What You Need to Know About Tummy Tuck

Reviewed by Richard J. Greco, MD, FACS

You're the proud mother of two children and are finally back to your pre-pregnancy weight. The only problem is that the skin, muscles and fat in your abdomen region sag. Or maybe you have always wanted flat, six-pack abs, and no matter how many sit-ups you do, it's just not happening.

Sound familiar? If so a tummy tuck may be an option. Dieting and exercise can tone the abdominal muscles, but they don't do much for that loose, sagging skin.

A tummy tuck (abdominoplasty) is a major cosmetic plastic surgery that flattens your abdomen by removing extra fat and skin, and tightening muscles in your abdominal wall.

The Tummy Tuck Procedure

Abdominoplasty is often performed with general anesthesia. It can also be done using a local anesthetic with a sedative. There may be some discomfort with local anesthesia. The tummy tuck surgery takes about two to five hours.

A tummy tuck usually begins with a relatively long incision across the abdomen, from hip bone to hip bone. The shape of the incision is like a smile, with a flat bottom. The flat part of the smile occurs at the bottom point of the abdomen immediately above the pubic area. The sides of the smile form a gentle curve along the pelvis up to the top of the hip bone. A second incision is made around the belly button to free it from the abdominal tissue.

The skin is separated from the abdominal wall, up to the ribs, exposing the vertical abdominal muscles (rectus muscles). These muscles have usually been stretched apart by previous pregnancies. The rectus muscles are then stitched into a new position, tightening the muscles and reducing the waistline. After the muscles have been repositioned and tightened, the excess skin is stretched and removed.

The remaining skin is redraped over the abdominal area and sutured in place. The belly button is then brought out through the overlying skin in its new location.

 

Preparing for Tummy Tuck Surgery

The first step to your new, flat belly is a consultation with a board-certified plastic surgeon. This evaluation will determine if you are a good candidate for a tummy tuck.

The surgeon will take a thorough medical history. He or she will review any medications that you are taking, whether you have any allergies or have had any prior surgeries or pregnancies. The surgeon will also perform a physical exam to measure the extent of excess fat and the degree of loose skin in your abdominal region.

He or she will also assess the condition of your abdominal muscles and skin tone while you are standing up and lying down. The surgeon will likely take some “before” photos during this consultation process.

Your expectations regarding the tummy tuck will also be discussed during this visit. Are you a candidate for a tummy tuck?

Once you have decided to undergo a tummy tuck, chosen a surgeon and scheduled your procedure, your doctor will give you a list of pre-operative instructions. This will likely include some lab testing such as routine blood work and a cardiac work-up if there is any history of heart disease.

In the two weeks leading up to your tummy tuck, your plastic surgeon will likely ask you to stop taking certain medications including aspirin, non-steroidal anti-inflammatory drugs (NSAID) and blood thinners, all of which can increase bleeding risk.

Certain herbal remedies may also increase bleeding risk. Just because a product or preparation is “all-natural” does not mean it is safe. For example, vitamin E, omega-3 fatty acids, green tea and gingko biloba all may increase bleeding risk during and after tummy tuck surgery.

Make sure you tell your surgeon about EVERYTHING that you are taking. But never stop taking any medication abruptly without first speaking to your doctor.

Your surgeon may also suggest that you add certain medications to your daily regimen in the days and weeks leading up to your tummy tuck such as 500 mg of vitamin C each day.

The pre-op instructions will also include a list of do's and don'ts about eating and drinking before your tummy tuck.

Most surgeons recommend that prospective patients kick the cigarette habit for the month before and the month after the tummy tuck. Smoking can cause a delay in wound healing and skin necrosis (death).

The good news is that many tools are available today to help smokers become ex-smokers.

Nicotine replacement products such as nicotine patches, nicotine gum and nicotine lozenges are available over-the-counter. A nicotine nasal spray and inhaler are currently available by prescription. These products can help relieve nicotine withdrawal symptoms.

Nicotine patches and or other nicotine replacement systems can't be used as smoking cessation aids immediately before or during surgery. They cause some of the same problems with wound healing as cigarette smoking. Tell your surgeon if you are using any nicotine replacement products.

Drugs such as buproprion SR (Zyban) and varenicline tartrate (Chantix) are non-nicotine pills that may help you quit smoking before a tummy tuck. Talk to your doctor about a prescription. Hypnotherapy or acupuncture may help some people quit smoking, too. Acupuncture involves placing extremely thin needles into the skin along specific acupuncture points to help curb the desire to smoke.

After Tummy Tuck Surgery

Tummy tuck is a major surgical procedure: you can expect a considerable recovery time compared with other plastic surgeries. Most people require one to three weeks before returning to work and a normal schedule. Some patients may not need an overnight hospital stay. Others may spend one or two days in the hospital, depending on the extent of the procedure.

Your abdomen will be swollen and sore for the first few days. Your surgeon can prescribe pain medication as needed. This typically entails narcotics for the first few days after surgery, and then non-narcotic pain relievers after that.

It is a good idea to exercise after surgery, but only after enough healing time has passed. Your surgeon will give you specific instructions on when you can exercise after your tummy tuck and what type of exercises are appropriate. As a general guideline, tummy tuck patients can start light to moderate activity after four weeks. After six to eight weeks, most people can resume all exercise and activity.

The abdominal scars will appear to worsen during the first three to six months. They may take nine months before they flatten and lighten in color. The scars never disappear completely, but clothing can hide them easily. Ask your surgeon if he or she recommends any creams or ointments to use after you've completely healed, to help with the scars.

People who have had tummy tucks should maintain their result, but they can have a second tummy tuck if they have children again. The good news is that even if you gain and lose a significant amount of weight, you will rarely need a secondary tummy tuck.

Tummy Tuck Risks

• Anesthesia risks
• Tissue loss
• Infection
• Collection of blood beneath the skin (hematoma)
• Collection of fluid under the skin (seroma)
• Blood clot to the lungs
• Aspiration pneumonia
• Bleeding under the skin flap
• Insufficient healing that may result in the need for a second surgery
• Death

These potential complications can be mitigated if you carefully follow your surgeon's pre- and post-surgery instructions, including quitting smoking. Note that these risks are higher in people with underlying medical conditions such as heart or lung disease, poor circulation or diabetes. In addition, people who have had another surgery recently in the abdominal region are at higher risk for complications.

Tummy Tuck Alternatives

The good news is that today's tummy tucks can be personalized based on your needs. If the problem is just loose skin, plastic surgeons can perform a “skin only” tummy tuck, which gets rid of excess skin, but leaves the muscles in-tact. If you have a small roll of loose skin and some muscle bulge from having children, you can have a smaller incision along your bikini line, have the muscle tightened, let your belly button “float down” slightly, and remove the extra skin. This operation is known as a mini tummy tuck. If the problem is excess fat alone, doctors can use liposuction it is weak ab muscles without loose skin, an endoscopic tummy tuck may be right for you. An endoscopic tummy tuck is performed using a small camera, called an endoscope, which is attached to small surgical instruments. It involves very small incisions that are easily concealed. The incisions are usually placed above the pubis or inside of the navel. The muscles are tightened and sutured through the incision. If you have loose ab muscles, loose skin, and excess fat, a complete tummy tuck will likely do the trick.

People who are obesity may be asked to consider weight loss first. This would include diet and exercise recommendations, and referral to a bariatric surgeon when appropriate. Popular weight loss surgery procedures include Lapband surgery and gastric bypass. In some rare cases, where patients have a significant amount of excess hanging skin, a patient may need a modification of the tummy tuck procedure called panniculectomy.

For less severe conditions, you may want to consider the less-invasive mini tummy tuck.

Consult a Qualified Plastic Surgeon for your Tummy Tuck

Before deciding on a tummy tuck, be sure to discuss treatment options with a board-certified plastic surgeon. Plastic surgeons should be certified by the American Board of Plastic Surgery. Such board certification ensures that your chosen surgeon has had extensive training and is up to date on new technology and techniques.

Tummy Tuck Costs

Considering a tummy tuck? Cost is likely one of the variables in your decision. Insurance companies typically do not cover elective, cosmetic surgery such as tummy tucks. Your carrier may cover a certain percentage if you have a hernia that will be corrected through the procedure, or if you have had surgery for weight loss. More on tummy tuck costs.

Related Topics

• Mommy makeover

[page updated May 26, 2010]