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Tummy Tuck (Abdominoplasty)

What is an Abdominoplasty (Tummy Tuck)?

Pregnancy and/or weight gain can result in baggy and excess abdominal skin, stubborn extra fat, stretch marks, stretched out abdominal muscles, loss of tone and a bulging abdomen contour. An abdominoplasty (a “tummy tuck”) creates a firmer, flatter belly and reverses the changes of pregnancy and/or weight gain. A tummy tuck can help women and men alike, correcting a protruding, saggy abdomen and creating a slimmer and tighter silhouette with reduced abdominal laxity. In some individuals, liposuction is added to additional remove excess fat deposits in the surrounding areas.

Abdominoplasty surgery in fact is three-dimensional surgery, addressing both the inside and the outside of the abdominal wall. In the deep layers, the foundation of the abdominal “core” is reconstructed by corseting the fascia overlying the abdominal muscles back together in the midline, known as “Rectus Plication”. A tummy tuck truly restores the abdomen’s muscle structure to improve posture, strength, muscle tone and ergonomics, decreasing waist diameter from the inside!

On the surface layers, a tummy tuck removes excess skin and fat from the lower abdomen, producing a taut and shapely abdominal contour. Baggy skin lying above the belly button is redraped over the reconstructed inner layers and the belly button is relocated. Abdominoplasty often permanently removes stretch marks, especially those located below the navel.

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Who is a Good Candidate for Abdominoplasty?

Good candidates for abdominoplasty surgery include individuals who are healthy, in good physical shape, and at their ideal body weight (or a stable weight following major weight loss). Please see our Preparing for Surgery section to learn more about optimizing your surgical experience.

Typical tummy tuck patients include Moms with excess or sagging abdominal skin after pregnancy, women or men whose abdomen protrudes out of proportion to the rest of their body, and individuals with “rectus diastasis”, where their abdominal muscles separated and weakened by multiple pregnancies or from weight gain. In this situation, there is splaying apart of the rectus abdominis muscles and effective loss of muscle tone.

Healthy and fit individuals following massive weight loss are also candidates for a special type of vertical abdominoplasty that can also involve a lower body lift.

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Is a Tummy Tuck Part of a Mommy Makeover?

A tummy tuck is often the very foundation of a Mommy Makeover! Because the muscles of the abdominal wall are permanently separated after having children (particularly after multiple children or twin pregnancies), a million sit-ups will not help to restore this anatomy. A tummy tuck and/or liposuction of the abdomen, flanks and pubic fat region is often recommended to bring the abdominal muscles back together in the midline, and to recreate a flat belly and waist contour.

Please see our Mommy Makeover section to learn about changes that commonly occur in the breasts, the tummy and other areas of your body after pregnancy, and about abdominoplasty as a component of a Mommy Makeover!

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What Are the Different Types of Abdominoplasty?

Traditional (Standard) Abdominoplasty

Most tummy tucks fall into the category of a traditional abdominoplasty. This procedure removes excess skin and fat from the abdomen, sutures the muscles of the abdominal wall back together in the midline, removes stretch marks that lie between the belly button or navel (“umbilicus”) and the pubic region, and addresses the entire abdominal wall from the xiphoid process below the sternum to the pubic bone. Abdominal skin is pulled downward and all excess skin and fat is removed. A small opening is made to bring the belly button through, allowing for smooth redraping of the abdominal skin downwards. Standard abdominoplasty is the gold standard for abdominal body contouring and achieves all the goals of a tummy tuck.

“Mini-Abdominoplasty”

A “mini-abdominoplasty” refers to a procedure that removes only a limited amount of abdominal skin in the lower area only. The navel is not relocated, and upper abdominal skin, fat or bulge are not addressed. The lower abdominal scar is typically the same or slightly shorter than a standard abdominoplasty. Most women seeking rejuvenation of their tummies after pregnancy require the traditional tummy tuck procedure to address recontouring of the entire abdominal wall and to ensure the best aesthetic results.

Vertical Abdominoplasty

Patients who have had massive weight loss are candidates for a vertical abdominoplasty. This procedure removes skin in a horizontal direction (standard abdominoplasty) and in a vertical direction (to decrease the abdominal circumference). An additional vertical scar extending upward from the low horizontal incision to above the belly button is required. Occasionally the entire torso is addressed by way of a lower body lift. The risk of complications such as wound healing difficulties and seroma can be higher for patients who are a candidate for these operations, based on details of previous weight loss surgery, the extent of excess hanging skin, ongoing dietary issues and/or nutritional deficits.

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What Really Happens During a Tummy Tuck?

Please see our Preparing for Surgery section to learn about what happens in the operating room on the day of surgery.

During a tummy tuck, a low horizontal incision is made in the lower abdominal crease above the pubic hair, similar to a C-section incision. The length of the incision depends on the amount of skin to be removed and whether liposuction will be added to the procedure (which often enables shortening of scars). The final scar is designed to fall within underwear and swim suit lines and can be tailored to suit your body and your wardrobe!

Excess skin and fat is permanently removed from the lower abdomen, creating a smoother, flatter abdominal contour. An incision around the navel allows for loose skin around the umbilicus to be pulled down and tightened as well. Internal corseting (“rectus plication”) of the separated abdominal muscles sutures them toward each other in midline to tighten the abdomen internally as well.

Individual factors and personal preferences will determine the specific technique selected to smooth and flatten your abdomen specifically. If an abdominal bulge or hernia is present, this is also routinely repaired in a standard abdominoplasty. Abdominoplasty generally takes 2-3 hours to complete, and an overnight stay is recommended.

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Is Liposuction Part of an Abdominoplasty Procedure?

Liposuction is often added to a tummy tuck to help contour the waist and additionally de-fat the upper and lower abdomen, flanks and pubic region, providing the very best shape to the tummy. When done in the hips and flank areas, liposuction often can enable shortening of the abdominal scar. Liposuction alone will not address excess skin or stretch marks, and will not help to tighten abdominal tone.

Depending on your particular situation, either abdominoplasty or liposuction (or both) may be recommended to achieve your specific goals. If liposuction is planned together with an abdominoplasty, it is usually done immediate after the tummy tuck to further contour these regions in one operation.

Liposuction can also 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. Your surgeon will examine these areas to determine whether liposuction is an appropriate addition to your procedure. Please see our Liposuction section for more information.

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What is the Recovery After Abdominoplasty?

Some moderate discomfort and swelling is expected for a few days following abdominoplasty surgery. 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. Please see our Postoperative Instructions section for additional information pertaining to recovery from an abdominoplasty.

Drains will be in place for a week or two after abdominoplasty surgery to remove wound fluid while healing and promote the flattest contour possible. Numbness, bruising and overall tiredness is common for 2-4 weeks after surgery. It can take 3 months up to a year for All surgical swelling to subside and for the very final results of a tummy tuck to be evident.

A tummy tuck is a major operation and has significant downtime and recovery. Approximately 6 weeks off exercise and heavy activities that raise heart rate or blood pressure (including carrying children and pets) is recommended. You will need to enlist help with some activities during the immediate postoperative period. Please see our Preparing for Surgery section to learn more about preparing for your tummy tuck.

Abdominoplasty is often combined with liposuction or other breast procedures, and is a common component of a Mommy Makeover. However, a tummy tuck is not an alternative to weight loss and should be postponed if additional weight loss or other pregnancies are planned for the best possible results.

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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. Please see our Preparing for Surgery section to learn about risks and potential complications related to surgery and Postoperative Instructions for additional information pertaining specifically to abdominoplasty.

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Please click here to see before and after abdominoplasty (tummy tuck) results!

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As women Plastic Surgeons, we intimately understand how a woman’s feelings about her body can influence her self-image, self-esteem and her femininity, and we aim to give you the result you are looking for! At your abdominoplasty consultation, your surgeon will spend a great deal of time with you to get to know you personally and take a complete medical history. We will explore your reasons for seeking a tummy tuck, examine your abdomen, and if you are an appropriate candidate for surgery, your options will be described in detail.

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Dr. Karen M. Horton, M.D. - Plastic Surgery, Physicians & Surgeons - Medical-M.D., San Francisco, CA