Tummy Tuck (Abdominoplasty)

Overview

After pregnancy or a large weight loss, the skin of the lower abdomen often stays loose, and the abdominal muscles can stay separated. A tummy tuck, or abdominoplasty, removes that loose skin and some fat and pulls the remaining skin down to sit flatter. In many cases the surgeon also repairs the separated muscles. The belly button stays attached to its stalk and is brought out through a new opening in the tightened skin.

It is a major operation. It leaves a long scar, it needs several weeks of recovery, and it carries a real risk of complications such as wound problems and blood clots. The first week is usually the hardest, because standing up straight pulls on the tightened skin.

The operation is about skin and muscle. It is not a weight loss treatment and does not stop weight from coming back.

Who needs it

Most people who ask about a tummy tuck fall into two groups.

After pregnancy. Pregnancy can stretch the skin of the abdomen beyond the point where it shrinks back, and it can leave diastasis recti, a gap between the two vertical bands of the rectus muscle (the "six pack" muscle) down the middle of the abdomen. This can leave a bulge that exercise does not fully correct. Some women also have back pain or a feeling of weakness in the core, and surgery does not always relieve these.

After major weight loss. People who have lost a lot of weight, through diet or after bariatric surgery, may be left with an apron of hanging skin called a pannus. It can cause rashes, infections in the skin fold and difficulty with clothing or exercise. Removing it is sometimes called a panniculectomy.

Surgeons usually look for:

• A weight that has been stable for several months. After bariatric surgery, many surgeons wait at least a year and until weight has settled.
• No plans for further pregnancies.
• Good general health, with diabetes, blood pressure and heart conditions under control.
• No smoking or nicotine of any kind (including vapes, gum and patches) for several weeks before and after surgery, since nicotine reduces blood flow to the skin and greatly raises the risk of wound breakdown.

A surgeon may advise against surgery if your weight is still high or changing, if you smoke, if you have had blood clots before, or if the main concern is fat under the muscle (visceral fat) that surgery cannot reach. That advice is part of a careful assessment, not a refusal of care.

How it is done

A tummy tuck is done under general anaesthesia and usually takes two to four hours, longer if it is combined with liposuction or other procedures.

Types of tummy tuck

• Full abdominoplasty: a cut low across the abdomen from hip to hip, and a second cut around the belly button. The skin is lifted up to the ribs, the muscles are repaired if needed, and the extra skin is removed.
• Mini abdominoplasty: a shorter cut and no change to the belly button. It suits people whose loose skin is only below the belly button.
• Extended abdominoplasty: the cut runs further round towards the back to deal with loose skin on the flanks, common after large weight loss.
• Fleur-de-lis abdominoplasty: adds a vertical cut down the middle to remove skin in both directions, used for some patients after very large weight loss.

Muscle repair

To close a diastasis, the surgeon folds and stitches the tough layer covering the rectus muscles together, a step called plication. This tightens the abdominal wall from the inside. The surgeon will also check for a hernia (a weak spot where tissue pushes through) and may repair it at the same time.

At the end, one or two drains are usually placed under the skin, and you wake with dressings and an abdominal binder (a wide elastic support band).

Recovery and how long you stay

Expect 1 to 3 nights in hospital. Many hospitals give injections to lower the risk of blood clots, along with compression stockings or calf pumps, and ask you to walk the day after surgery. You will walk slightly bent forward for the first week or so because the skin is tight. Sleeping with your head and knees raised helps.

Drains come out when the fluid slows down, which may be before discharge or after one to two weeks. Surgeons usually ask you to wear the binder for about six weeks, avoid lifting anything heavy for six weeks, and avoid driving until you can brake hard without pain, often about two weeks. Desk work is usually possible after two to three weeks. Swelling can last several months, and the scar takes a year or more to fade.

Risks to talk through with your surgeon include seroma (fluid collecting under the skin after the drains come out), wound breakdown or delayed healing along the scar, infection, numbness of the lower abdomen, a wide or raised scar, an uneven belly button, and blood clots in the legs or lungs.

Of the cosmetic operations on this site, a tummy tuck usually needs the longest stay: 2 to 3 weeks in the destination. Drains are the main reason. Some come out before discharge and others after a week or two, and the surgeon wants them out and the wound checked before a long flight. Because you walk bent forward at first, the trip home is easier once you can stand straighter, and your surgeon decides the flying date. Patients from the US and Canada often choose Mexico, and patients from Europe and Australia often look at Thailand or Turkey, though India and Malaysia offer the operation too. MediCurage looks for a stay close to the hospital with a lift and a bed you can get out of easily, since bending and climbing stairs are hard in the first weeks.

Questions to ask your surgeon

1. Do I need a full, mini or extended tummy tuck, and why?
2. Do I have a diastasis or a hernia, and will you repair it?
3. Will you add liposuction, and does that change the risks?
4. Will I have drains, and will I go home with them?
5. What do you do to lower my risk of blood clots, during the stay and on the flight home?
6. Where will the scar sit, and how long will it be?
7. How long should I stop smoking or nicotine before and after?
8. How soon could a problem with the wound show, and who will check it after I go home?

Bring your weight history, details of any pregnancies and earlier abdominal surgery, and a list of your medicines. These change how the surgeon plans the operation.