Abdominoplasty, commonly known as a “tummy tuck,” is performed to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The best candidates are in relatively good shape with fat deposits with loose abdominal skin. If there is a large fat accumulation, liposuction may be suggested first to remove excess fatty deposits, followed by a tummy tuck to address loose skin and muscles at a second stage.
Women whose abdominal muscles and skin have been stretched out from multiple pregnancies, as well as older women who have a loss of skin elasticity due to age or weight fluctuations, are also good candidates. Women who are planning future pregnancies may be advised to wait, as the vertical muscles in the abdomen that are tightened during surgery will tend to separate again during pregnancy. If your fat deposits are mostly located below the navel, a less complex procedure called a mini-tummy tuck or partial abdominoplasty may be recommended. Both a partial and complete abdominoplasty may be performed in conjunction with liposuction to remove fat deposits from the hips, waist, or thighs for a better contour.
A tummy tuck is nearly always performed under general anesthesia, but can be performed under twilight anesthesia or with an epidural in some cases. Some surgeons will perform selected abdominoplasties in an outpatient surgery center, but most prefer a hospital setting where you can recover overnight.
Methods and technologies for tummy tucks continue to evolve. These are the most commonly used today:
There are several techniques for an abdominoplasty, but the most common involves an incision made across the lower abdomen, just above the pubic area. This incision can be angled so that it is easier to conceal. A second incision is usually made to free the navel from surrounding tissue. The surgeon separates the skin from the abdominal wall all the way up to your ribs and lifts a large skin flap to reveal the vertical muscles in your abdomen. These muscles are tightened by pulling them close together and stitching them into their new position. The skin flap is then stretched down and the extra skin is removed. A new opening is made for the belly button. The incisions are closed with sutures and/or staples, and gauze is placed over the incision area.
In a partial or modified tummy tuck, the incision is much shorter and the navel may not need to be moved. The skin is separated only between the incision line and the navel. This skin flap is stretched down, the excess is removed, and the flap is stitched back into place.
- Time: 2-5 hours
- Cost: $6,000-$15,000, plus hospital and anesthesia
- Back to work: 2-3 weeks
- Recovery: After surgery, discomfort can be controlled with medication. You may need to remain in the hospital for two to three days or hire nursing care at home. When you leave the hospital, the dressing will be replaced with an abdominal supporter that you will be instructed to wear for several weeks. Bed rest is recommended with your legs bent at the hips in order to reduce the strain on the abdominal area. You may be up and around in a few days, but avoid straining for three or four weeks. You will be given instructions for showering and changing your dressings. At first you may not be able to stand up straight without feeling a tugging sensation, but you should start walking as soon as possible as your body accommodates to your newly tightened abdomen. Post-op bruising is usually minimal, but swelling may take up to three months to settle. You may experience a loss of sensation of the abdominal skin that may take several months to return. Surface stitches will be removed in five to seven days, and deeper sutures, with ends that protrude through the skin, will come out in two to three weeks. Lighter bandages will be applied that will be replaced with an abdominal support garment, which is to be worn for several weeks. If you start out in top physical condition with strong abdominal muscles, recovery from abdominoplasty will be much faster. Moderate exercise will help you heal better, reduce the chance of blood clots, and tone muscles but vigorous exercise should be avoided for four to six weeks. It will take nine months to a year before your scars flatten, soften, and fade out.
- Risks and side effects: Possible complications include poor healing, skin loss, asymmetries, and the need for a secondary procedure. This surgery does produce a permanent scar, which can extend from hip to hip. The scar can be placed so that it will not show under most clothing, including bathing suits. Everyone heals differently, and in some cases, the scar may be thick, raised, and irregular. Occasionally, a projection of bulging tissue called a “dog ear” can result, which can be easily revised at a later date if necessary. Infections can be treated with drainage and antibiotics but will prolong your healing process. The risk of blood clots can be minimized by moving around as soon as possible after surgery.
Wendy Lewis is a nationally recognized aesthetics consultant and the author of the Vibrant Nation Health and Beauty Guide, Cosmetic Procedures and Plastic Surgery After 50: Expert Advice for Choosing the Best Option for You.