Changes in body shape resulting from weight gain or pregnancy can result in baggy and excess abdominal skin, stubborn fat, stretch marks, loose abdominal muscles, loss of tone and a bulging abdomen contour. An abdominoplasty creates a firmer, flatter belly and reverses those changes. A tummy tuck can help both women and men to correct a protruding and saggy abdomen. The result is a slimmer and tighter silhouette with reduced abdominal laxity. In some cases liposuction is recommended to additional remove excess fat in the surrounding areas and enhance the overall result.
Abdominoplasty addresses both the inside and the outside of the abdominal wall in a three dimensional procedure. The deep layers of your abdominal wall (often described as the core) are the rectus muscles (or 6-pack muscles) that are contained within a thick layer called fascia. Increasing abdominal contents either due to pregnancy or weight gain stretches the muscles pushing them apart and stretching the fascia. As a result, even when fat is lost the contour of the abdomen does not return. A tummy tuck addresses this problem by reconstructing the fascial layer and bringing the muscles back to their original position. A tummy tuck therefore restores the abdomen’s muscle structure and improves posture, strength, muscle tone and ergonomics.
Following weight loss excess skin and fat often persists in the lower abdomen. A tummy tuck removes this excess producing a taut and shapely abdominal contour. Baggy skin is lifted off the muscle layer and pulled taut so that skin lying above the belly button is re-draped down to the bottom of the abdomen and the belly button is relocated. Abdominoplasty therefore often permanently removes stretch marks that are below the navel.
What Are the Different Types of Abdominoplasty?
Your individual anatomy and personal preferences will determine the technique selected to smooth and flatten your abdomen. If an abdominal bulge or hernia is present, this is also routinely repaired in a standard abdominoplasty. The following are the different types that may be discussed.
The majority of patients seeking abdominoplasty will require a standard technique. A horizontal incision is made in the lower abdominal crease above the pubic hair, similar to a C-section incision but longer. The length of the incision depends on the amount of skin to be removed and whether liposuction will be added to the procedure. The final scar is designed to fall within underwear and swimming costume lines and can be tailored to suit your body. The procedure separates the skin and fat from the underlying muscle layer. The abdominal wall is sutured in the midline to repair the muscles and put them back to their original position from your breastbone to the pubic bone. Excess skin and fat is removed from the abdomen removing stretch marks that lie between the belly button and pubis and the remaining abdominal skin is re-draped and pulled taut over the tightened muscles before an incision is made to re-create the belly button through. Standard abdominoplasty is the gold standard for abdominal body contouring and achieves all the goals of a tummy tuck.
Mini-abdominoplasty concentrates on the lower abdominal area below the belly button. It removes excess skin and fat from this area and upper abdominal skin, fat or bulge are not addressed. The scar is typically the same or slightly shorter than a standard abdominoplasty and as the belly button is not relocated there is no scar around it. Mini-abdominoplasty is suitable for those with a small amount of excess in the lower abdomen. Most women seeking rejuvenation of their tummies after pregnancy will require a traditional tummy tuck to ensure the best aesthetic results.
Patients requesting abdominoplasty following massive weight loss often require a vertical abdominoplasty to addresses the excess skin in both a horizontal and a vertical direction. In addition to the lower abdominal horizontal incision, there is also a vertical scar that extends up from the horizontal scar to above the belly button. The skin is tightened and re-draped to improve the contour both anteriorly and at the side of the abdomen.
Lower Total Body Lift
Occasionally after massive weight loss the entire torso requires removal of excess skin and fat in order to achieve the desired contour. In these cases a lower body lift is recommended. The resulting scar is circumferential. In patients requiring this type of procedure the risk of complications such as delayed wound healing, wound breakdown and seroma is higher.
Who Is A Good Candidate?
You should be in good physical shape and at your target weight that is stable before embarking on abdominoplasty. Tummy tuck patients include men or ladies that have previously experienced weight gain and are now back at a healthy weight but whose abdomen protrudes out of proportion to the rest of their body. Requests for abdominoplasty commonly come from ladies that have completed their families and are dissatisfied with excess or sagging abdominal skin coupled with rectus diastasis, where their abdominal muscles have been separated and weakened by multiple pregnancies.
Patients that have experienced massive weight loss due to diet and exercise or following bariatric surgery may be candidates for a special type of vertical abdominoplasty or lower body lift providing you are otherwise healthy.
Who Is Not a Good Candidate?
Those with significant medical problems and smokers are not suitable. If you have not yet achieved your target weight you should delay surgery to achieve the best long-term effects. If you are planning to have more children you should consider waiting until you have completed your family. Those with unrealistic expectations or those who have been encouraged by others to change their appearance are not good candidates.
What To Expect During Your Consultation
At your initial consultation, I spend a great deal of time getting to know you personally and taking a full medical history. The success of any cosmetic procedure relies on you being open with me at this stage. It is important for me to explore your reasons for seeking abdominoplasty, what you dislike and your expectations of surgery. I also need to know about your general health, lifestyle and medications, prescribed or otherwise. I specifically need to know about previous operations (abdominal / hernias / bariatric).
I will examine your torso and assess what components are problematic and what can be done to address your concerns. At the end of that consultation I will describe the surgical options to address your problems and devise your personal surgical plan. I will also explain the risks and limitations of surgery to you at this stage. I always have a second consultation to answer any questions before we book surgery.
As a female Plastic Surgeon I have an intimate understanding of how a ladies’ feelings about her body can affect self-image and femininity. I want to work with ladies to achieve the desired outcome whether that is being able to fit back into your clothes, to improve your self-confidence or to simply have your pre-pregnancy body back. For men I offer a woman’s perspective on your concerns and aim to help you re-create the physique you desire.
Preparing for Abdominoplasty
You should be physically fit and at or close to your ideal weight which should be stable prior to embarking on abdominoplasty. Your health will be assessed pre-operatively and you may need some tests that will be arranged if required. You should stop aspirin, anti-inflammatory medications and any non-prescribed medication at least a week before surgery. If there is any change in your health prior to your surgery date you should let me know. Your health and general well being are my primary concern when I am treating you therefore if you are unwell for any reason it may be necessary to postpone surgery.
What to Expect on the Day of Surgery
You will need to come to hospital starved and ready for a general anaesthetic. Surgery generally takes one and a half to two hours, and an overnight stay may be required.
You will return to the ward around an hour after surgery and be encouraged to mobilise and eat and drink. You will feel swollen and bruised and you will be given appropriate painkillers. It is unusual to require drains but you will be given a compressive dressing.
What to Expect After Surgery
You will go home with some compressive dressings and you should keep the wounds clean and dry for the first week. You will need someone to collect you and support you at home for the first few days. Some moderate discomfort is expected for a few days and you will be given oral pain medication for a week or two postoperatively. Short walks and deep breathing exercises are encouraged immediately after surgery to promote circulation in the legs and lungs. You will be reviewed in clinic at one-week post op and the dressings are changed. Numbness, bruising and overall tiredness is common for a few weeks after surgery.
You can return to light exercise at two weeks but should not do anything strenuous for 4 weeks, including picking up and carrying your children. Abdominal exercises should be avoided for 6 weeks and then you should build back up gradually. You should arrange to take a couple of weeks off work.
Once the scar has healed you can start to massage with a simple moisturiser. Bruising and swelling will start to settle over the first few weeks and you may find that one side settles more quickly than the other leaving you asymmetric (lopsided) whilst the other side catches up. This is perfectly normal and we will not start to see the final results for at least six weeks, sometimes longer. The scar will be red/pink initially and slowly fade over many months or years. It can take several months for all surgical swelling to subside and for the very final results to be evident.
Is a Tummy Tuck Part of a Mummy Makeover?
A tummy tuck is the most common part of a Mummy Makeover. Your abdominal (rectus) muscles are permanently separated after having children and exercises such as sit-ups will strengthen the muscles but not put them back where they started. Consequently even the thinnest of ladies can experience abdominal bulge after pregnancy. A tummy tuck will bring the abdominal muscles back together in the midline, and to recreate a flat belly and waist contour.
Is Liposuction Part of a Tummy Tuck?
I often recommend that liposuction be added to a tummy tuck to help contour the waist and remove excess fat from the upper and lower abdomen, flanks and pubic region, enhancing the final result. In some cases adjunctive liposuction can allow the abdominal scar to be shorter. Liposuction on its own will not address excess skin or stretch marks or tighten abdominal tone so is rarely an option for the post-pregnancy or post-weight loss individual.
Depending on your individual anatomy and aspirations, either abdominoplasty or liposuction (or both) may be recommended to achieve your specific goals.
Liposuction can be done on other body areas (outer or inner thighs, buttocks, arms, back rolls, neck) at the same time as a tummy-tuck to further compliment the procedure. Where appropriate this will be discussed with you.
What Are Potential Risks and Complications of Abdominoplasty Surgery?
When you are considering any type of surgery, you should be fully educated about potential risks and complications. Most patients are delighted with outcome of their procedure. Sensation usually changes following a full abdominoplasty. Although permanent numbness is uncommon, sensation can take a number of months to return. In addition to numbness, bruising and swelling are common. Uncommon complications include infection, haematoma, delayed healing, skin necrosis, skin loss, seroma (a collection of tissue fluid) and thickened scar. The scars will be red or pink for a number of months and often turn purple before they fade to a pale white line. Some patients develop abnormally thickened scars that may require additional treatment in the clinic. It is very unusual to have scars that require additional surgery. Complications of any general anaesthetic include potential cardiac or respiratory problems and blood clots in the leg (DVT or in the lung (PE).
In the long term the abdomen can become lax and the result can change with fluctuations in weight or further pregnancies.