Tummy Tuck/Abdominoplasty

What Is a Tummy Tuck (Abdominoplasty)?

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.

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:

• Women who have baggy folds of skin on the abdomen and/or weakened abdominal muscles after pregnancy
• 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
• 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:

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

What Are the Treatment Options?

There are several ways to correct an out-of-shape abdomen. The method used depends on the amount of fat or excess skin to be removed, the patient’s overall health, age and preferences. Options include:

• Tummy tuck (abdominoplasty)
• Mini-tummy tuck
• Endoscopic tummy tuck
• Panniculectomy
• Liposuction

Tummy Tuck (Abdominoplasty)

Abdominoplasty, commonly called a “tummy tuck,” is useful in removing loose, stretched skin on the abdomen. This operation is usually performed under general anesthesia and involves surgically cutting out excess skin and fat from the belly and tightening the abdominal muscles. The belly button may be repositioned during the procedure. The result is a flatter abdomen.

Mini-Tummy Tuck

A partial abdominoplasty, or tummy tuck, may be an option if a patient needs a less extensive abdomen-tightening procedure. This operation, usually done under local anesthesia and sedation, removes excess skin in a smaller area of the belly than with a complete abdominoplasty, so the scar is shorter. Unlike in a full tummy tuck, the belly button is not moved. The surgeon may tighten the abdominal muscles along with removing skin and fat.

Endoscopic Tummy Tuck

Patients with small amounts of excess abdominal skin and fat may be eligible for an endoscopic tummy tuck (abdominoplasty). The surgeon performs a tummy tuck through several small incisions while looking through a lighted tube called an endoscope. Endoscopic surgery leaves smaller scars than traditional surgery and may reduce bleeding, bruises and swelling.

Panniculectomy

This surgery is similar to a tummy tuck but is more complex. Panniculectomy cuts out the large abdominal apron of fat that hangs down in obese people or those who have lost a great deal of weight.

Liposuction

If a patient has firm, elastic skin, he or she may be able to have liposuction instead of a tummy tuck. As the name implies, liposuction uses suction to remove fat deposits. The suction usually comes from a high-pressure vacuum pump. This suction pump attaches to a tube, which the surgeon inserts into a small cut in the body.

For further information about liposuction, go to Liposuction.

What Are The Risks of a Tummy Tuck (Abdominoplasty)?

Abdominoplasty is generally safe. Any surgery, however, has the potential for complications and the patient should clearly understand any and all risks involved.

These risks include:

• A bad reaction to anesthesia
• Unplanned hospital admission
• A collection of blood under the skin (hematoma, or “blood blister”)
• Poor healing and excess scarring
• A degree of permanent numbness of the abdomen

Severe complications are rare. They include:

• Heavy bleeding
• Infection
• Blood clots, particularly in women taking birth control pills
• Skin tissue death (necrosis), especially in smokers and people with diabetes
• Lung problems
• Death

How Do I Prepare for Tummy Tuck Surgery?

During the first appointment with the surgeon, patients should discuss expectations and concerns to make sure the surgery will achieve the desired look. Remember – a tummy tuck will improve the body’s shape, but will not achieve perfection.

After the exam, the surgeon will discuss treatment options and recommend the best option to achieve the goals.

During the consultation, the surgeon should explain:

• The procedure
• Benefits, risks and costs
• Recovery time

Follow The Doctor’s Orders

The doctor will instruct the patient how to prepare for surgery, such as when to stop eating and drinking before the operation. In addition, the surgeon may advise these precautions:

• Female patients taking oral contraceptives should stop taking it and use another birth control method until after the surgery. This reduces the risk of getting a blood clot in the legs.
• Avoid taking aspirin, ibuprofen and other nonsteroidal anti-inflammatory drugs for seven to 10 days before surgery. These drugs contribute to bleeding during and after surgery. Some vitamins and herbs also affect bleeding, so patients should ask their doctor which nutritional supplements they should avoid.
• Patients who smoke should stop smoking for a time before and after the surgery if the surgeon recommends it. Smokers are at risk of getting a chest infection after anesthesia. Also, smoking reduces blood flow to the skin, which can raise the risk of circulation problems after surgery.

  For further inforamtion about how to stop smoking, go to Smoking: How to Stop.

Some patients have abdominoplasty on an outpatient basis, allowing them to go home the same day of surgery. Others are admitted to the hospital for a brief hospital stay.

How Is a Tummy Tuck Done?

The type of anesthesia administered depends on several factors, including the extent of surgery and the patient’s tolerance of pain. Most people having this surgery have general anesthesia, so that they are unconscious and pain-free during the operation.

For a mini-tummy tuck, patients may instead receive local anesthesia that is combined with a sedative to cause drowsiness. Local anesthesia numbs only the area to be treated, so the patient may experience some tugging during the procedure.

Surgical Techniques

Techniques for doing a complete tummy tuck vary. Most commonly, the surgeon makes a

long, horizontal incision in the pubic area, extending almost from one hip to the other. Often, the surgeon can place this incision low enough to not show under a swimsuit.

• After making the cut, the surgeon removes any excess skin between the pubic area and the navel (belly button). To tighten the contour of the abdomen, the surgeon takes the skin on the upper part of the abdomen and stretches it downward.
• Then the surgeon repositions the navel in the middle of the stretched skin. It should end up in a fairly normal position.
• The abdominal muscles are often loose, and the surgeon can tighten these muscles during the operation.
• Finally, the surgeon stitches the incisions. Small tubes are inserted under the skin for a short time to drain fluid from the wounds.

Variations to this procedure include:

• Mini-tummy tuck: The procedure for a partial tummy tuck is similar to that of a complete abdominoplasty. The incision is shorter, and usually the navel and the skin above the navel are left alone.
• Endoscopic tummy tuck: The surgeon performs abdominoplasty through several small incisions while using an endoscope, a lighted, tube-like viewing device. The device has a camera that sends images to a video monitor.

What Can I Expect After Tummy Tuck Surgery?

After surgery the following temporary symptoms are common. They usually resolve quickly.

• Discomfort or pain, which may need pain medication during the first few days
• Bruises and swelling of the abdomen
• Bleeding
• Numbness of the central part of the abdomen below the navel
• Nausea or vomiting after general anesthesia

Patients usually need to wear a pressure garment over the treated area to control swelling and help in healing. The surgeon will instruct the patient in how long to wear this garment. During that time, take it off only to bathe. Also, patients may wear elastic stockings to reduce the risk of blood clots.

Results will become more apparent as swelling goes down. Some patients may not see the final result for three to six months or longer.

The surgeon’s incisions will leave scars, but they usually are made in places that are not noticeable. It may take many months before these scars begin to fade.

How Long Does Healing Take?

Everyone heals at different speeds, so these are general guidelines for healing after a tummy tuck.

• Non-dissolving stitches will be removed within 10 days after surgery.
• Patients can resume normal activities and light work within a few weeks. Avoid strenuous exercise or heavy lifting for a month. Patients should wait at least two weeks or until the wounds heal before having sex.
• Bruises take three weeks or longer to fade. Swelling can take six months to disappear but begins to recede after the first week.
• Numbness of the abdomen below the navel usually goes away after several months. A degree of permanent numbness may remain, however.

Will the Results Last?

Results last a long time if patients do not gain or lose a lot of weight. Remember that abdominoplasty is not a substitute for a healthy diet and regular exercise.

If a woman becomes pregnant after a tummy tuck, there is a risk that the skin may stretch again. Aging also will cause some laxity of the skin.

Tummy Tuck: Frequently Asked Questions

Here are some frequently asked questions related to abdominoplasty (tummy tuck):

Q: My surgeon said I should have a tummy tuck instead ofliposuction because I have too much loose skin. Why wouldabdomen surgery be better for me?

A: The best candidates for liposuction have firm, elastic skin. If it is likely that the abdominal skin might hang down in an unattractive fold after liposuction, a surgeon may recommend an abdominoplasty, or “tummy tuck,” instead. The main goal of this operation is to remove loose, stretched skin on the abdomen, but it also can remove excess fat.

Q: What will I look like after a tummy tuck?

A: Expect a flatter, firmer abdomen. The results may not be apparent for months, as it takes time for swelling and bruises to disappear. There will be some scars, but these will fade over time.

Q: How soon can I return to work after a tummy tuck?

A: How long you will need to take off work depends on your general fitness and the extent of your surgery. If you feel well, you may return to light work in one to three weeks. Heavy lifting requires a month or more of recovery.

Q: What is a mini-tummy tuck?

A: This partial procedure removes excess skin in a smaller area of the belly (just the lower part of the abdomen) than with a complete abdominoplasty. Unlike in a full abdominoplasty, the belly button is usually not moved. The surgeon may tighten the abdominal muscles along with removing skin and fat. A mini-abdominoplasty can give very good results.

Q: Will insurance pay for a tummy tuck?

A: If you are having the surgery for cosmetic reasons, most insurance companies will not pay for it. Health insurance may cover part or all of the surgery if it is done mainly to improve function or along with a medically needed procedure such as a hernia operation. Ask your insurance company whether it will cover the costs of your surgery.

Tummy Tuck: Putting It All Together

Here is a summary of the important facts and information related to abdominoplasty (tummy tuck):

• Abdominoplasty or tummy tuck is a surgical procedure to remove excess skin and fat and tighten abdominal muscles. It is not a weight-loss technique.
• The best candidates for a tummy tuck are healthy adults who have a fairly normal weight. They have one or both of these conditions: (1) excess fat and skin on the abdomen that will not go away with exercise and diet or (2) weakened abdominal muscles that may be causing medical problems.
• Decrease the risks of abdomen surgery by following the surgeon’s advice before and after surgery.
• After a tummy tuck, expect to have some discomfort, bruises, swelling and temporary numbness of the abdomen.
• The full effects of this operation may take three months or longer to be realized – when healing is complete.
• Remember that a tummy tuck will improve body shape, not achieve perfection.

Tummy Tuck: Glossary

Here are definitions of medical terms related to abdominoplasty (tummy tuck):

Abdomen: The part of the body that lies between the chest and the pelvic region

Abdominoplasty: An operation that involves surgically cutting out excess skin and fat from the abdomen and sometimes tightening abdominal muscles; commonly called “tummy tuck”

Anesthetic: A drug used to temporarily reduce or stop pain sensation

Incision: Surgical cut

Liposuction: Cosmetic surgery to improve body shape by removing pockets of excess fat from specific areas of the body, including the abdomen

Mini-abdominoplasty: Surgery that removes excess abdominal skin in a smaller area than with a complete abdominoplasty and usually does not involve moving the navel; also may tighten the abdominal muscles

Navel: Belly button

Panniculectomy: A surgery that cuts out the large abdominal apron of fat that hangs down in obese people or those who have lost a great deal of weight; more extensive than abdominoplasty

Tummy tuck: A common term for abdominoplasty, an operation that involves surgically cutting out excess skin and fat from the abdomen

Tummy Tuck: Additional Sources Of Information

Here are some reliable sources that can provide more information about abdominoplasty (tummy tuck):

American Society for Aesthetic and Plastic Surgery 
Phone: 1-888-272-7711
http://www.surgery.org

American Society of Plastic Surgeons 
Phone: 1-888-475-2784
http://www.plasticsurgery.org

Cosmetic Surgery and Skin Care News 
http://www.cosmetic-surgery-news.com/cosmetic_surgery.htm