What You Need to Know About Tummy Tuck

Reviewed by Richard J. Greco, MD, FACS

You're the proud mother of two children and you're finally back to your pre-pregnancy weight. Unfortunately, the skin, muscles and fat in your abdominal region now sag. Or, maybe you've always wanted flatter abs, but no matter how many sit-ups you do, it's not happening.

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

Tummy tuck (abdominoplasty) is a highly invasive cosmetic plastic surgery procedure that flattens your abdomen by removing extra fat and skin and tightening the muscles in your abdominal wall. And contrary to what you may think, it's not reserved for women. Male tummy tuck surgery is on the rise.

The Tummy Tuck Procedure

Abdominoplasty is often performed with general anesthesia, but it can also be done using a local anesthetic with a sedative. Tummy tuck surgery takes about two to five hours.

The procedure 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. 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 may have been stretched apart by previous pregnancies. The rectus muscles are then stitched into their new position. 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 moved to its new location.


Preparing for Tummy Tuck Surgery

The first step toward 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, any allergies you have and whether you 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.

Once you have decided to undergo a tummy tuck, chosen a surgeon and scheduled your procedure, your doctor will give you a list of preoperative instructions. This will likely include routine blood work and a cardiac work-up if you have 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 and other nonsteroidal anti-inflammatory drugs as well as any medicines that thin your blood — all of which can increase bleeding risk.

Certain herbal remedies may also increase the risk of bleeding. 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 ginkgo biloba all may increase bleeding risk during and after tummy tuck surgery.

Make sure you tell your surgeon about EVERYTHING you are taking, and don't stop taking any medication abruptly without first speaking to your doctor.

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 quitting or reducing your smoking as much as you can before surgery. Ideally, one would stop for at least a month before and after the tummy tuck. Smoking can cause a delay in wound healing as well as skin necrosis (skin death).

Tummy Tuck Recovery

You will likely experience mild to moderate discomfort after your abdominoplasty, and you will require prescription pain medications for up to two weeks after your procedure. Your surgeon will tell you when it is OK to return to your normal activities. There will be some swelling and bruising, which will improve in about 10 days but will take months to subside entirely.

Tummy Tuck Risks

Like all surgeries, tummy tuck carries certain risks, including infection, anesthesia complications, hematoma (collection of blood under the skin that may clot) and seroma (collection of fluid under the skin). Risks can be minimized by choosing a qualified plastic surgeon and closely following his or her pre- and post-op instructions.

Tummy Tuck Alternatives

Today's tummy tucks can be personalized based on your needs. If you have loose abdominal muscles, sagging skin and excess fat, a complete tummy tuck will likely do the trick. If the problem is just loose skin, plastic surgeons can perform a "skin only" tummy tuck. This procedure gets rid of excess skin but leaves the muscles intact.

If you have a small roll of loose skin and some muscle bulge from having children, you may be a candidate for a procedure known as mini tummy tuck. This operation involves a smaller incision along your bikini line. The surgeon then tightens the muscle, allowing your belly button to "float down" slightly, and removes excess skin.

If the problem is excess fat alone, doctors can use liposuction. If you have weak ab muscles without loose skin, an endoscopic tummy tuck may be right for you. This procedure involves very small incisions above the pubic area or inside the belly button. A thin, flexible tube with a camera is inserted through the incisions, and tiny instruments are used to tighten the muscles.

It is important to note that tummy tuck is not a treatment for obesity. If you are overweight or obese, you may be asked to consider weight loss prior to undergoing tummy tuck. This may include diet and exercise or a referral to a bariatric surgeon if appropriate. Popular weight loss surgery procedures include Lapband surgery and gastric bypass.

If you have a significant amount of hanging skin (pannus), you may need a panniculectomy instead of a tummy tuck. This body contouring surgery is often an option after massive weight loss following bariatric surgery.

Consult a Qualified Plastic Surgeon for Your Tummy Tuck

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

Tummy Tuck Costs

Cost is likely one of the variables you will weigh when deciding whether to undergo abdominoplasty. Insurance companies typically do not cover elective cosmetic surgery procedures such as tummy tuck. Your insurer may cover a certain percentage if you have a hernia that will be corrected through the procedure or if the surgery is needed as a result of a pregnancy complication.