Tummy tuck

Overview

A tummy tuck — also known as abdominoplasty — is a cosmetic surgical procedure to improve the shape and appearance of the abdomen.

During a tummy tuck, excess skin and fat are removed from the abdomen. Connective tissue in the abdomen (fascia) usually is tightened with sutures as well. The remaining skin is then repositioned to create a more toned look.

You might choose to have a tummy tuck if you have excess fat or skin around the area of your bellybutton or a weak lower abdominal wall. A tummy tuck can also boost your body image.

Why it's done

There are a number of reasons you might have excess fat, poor elasticity of the skin or weakened connective tissue in your abdomen. These include:

• Significant changes in weight
• Pregnancy
• Abdominal surgery, such as a C-section
• Aging
• Your natural body type

A tummy tuck can remove loose, excess skin and fat, and tighten weak fascia. A tummy tuck may also remove stretch marks and excess skin in the lower abdomen below the bellybutton. However, a tummy tuck won't correct stretch marks outside of this area.

If you've previously had a C-section, your plastic surgeon might be able to incorporate your existing C-section scar into your tummy tuck scar.

A tummy tuck can also be done in combination with other body contouring cosmetic procedures, such as breast surgery. If you've had fat removed from your abdomen (liposuction), you may decide to have a tummy tuck because liposuction removes tissue just under the skin and fat but not any excess skin.

A tummy tuck isn't for everyone. Your doctor might caution against a tummy tuck if you:

• Plan to lose a significant amount of weight
• Might consider pregnancy in the future
• Have a severe chronic condition, such as heart disease or diabetes
• Have a body mass index that's greater than 30
• Smoke
• Have had a previous abdominal surgery that caused significant scar tissue

Risks

A tummy tuck poses various risks, including:

• Fluid accumulation beneath the skin (seroma). Drainage tubes left in place after surgery can help reduce the risk of excess fluid. Your doctor might also remove fluid after surgery using a needle and syringe.
• Poor wound healing. Sometimes areas along the incision line heal poorly or begin to separate. You might be given antibiotics during and after surgery to prevent an infection.
• Unexpected scarring. The incision scar from a tummy tuck is permanent, but it's typically placed along the easily hidden bikini line. The length and visibility of the scar varies from person to person.
• Tissue damage. During a tummy tuck, fatty tissue deep within your skin in the abdominal area might get damaged or die. Smoking increases the risk of tissue damage. Depending on the size of the area, tissue might heal on its own or require a surgical touch-up procedure.
• Changes in skin sensation. During a tummy tuck, the repositioning of your abdominal tissues can affect the nerves in the abdominal area, and infrequently, in the upper thighs. You'll likely feel some reduced sensation or numbness. This usually diminishes in the months after the procedure.

Like any other type of major surgery, a tummy tuck poses a risk of bleeding, infection and an adverse reaction to anesthesia.

How you prepare

You'll talk to a plastic surgeon about a tummy tuck. During your first visit, your plastic surgeon will likely:

• Review your medical history. Be prepared to answer questions about current and past medical conditions. Talk about any medications you're taking or have taken recently, as well as any surgeries you've had.

  Tell your doctor if you are allergic to any medications. If your desire for a tummy tuck is related to weight loss, your doctor will likely ask detailed questions about your weight gain and loss.

• Do a physical exam. To determine your treatment options, the doctor will examine your abdomen. The doctor might also take pictures of your abdomen for your medical record.
• Discuss your expectations. Explain why you want a tummy tuck, and what you're hoping for in terms of appearance after the procedure. Make sure you understand the benefits and risks of the procedure, including scarring. Keep in mind that previous abdominal surgery might limit your results.

Before a tummy tuck you might also need to:

• Stop smoking. Smoking decreases blood flow in the skin and can slow the healing process. In addition, smoking increases the risk of tissue damage. If you smoke, your doctor will recommend that you stop smoking before surgery and during recovery.
• Avoid certain medications. You'll likely need to avoid taking aspirin, anti-inflammatory drugs and herbal supplements, which can increase bleeding.
• Maintain a stable weight. Ideally, you'll maintain a stable weight for at least 12 months before having a tummy tuck. If you're severely overweight, your doctor will recommend that you lose weight before the procedure. Significant weight loss after the procedure can diminish your results.
• Arrange for help during recovery. Make plans for someone to drive you home after you leave the hospital and stay with you for at least the first night of your recovery at home.

What you can expect

A tummy tuck is done in a hospital or an outpatient surgical facility. During a tummy tuck, you'll be under general anesthesia — which makes you completely unconscious and unable to feel pain. In some cases, you might be given a pain-relieving medication and be moderately sedated (partially asleep).

Before the procedure

There are a number of different procedures for a tummy tuck, depending on your goals and the extent of change you would like to see. During the typical tummy tuck, your plastic surgeon makes incisions to remove most of the skin and fat between your bellybutton and pubic hair in a horizontal oval or elliptical shape. Connective tissue (fascia) that lies over the abdominal muscles is then tightened with permanent sutures.

The amount of excess skin removed and the type of procedure you have will determine the shape and length of the incision. The incision above the pubic hair will be stitched together and will leave a scar that falls along the natural crease within the bikini line.

Your plastic surgeon will also reposition the skin around your bellybutton. Your bellybutton will be brought out through a small incision and sutured in its normal position.

During the procedure you might be given an antibiotic to prevent infection.

The procedure typically takes about two to three hours.

After the procedure

After a tummy tuck, your abdominal incision and bellybutton will likely be covered with surgical dressing. Small tubes might be placed along the incision site to drain any excess blood or fluid.

Members of your health care team will help you walk as early as the first day after a tummy tuck to help prevent the formation of blood clots.

You'll likely be given pain medication. It's normal to have swelling in the surgical area.

Drains might be left in place for several days after surgery. Your doctor or another member of your health care team will show you how to empty and care for your drains. You might need to continue taking an antibiotic as long as the drains are in place.

Your surgeon might also prescribe a blood-thinning medication for a short time after your tummy tuck.

You'll wear a supportive abdominal garment (abdominal binder) for about six weeks after your tummy tuck. This helps prevent fluid buildup and provides abdominal support while you heal. Your doctor will explain how to care for your scar.

For the first six weeks after a tummy tuck, you'll need to be careful when moving around. You'll also need to avoid positions that strain your incision line — such as quickly bending at the waist — to prevent the reopening of the wound.

You'll need to schedule regular follow-up visits. Ask your doctor how often you need to be seen.

Results

By removing excess skin and fat and strengthening your abdominal wall, a tummy tuck can give your abdomen a more toned and slimmer appearance.

Tummy tuck results are usually long lasting if you maintain a stable weight.