Also known as abdominoplasty
Tummy-tuck surgery or abdominoplasty, can flatten your abdomen by removing loose, excess fat and skin and tightening muscles in the abdominal wall. It can also remove some if not all of the stretch marks in your lower abdomen. It is popular following pregnancy, massive weight loss or whenever a flabby abdomen with weak muscles impairs body contour. Most patients report improved self-esteem as a result of this procedure.
When to Consider a Tummy Tuck
· If you've got flab, stretch marks or excess skin in your abdomen that does not improve with diet or exercise.
· If the shape of your abdomen has been affected by pregnancy or massive weight loss.
· If you feel that your protruding abdomen is unattractive.
· If your self-confidence is marred by your stomach contour.
Many people who consider a tummy tuck also consider liposuction, breast surgery, rhinoplasty, fat transfer and a lower body lift.
· Tummy-tuck surgery will restore a flat tummy.
· You will look better in clothes and swimwear.
· You will have a more youthful-looking body.
Cons
· You will have a scar (located in the bikini area).
· Another pregnancy may influence surgery results, so it is best to wait until you’ve finished having children before undergoing this procedure.
· Weight gain following abdominoplasty may negatively affect your surgery results.
These are the top three pros and cons to weigh when considering a tummy tuck. If you want to focus on what is unique to you, please consult with your aesthetic plastic surgeon.
Am I a good candidate for a tummy tuck?
There comes a time when you realize that efforts at dieting and exercise are yielding lower numbers on your bathroom scale but not changing the appearance of your sagging and protruding abdomen. The following are some common reasons why you may want to consider a tummy-tuck:
· Aging, heredity, pregnancy, prior surgery or weight fluctuations have left you with extra skin on your abdomen, abdominal muscle weakness, or both.
· You do not smoke. Smoking slows down the healing process and increases the risk of serious complications during and after surgery. If you smoke, you must quit at least six weeks before surgery.
· Your weight is stable. Slender individuals with extra fat and loose skin in the lower tummy are the best candidates; if you are generally obese, this procedure is not appropriate for you.
· If you have a significant amount of intra-abdominal fat surrounding your internal organs, you may need to slim down before considering a tummy tuck
· You are physically healthy. You must be in relatively good physical shape to tolerate this procedure.
· You are finished having children. The muscles that are repaired during an abdominoplasty can separate again during future pregnancy.
· Internal or external scars from any previous abdominal surgery may also affect your candidacy.
If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.
How is a tummy-tuck procedure performed?
In this surgical procedure, your surgeon will remove your loose abdominal skin and tighten up your abdominal muscles with sutures.
· Your surgeon will mark your abdomen to indicate the location of the incisions, the center of your torso and the location of the repositioned navel.
· A solution of lidocaine (a local anesthetic) and epinephrine (a vasoconstrictor that controls bleeding by constricting blood vessels) will be injected.
· The primary tummy tuck incision will be above the pubic mound, from one hipbone to the other. In a full abdominoplasty, another incision is made around your navel. In a mini-tummy tuck, your surgeon will use a shorter incision.
· The surgeon will loosen the skin from your abdominal wall to your ribcage and then place sutures in the fascia of your abdominal muscles to pull them into a tighter position. This is the muscle repair portion of the surgery.
· After your abdominal muscles have been sutured, your surgeon will remove excess fat by liposuction or other methods. Your abdominal skin is then stretched down over your incision line and the excess skin is removed.
· Next, your surgeon will mark the placement of your navel. Although the skin around your navel has been moved, the navel almost always stays in the same place. Your surgeon cuts a hole through the redraped skin and sutures it around your navel.
· Your surgeon will use tissue glue, sutures, staples or Steri-Strips to close the incisions.
· In a full abdominoplasty, the surgeon will often insert one or more drains to prevent fluid buildup, which can cause pressure on the incision. The drain is a clear plastic tube placed through a very short incision below the main incision, which leads out of the body to a small oval-shaped bulb. Each time you empty a bulb and before you close it again, you will be asked to squeeze it to help drain the wound.
The goal of your aesthetic plastic surgeon and staff is to help you achieve the best results and to make your surgical experience as easy and comfortable as possible.
What are my options?
A personal consultation with your board-certified aesthetic plastic surgeon will determine the best option for you. Here are some different approaches:
Full Abdominoplasty
In addition to the incision across the lower abdomen, a traditional tummy tuck nvolves an incision around the navel. Excess skin is removed, muscles are tightened and liposuction may be used to contour the abdomen. This surgery removes skin from above the navel down to the pubic area that has been compromised by pregnancies, genetic laxity or obesity.
Mini Abdominoplasty
A single incision is made in the pubic area, which will be placed as low as possible and can range from a few inches to the entire span of your abdomen. Through this incision, your surgeon will remove excess skin, tighten slack muscles and possibly use liposuction to further refine the area. The ideal candidate for a mini-tummy tuck has laxity and protrusion below the navel. A mini-tummy tuck is usually recommended for those who have always been in fairly good shape but cannot achieve their aesthetic goals with diet and exercise.
If you have excess skin in the love handles or hips, your incision can be made longer to address this problem. The high lateral tension tummy tuck was one of the first procedures developed to address skin excess after significant weight loss or pregnancy. The technique uses a layer in the deeper tissue to support and maintain the repair. This procedure includes a tummy tuck in the front of the abdomen and transfers the lift over the hip to the side of the thigh to improve contour in this area, suspending and improving the hip and thigh. You can simulate the effect by grabbing the skin on the sides of your waist and pulling up as if you’re putting on a pair of pants.
What will my tummy tuck incisions and scars be like?
The incision for a full abdominoplasty usually runs from hipbone to hipbone, and may be in a V-cut or U-cut shape, so that the scar can be hidden in a bikini. Your surgeon will determine the shape and length of the incision based on your preferences and the amount of correction you need. You may also have an incision around the navel.
With a mini-tummy tuck, the surgeon can place the incision as low as possible; it can be hidden in the pubic bone area. The abdominal skin that is removed is below the navel, and there are no incisions around the navel. The length of the mini-tummy tuck incision will vary based on how much skin your surgeon removes.
With a high lateral tension abdominoplasty, scars are longer and often higher than scars in more traditional abdominoplasties and mini-tummy tucks. It is common not to excise the umbilical (navel) site, because not as much skin is removed centrally.
Select a surgeon you can trust
It’s important to choose your surgeon based on:
· Education, training and certification
· Experience performing tummy-tuck surgery
· Your comfort level with him
After finding a board-certified plastic surgeon in your area who is experienced in performing tummy-tuck surgery, you will need to make an office appointment to set up your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit.
During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your surgeon will evaluate you as a candidate for tummy-tuck surgery and clarify what approach is best for you. Understanding your goals and medical condition, both alternative and additional treatments may be considered.
You should come to the consultation prepared to discuss your complete medical history and answer the following questions:
· Do you have any medical conditions or drug allergies?
· Are you being treated for any medical conditions?
· Have you had any previous surgeries?
· What are your current medications and vitamin and herbal supplements?
· What is your current use of alcohol, tobacco and recreational drugs?
· What is your history with any noninvasive cosmetic procedures?
· What outcome do you expect from the surgery?
· What is your chief motivation in undergoing an abdominoplasty?
Your surgeon may also:
· Ask you to look in a mirror and point out exactly what you would like to see improved.
· Take photos for your medical record, using computer imaging to show improvements you can expect.
· Evaluate your health status, including preexisting health conditions or risk factors.
· Evaluate the elasticity of your skin.
· Discuss your ideal weight, realistic weight and current weight and possibly suggest a weight loss program before surgery.
· Discuss your plans related to future pregnancies.
Based on your goals, physical characteristics, and the surgeon’s years of training and experience, your surgeon will share recommendations and information with you, including:
· An approach to your surgery, including the type of procedure or combination of procedures.
· The outcomes that you can anticipate.
· Your financial investment in the procedure.
· Associated risks and complications.
· Options for anesthesia and surgery location.
· What you need to prepare for your surgery.
· What you can expect to experience after surgery.
· Show before-and-after photos of cases similar to yours and answer any questions.
Questions to ask your aesthetic plastic surgeon
For a general list of questions to ask your surgeon about his or her background, to find out about plastic surgery safety and to plan your procedure, we developed these questions to help you:
· Make the most informed and intelligent decisions about your procedure.
· Confirm that you have the right surgeon for your procedure.
· Make your initial consultation as rewarding as possible.
· Understand your options, potential outcomes and risks.
It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation.
· Am I a good candidate for a tummy tuck?
· Are the results I am seeking reasonable and realistic?
· Do you have before-and-after photos I can look at for the procedure I am undergoing?
· Will my scars be visible? Where will my scars be located?
· What kind of anesthesia do you recommend for me?
· What will be the costs associated with my surgery?
· What will you expect of me to get the best results?
· What kind of recovery period can I expect and when can I resume normal activities?
· What are the risks and complications associated with my procedure?
· How are complications handled?
· What are my options if the cosmetic outcome of my surgery does not meet the goals we agreed on?
How do I prepare for a tummy tuck procedure?
Your surgeon will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history and perform a physical exam to determine your fitness for surgery.
In advance of your procedure, your surgeon will ask you to:
· Stop smoking well before undergoing surgery to better promote healing.
· Avoid taking aspirin, certain anti-inflammatory medications and some herbal medications that can cause increased bleeding.
· Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.
· If he or she recommends weight benchmarks or lifestyle changes, do your best to achieve them to ensure the best results and minimize the chance of complications.
Prepare your home for your recovery before surgery:
· If you have children, arrange for them to be cared for.
· If you will not have someone to prepare every meal, have easy-to-reheat meals on hand or cook your own and freeze them for heating up later. Choose healthful meals and snacks.
· Place all of your food and toiletries within easy reach, preferably at hip level, so that you do not have to reach, bend over or climb up to get them.
· Purchase several bags of frozen peas, usually three "sets" of what you will require for icing your surgical area.
· Have an area set up on your nightstand for your medications, with a medication organizer (with day and time dose compartments) and a written backup schedule/check list.
· Place several bottles of water and plain, low-sodium crackers on your nightstand.
· Place Wet-naps, Kleenex and a roll of paper towels within reach.
· Place a digital thermometer near the bed so that you will be reminded to take your temperature.
· Make sure your remote controls have fresh batteries or are fully charged.
· Have plenty of reading materialand movies ready in advance so that you will have something to do when you are not sleeping.
· Have your cellphone, charger cord and a power supply nearby as well. You can use your cellphone in an emergency and also to call or text your caretaker.
· Set up your bed with plenty of pillows, including body pillows. If you have a recliner, you may wish to sleep there instead.
Whether your surgery is performed on an inpatient or outpatient basis and whether you stay overnight at a recovery center is based on many variables, including your medical issues, the amount of surgery you will undergo, the length of time your surgery takes, other procedures that may be performed at the same time, and the availability of your caregiver at home. Your board-certified plastic surgeon is your best guide. If you go home the same day, be sure to arrange for someone to drive you home after surgery and to stay with you for at least the first night following surgery.
What can I expect on the day of tummy-tuck surgery?
Your tummy-tuck surgery may be performed in an accredited hospital, a free-standing ambulatory facility or an office-based surgical suite. Your surgeon will give you an estimate of how long your surgery will last based on the details of your surgery.
· You will receive medications to keep you comfortable during the surgical procedure. Local anesthesia combined with sedation may be an option or you will receive general anesthesia. An anesthesiologist or nurse anesthetist will be present to administer sedatives or general anesthesia and assist in monitoring.
· For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
· Your plastic surgeon will follow the surgical plan discussed with you before surgery. Once the surgery has begun, he or she may decide to combine various techniques or change a technique to ensure the best result. It is important that you feel comfortable and trust your doctor to make these decisions.
· The surgical dressings used will depend on the procedures you undergo. Surgical drains may also be placed.
· After surgery, you will be taken into a recovery area, where you will continue to be closely monitored.
· Before leaving for home, you (or someone looking after you) should feel comfortable emptying and resetting your drains.
· You may go home on the day of surgery or spend one or two nights in an aftercare center with a nurse, unless you and your plastic surgeon have made other plans for your immediate postoperative recovery. * Under no circumstances will you be permitted to go home alone or stay home without another adult present. Follow your doctor’s recommendation in relation to this decision.
Your doctor will discuss how long it will be before you can return to your normal level of activity and work following liposuction. After surgery, you and your caregiver will receive detailed instructions about your postsurgical care, including information about:
· Drains, if they have been placed
· Normal symptoms you will experience
· Any potential signs of complications
You may expect the following immediately after the procedure:
· As the anesthesia wears off, you may feel dizzy, disoriented, and nauseated. These sensations should pass within a few hours, although some types of oral pain medications may cause these symptoms to recur.
· If you return home the same day, you will need someone to drive you. Depending on the extent of the procedure, you may be required to spend a night or two in the hospital recovering from surgery.
· Immediately following an abdominoplasty, expect your abdomen to feel very sore or tender. Any pain you feel can be controlled with pain medications.
· Most tummy tuck patients require several days of bed rest, even if they return home the same day as their surgery.
· Your incision site will be covered with a dressing to keep the area clean and protected. You will also be wearing a wide elastic compression garment to reduce swelling and provide support to the skin as it tightens. You will wear this garment for several weeks.
· Depending on the extent of your abdominoplasty, you may have tubes in your incision to drain away fluid. You will be asked to empty the drains a few times a day and keep track of how much fluid comes out. Drains are usually removed from three to fourteen days after your surgery, depending on how much fluid is coming out.
· If you have traditional sutures, these will typically be removed within the first week or two (absorbable sutures will not have to be removed).
· Your surgeon should provide you with detailed instructions for managing your drains, changing your bandages, and showering during recovery. You will also be told whether you can put any ointment on your incisions to reduce discomfort.
· Common side effects experienced by abdominoplasty patients include redness, bruising, and swelling. These effects usually subside in one to three weeks as your body adjusts to the new contours and the incisions heal.
Recovery time frame after a tummy tuck
Recovery from a tummy tuck procedure occurs over a period of six months or more. In the first couple of days, managing pain and avoiding complications is your top priority. The first week will be the worst, and you will still feel like you are recovering for about two to three weeks. After a few weeks, regaining mobility and fitness becomes important. After several months, you can start evaluating the aesthetic outcome of your surgery. It is important to remember that the time it takes to recover varies greatly among individuals.
· The first few days after surgery, you should rest quietly. Remember, you must not take aspirin or certain anti-inflammatory medications. To prevent coughing and bleeding, do not smoke after your procedure. Do not drink alcohol for five days after surgery or while you are taking pain medication.
· Arrange for someone to help you get around the house and help with your medication for at least the first two days after surgery.
· Make sure you continue to have lots of help at home—this cannot be stressed enough. You'll be tempted to try to help around the house, but you won't feel like yourself for at least seven to ten days and you still shouldn't do any heavy lifting (such as picking up your children or baskets of laundry) for four to six weeks. If you have small children, you must put someone else totally in charge of their care for at least two weeks.
· Follow your surgeon’s instructions carefully. The first two days are the most uncomfortable, so if you are instructed to take medications at certain times, stay on the schedule. Discomfort typically drops down to a "nagging" level by five to seven days.
· You will likely go back for follow-up with your surgeon within five days. During this visit, your doctor can remove the drains. Swelling should subside within five weeks.
· Call your surgeon immediately if you notice an increase in swelling, pain, redness, drainage, or bleeding in the surgical area, or if you develop fever, dizziness, nausea, or vomiting. Other red flags include shortness of breath, chest pains, and an unusual heartbeat.
· You should be up and walking the day after surgery, although slowly. It is important to walk to discourage swelling and to prevent blood clots in the legs. However, avoid strenuous exercise for four to six weeks, because it can trigger unnecessary fluid retention in the treated areas.
· Plan to take about two weeks off from work, depending on the physical demands of your job.
· Make an effort to ease back into your normal routine gradually rather than all at once.
· The recovery period is typically longest for patients undergoing a traditional abdominoplasty, rather than a mini-tummy tuck, and for those who are combining a tummy tuck with other surgical procedures.
· Wearing your compression garment as directed reduces the likelihood of loose or sagging skin after an abdominoplasty. The compression garment also helps to control swelling, resulting in a shorter recovery period.
How Long Will My Results Last?
Barring another pregnancy or significant weight gain, your results should be permanent, although plastic surgery will not prevent the effects of normal aging. Once the skin is tightened, it will get a little looser as you age, but not much. However, if you gain and then lose a large amount of weight after a tummy tuck, the abdominal skin could stretch out again, negatively impacting the overall contour. Likewise, if you become pregnant your abdomen will loosen again. For this reason, it is best to wait until after you finish having children to undergo a tummy tuck. If you’re planning to lose weight, do it before the surgery.
Maintain a relationship with your aesthetic plastic surgeon
For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you have any questions about your abdominoplasty healing and results.
The cost of a tummy tuck varies from doctor to doctor, from one geographic area to another, and with the techniques involved. Because abdominoplasty is elective surgery, insurance does not cover these costs. Many surgeons offer financing plans to make the procedure more affordable.
These numbers only reflect the physician/surgeon fees last year and do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments or other miscellaneous costs related to a tummy tuck.
Choose your surgeon based on quality, training and experience—not cost.
Fortunately, significant complications associated with tummy tucks are infrequent and the satisfaction rate is high. The overall complication rate is small if the operation is done by an experienced plastic surgeon operating in an accredited facility.
All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
· Adverse reaction to anesthesia
· Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
· Infection and bleeding
· Changes in skin sensation
· Scarring
· Allergic reactions
· Damage to underlying structures
· Unsatisfactory results that may necessitate additional procedures
You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your tummy-tuck surgery.
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