy tuck may be an option.

Frequently asked questions?

Why is it needed?

Skin has a limit to which it can stretch and still return to normal. When it stretches beyond that point, due to pregnancy or a large weight gain followed by weight loss, the result is much like a balloon that has been blown up and deflated. The skin becomes stretched and crinkly and does not respond to exercise or diet.

While most people have a tummy tuck for cosmetic reasons, others have the surgery to correct weakened abdominal muscles that are causing medical problems, such as back pain. Doctors consider this operation to be reconstructive when it is medically necessary and mainly improves function. In these cases, health insurance may pay for part or all of the surgery.

Abdominoplasty is sometimes done in combination with liposuction to remove pockets of excess fat from specific areas of the body using a suction pump.

A tummy tuck also can be combined with a hysterectomy or tubal ligation.

When is this surgery helpful?

Abdominoplasty works best in people whose weight is fairly normal. A tummy tuck is not a weight-loss technique and is not suitable for obese people.

The surgery may help:

1. Women who have baggy folds of skin on the abdomen and/or weakened abdominal muscles after pregnancy.
2. Men and women who have a large amount of fat and loose skin on the abdomen that will not go away with exercise or diet, and whose skin is not elastic enough to have liposuction.
3. Older people who, due to age and being a little overweight, have sagging, loose skin on the abdomen or weakened abdominal muscles.

Patients should wait to have this operation if they:

• plan to lose a lot of weight
• want to get pregnant again

Patients should talk to their physician if they have:

1. Diabetes or a history of blood clots.
2. Heart or lung disease or other severe medical problems.
3. Abdominal scars from past surgeries. Scars above the belly button could become more noticeable after a tummy tuck.

Procedure

There are a number of different tummy tuck techniques available. The most common procedure is performed under a general anesthesia and is called the full tummy tuck. In the full tummy tuck, an incision is made across the lower abdomen, just above the pubic area and where possible also below the bikini line. Another incision is made near the belly button to free the surrounding skin, and the all of the skin is separated from the abdominal wall. Then the surgeon pulls the loose muscles from the left and the right sides and sutures them together. This both tightens the muscles to create a stronger abdominal wall and a smaller waist. Excess skin is removed, and a new opening is made for the belly button at the right position. The incisions are closed with sutures (stitches) and/or staples, and gauze is placed over the incision area to protect it for the first few days.

Partial abdominoplasty information

If your only problem area is below the belly button, you may benefit from a less complex procedure called a partial abdominoplasty or partial tummy tuck, which can often be performed on an outpatient basis, under local anaesthetic, such as that used by dentists. Or, your surgeon may recommend either a partial or complete abdominoplasty done in conjunction with liposuction to remove fat deposits from the hips, for a better body contour. Sometimes liposuction alone offers the best results.

Frequently asked questions?

How long does the tummy tuck take?

A tummy tuck operation generally lasts between 2-5 hours, all depending on the extent of the work. A partial abdominoplasty takes only about 1 or 2 hours.

Do I have to stay in the hospital?

This depends on the extent of the repair. One or two overnight stays after the surgeries are most common. If the area of repair is minimal, you may be able to go home the same day.

How much pain is there?

For the first few days after the tummy tuck, your abdomen will be swollen and you are likely to feel both pain and discomfort which is controlled by analgesic style medication. Depending on the extent of the surgery and the technique used, you may be released within a few hours or you may have to remain hospitalized for two to three days.

What can I expect after a tummy tuck?

Bed rest for two to three days is definitely required. While the patient is in bed, the legs should be bent at the hips to reduce the strain on the abdominal area where the tummy tuck has been performed. The patient will be provided with a firm abdominal binder to offer support to the tightened areas. The doctor will also give instructions for showering and changing dressings. Even if the patient may not be able to stand-up straight at first, they should start walking as soon as possible to make a good recovery.

The surface stitches will be removed after five to seven days, and then any deeper sutures, with ends that protrude through the skin, will come out after two to three weeks.

Recovery

It may take you several weeks to feel completely back to normal. If you are in good physical condition, recovery will be much faster. Some people return to work after two weeks, while others take four weeks to recuperate.

After about three days, you may begin to engage in light activities. At this moment, the gauze bandaging may be replaced by a new stronger abdominal supporter. Even if you’ve never really exercised before, you should begin a light exercise program to reduce swelling, to lower the chance of blood clots, and to generally improve muscle tone. However, more vigorous exercises, especially lifting, should wait until you can do it comfortably and your surgeon gives you permission.

Your scars may appear to get worse during the first few months, however this is normal. It may take up to a year before your scars flatten out and lighten in color. While they'll never disappear completely, these scars will be placed so that they’ll be covered by your clothes, including most bathing suits.

Risks

Tummy tuck surgery, though known to be successful in maximum cases, carries its share of risks too. Some of these risks are:

• unfavorable scarring
• bleeding (hematoma)
• infection
• fluid accumulation
• poor wound healing
• skin loss
• blood clots
• numbness or other changes in skin sensation
• anesthesia risks
• skin discoloration and/or prolonged swelling, etc.

Frequently asked questions?

Is an abdominoplasty permanent?

Although not permanent, a tummy tuck can last for many years and if there are no large weight gains, or pregnancies after the procedure then the changes will be relatively permanent. Certainly some relaxation of the tissues can reoccur but not to the extent prior to surgery.

When can I return to work?

Most of your recovery will depend on your physical condition. Most people can return to work after 2 to 3 weeks, which other can take longer to recuperate. Exercise will help to reduce swelling, lower the chance for blood clots and tone muscles quicker. The scars may appear to worsen during the first few months as they heal, but that is completely normal.

Benefits

A tummy tuck, or abdominoplasty, can tighten the abdominal muscles, as well as the sagging and excess skin and accumulated fatty tissues. After the procedure the abdomen is firmer and flatter, and the waist will be smaller as well.

The scale of improvement depends upon a combination of the extent of the tummy tuck surgery and the patient's general skin tone, body build, and healing process. Most people are very happy with the results, and report a better "body image" after the surgery.