Tummy Tuck Frequently Asked Questions
Understanding Tummy Tucks or Abdominoplasties
What exactly is a tummy tuck or abdominoplasty?
Women and men who have loose, excess skin in their abdomen can benefit from having the excess skin removed in an operation normally performed by a plastic surgeon known as a tummy tuck or abdominoplasty. It is a major surgical procedure in which your plastic surgeon removes skin and fat from the middle and lower abdomen and tightens loose abdominal muscles which may have been stretched by pregnancy, obesity, or other causes. By removing the skin and fat, the procedure will dramatically reduce a protruding abdomen and give a more normal look to your abdomen. The procedure can also improve the appearance of stretch marks because many can be removed by the surgery.
What's the difference between an abdominoplasty and a panniculectomy?
In an abdominoplasty, excess skin and fat are removed and the abdominal wall muscles are tightened. In a panniculectomy, only the pannus, the hanging folds of abdominal skin and fat on the front of your abdomen are removed. Frequently, larger quantities of skin and fat are removed in a panniculectomy than in an abdominoplasty.
Are there different kinds of abdominoplasties?
Yes. There are five principal types of abdominoplasties performed: traditional, circumferential, extended, mini, and endoscopic.
Traditional abdominoplasty
In traditional abdominoplasty, an incision is made from hip to hip along the bikini line. The skin is lifted off the abdominal wall up to the rib line. The navel is cut away from the tissue surrounding it so that it can be repositioned and stitched into a new location in the skin later. The abdominal wall muscles are then pulled together and sutured to give a more pleasing waistline. Finally, the overlying skin is pulled down, the navel hole is created, the navel is sewn in, and the overlying skin is sutured into place at the bikini line at the top of the pubic area. Normally, a temporary drain is placed to remove excess fluid from beneath the incision. All the incisions are then closed and covered with dressings. The surgery takes between 3 to 5 hours.
Circumferential abdominoplasty
A circumferential abdominoplasty is normally performed on patients who have lost massive amounts of weight, often after bariatric surgery. Often called a lower body lift, a circumferential abdominoplasty is more extensive and much more skin is removed than in a traditional or a mini–abdominoplasty. In this procedure, the surgeon cuts an incision around the entire circumference of the body at the waistline. Liposuction is used to remove excess fat from the surrounding areas. The abdominal muscles are then tightened and sutured and the navel is repositioned. The excess skin is cut away and the remaining skin is stretched and sutured together. The surgery takes 4 to 5 hours.
Extended abdominoplasty
Extended abdominoplasty is another option for massive weight loss patients.
The surgeon makes an incision across the stomach to the back of the hips. Liposuction is used to remove fat and achieve an attractive body contour. Excess skin is removed from the sides of the body and the muscles in the stomach and love handle areas are tightened and sewn together. The navel is then repositioned and the skin is sutured closed. The surgery takes 4 to 5 hours.
Mini–abdominoplasty
In a mini–tummy tuck, a horizontal incision is placed just within or above the pubic area. If the amount of loose skin is minimal and the fat is located below the navel, it may be possible to avoid an incision around the navel. If there is loose skin above the navel, however, the surgeon may make a second incision around the navel, but this technique does not involve cutting away and repositioning the navel. Although the length of the incision involved in this technique depends on the amount of skin that is to be removed, it is much smaller than the one created during traditional abdominoplasty surgery. Excess skin and fat are removed and the abdominal muscles are tightened before the overlying skin is pulled down and sutured. A mini–abdominoplasty is often combined with liposuction to remove additional fat. The surgery takes 2 to 3 hours.
Endoscopic abdominoplasty
An endoscopic abdominoplasty is a minimally invasive procedure used to remove smaller amounts of skin and fat. It can be used when there is only a mild degree of excess skin, fat, and muscle laxity. An endoscope, a camera device, is inserted through small holes in the pubic area and the navel to minimize and hide scarring, rather than creating a large incision. Excess fat is liposuctioned, the abdominal wall muscles are tightened and sutured together, and the incisions are then closed. Remember, though, an endoscopic abdominoplasty does not remove excess skin. The procedure takes 2 to 4 hours.
What are the benefits of a tummy tuck or abdominoplasty surgery?
Massive weight loss patients have loose skin that hangs in folds and creates hygiene and wound problems. Although there has been a substantial loss of weight, because there is so much hanging skin, a slim body contour cannot be achieved. An abdominoplasty can remove the large amounts of skin around the abdomen and give patients a more normal contour. For patients with smaller amounts of excess skin, as for example from pregnancies, a tummy tuck can tighten the abdomen and create a flatter and slimmer waistline.
Stretch marks can often be removed, particularly if they are located below the navel. For stretch marks that cannot be removed, their appearance can often be improved when the skin is pulled taut.
The abdominal muscles can separate at the waistline as a result of pregnancy, obesity, or age, and appear to sag. During a tummy tuck those muscles will be pulled together and sutured to give a slimmer appearance.
There is a high rate of satisfaction among tummy tuck patients. A survey of 200 patients showed improvement in symptoms among 95% of the patients, 86% were satisfied with the results of their surgery, and 86% would recommend it to a friend. Other studies have shown similar results.
It can improve the way your clothes fit, giving you improved self–confidence and a better appearance. It is important, however, to have realistic expectations about what can be achieved. We can make a big improvement, but we can't achieve perfection, the rest is up to you.
Will I have a flat tummy after a tummy tuck or abdominoplasty?
You will certainly have a flatter tummy and a slimmer profile, but the end result depends to a large extent on the patient's body, the amount of muscle separation and stretching that has occurred prior to surgery, and the extent to which the muscles relax after surgery. Every abdominoplasty is different. The doctor tightens the muscles as much as possible during the surgery, but some patients' muscles relax more after surgery than others. There will be a very big improvement, but some patients may not have an absolutely flat tummy. Remember, though, there is a high satisfaction rate among abdominoplasty patients.
Will my muscles be strengthened after a tummy tuck or abdominoplasty?
A tummy tuck is usually an aesthetic form of surgery. The muscles will be tightened up to give a better aesthetic appearance, but they will not be strengthened. For that you need to start an exercise program after you have healed and the doctor says that you can start or resume exercising. You should find exercise easier to do, though, once the folds of skin are no longer in the way and you can move more freely.
Can a tummy tuck or an abdominoplasty help me lose weight?
A tummy tuck is not a good way to lose weight. Normally, the weight of the skin that is removed is on the order of 1 to 5 pounds, although it can be as much as 10 pounds or more in extreme cases. Skin itself, although it may look like a lot of heavy material, does not weigh as much as some other types of tissue.
A patient's weight should be at their desired goal and stable for at least 3 months prior to surgery. The surgery will be easier for the patient to undergo and for the surgeon to perform.
I've lost a lot of weight so far, but I still have more to go. Can I have a tummy tuck or abdominoplasty now?
It is best to be at your ideal, target weight before having a tummy tuck, a weight you believe you can maintain without either losing or gaining weight. Your weight should be stable for at least three months prior to surgery. If you lose additional weight after your surgery, folds in the skin are likely to form again and you may want additional surgery to correct them. If you gain weight, you may find yourself needing additional surgery later to correct the same problems.
Dr. Pittman–Waller does not perform abdominoplasties on patients who have a body mass index, or BMI, greater than 30. In other words, you can be overweight, but not obese. The risk of surgical complications increases significantly for patients with a BMI over 30.
What is the body mass index or BMI anyway?
The body mass index, or BMI, is calculated by dividing your weight in kilograms by the square of your height in meters. It provides a rough guide to whether you are of normal weight, overweight, or obese. But it's not perfect. Some athletes who have 6% body fat will fall into the overweight or even obese category because of the weight of their muscle mass. At any rate, it's the best guide we have and you should be at 30 or below to have a safe abdominoplasty surgery.
I'd like to have a tummy tuck or abdominoplasty, but I may still want to have more children. Should I wait?
Future pregnancies will have a negative effect on the results of a tummy tuck or abdominoplasty. The primary reason for having an abdominoplasty is to remove loose or hanging skin. A future pregnancy will once again stretch your skin and undo the gains of your surgery. You would likely have to undergo a second abdominoplasty to recapture the improvements to your body's appearance. It's best to wait till you are sure you are finished having children.
How can I calculate my BMI?
We have a BMI calculator here on our website to help you keep track of your BMI. Click here to go to the BMI calculator.
Who are the best candidates for a tummy tuck or abdominoplasty?
The best candidates fall into the following categories below. All good candidates are in good health and have a body mass index, a BMI, of 30 or less.
- Women who have had one or more pregnancies that have stretched the skin around their abdomen and their abdominal muscles and who want to achieve a slimmer profile.
- Men and women who have lost a lot of weight, greater than 50 to 100 pounds and who have hanging folds of skin around the abdomen.
- Men and women in good health who have an abdomen that protrudes and is out of proportion to the rest of the body.
- Men and women who are in good health and have excess fatty tissue in the abdominal area.
- Older men and women who have sagging skin due to their age or weakened abdominal muscles.
- Men and women who have fat deposits in their abdomen that don't respond to diet or weight loss programs.
Above all, good candidates for abdominoplasties should have reasonable expectations about what plastic surgery can achieve. We can make a very big improvement, but maintaining the tight, flatter abdomen is up to you.
Who is not a good candidate for a tummy tuck or abdominoplasty?
- Men and women who do not have realistic expectations of what can be achieved.
- Men and women who have a BMI above 30. The surgical complication rate increases significantly for obese patients.
- Men and women who are not in good health.
- Men and women who plan to lose a significant amount of additional weight—20 pounds or more.
- Women who plan to have additional pregnancies. Muscles and skin that are tightened in an abdominoplasty can be stretched out again by a subsequent pregnancy.
- Men and women who will not stop smoking one month before surgery and one month after.
- Some men and women who have certain types of excess scarring—keloid or hypertrophic scarring—from previous surgery. You should discuss this situation with the doctor.
I am over 50 years old. Is it too late for me to have a tummy tuck or abdominoplasty?
General good health is important, not age.
Will financing cover the cost of a tummy tuck?
At Dr. Pittman–Waller's office, we work with several financing companies to provide financing for our patients' surgical procedures. Tummy tucks are normally eligible for financing.
Will insurance pay for my tummy tuck or abdominoplasty?
It depends. Insurance will generally pay for abdominoplasties if there is a medical reason for the surgery, not just an aesthetic reason. If, for example, you have developed a hernia, a spreading of the anterior muscles, or the folds of skin are causing rashes or wounds, then insurance may pay for it. Each company has its own rules and decisions are normally made on a case by case basis. The doctor will be happy to assess your situation and see whether there is a possibility that the insurance company will pay for it. Remember, though, it's the insurance company that makes the final decision and not the doctor or the office staff.
What happens in a tummy tuck or abdominoplasty?
As we have discussed above, there are five different kinds of tummy tucks or abdominoplasties. In a traditional abdominoplasty, the doctor will make an incision from hip to hip and cut the navel from its surrounding skin. She will cut away the excess skin, pull together the abdominal wall muscles, and suture them together. She normally does a small amount of liposuction to smooth the body contours, but she won't do a large amount because of the risk of surgical complications. The skin is then pulled down to the pubic line and a hole is made in the skin for the navel. The large incision is closed using special, barbed sutures and the navel is reattached to the skin and sutured in place. The procedure normally takes 3 to 5 hours and general anesthesia is used.
Can other surgical procedures be performed at the same time as a tummy tuck or abdominoplasty?
A limiting factor in performing additional procedures is the length of time of the surgery. If the surgery lasts too long, complications can arise.
Two additional procedures that can be considered, however, are a breast augmentation or a breast lift. A breast augmentation can be performed through the abdominal incision so that there are no visible scars on the breasts. An abdominoplasty together with a breast augmentation is often known as a "mommy makeover." Another common breast surgery that can be combined with a tummy tuck is a breast lift or mastopexy.
A conservative amount of liposuction can be done at the time of the tummy tuck or abdominoplasty, but not too much. It is very important that the blood supply to the area be preserved so the skin doesn't die. The surgery itself cuts many blood vessels and doing a lot of liposuction at the same time could seriously reduce the blood supply and cause skin necrosis, or cause the skin to die. The doctor will discuss with you what can be done and what can't be done and she will be happy to do as much as she feels is safe.
Other procedures like a hernia repair can often be performed together with a general surgeon at the same time as the abdominoplasty.
What sort of anesthesia is used during the tummy tuck or abdominoplasty?
Abdominoplasties are usually performed with general anesthesia. Dr. Virginia performs tummy tucks or abdominoplasties together with an anesthesiologist, a medical doctor trained in the administration of anesthesia, in order to reduce the risk of general anesthesia to the lowest level possible.
What kind of sutures does the doctor use for a tummy tuck or abdominoplasty?
Dr. Pittman–Waller prefers to use a new type of suture, a barbed absorbable suture manufactured by Quill. There is no need to have the suture removed at a later date as the body absorbs the suture over time. Because the suture is barbed, it is not necessary to tie knots during the surgery, so the length of time of the operation is shortened.
How bad is the scarring after a tummy tuck or abdominoplasty?
There is a trade off in abdominoplasties. Patients must accept a long scar in place of hanging folds of skin and fat. For patients who choose tummy tucks, they believe the trade off is worth the new body contour they will have.
Except for mini and endoscopic abdominoplasties, there is always a long, low scar from hipbone to hipbone, passing along the top of the pubic area, just above the hairline and normally a scar around the navel. Sometimes there is also a short vertical scar above the pubic area. The scars will fade and flatten with time, but they will always be there. A mini–tummy tuck will normally not have the scar around the navel and an endoscopic tummy tuck will have the least scarring of all—but it is only effective in tightening up the muscles and there is no removal of loose, hanging skin.
Within a few weeks of surgery, the scars begin to appear dark and thick. After a few months, the scars begin to mature. As they do, they flatten and fade in color.
If you smoke or have smoked, you have a greater chance of developing a thicker, ropier scar.
Is a tummy tuck or abdominoplasty painful?
Dr. Pittman–Waller takes special precautions to reduce or eliminate the amount of post–surgical pain associated with the abdominoplasty. She places an ON–Q pain pump during the operation and leaves it in place for the first three days after the surgery. The ON–Q has small catheters, little tubes that are attached under the skin through which a non–narcotic local anesthetic is continually pumped into the incision for three days. The anesthetic bathes the area and reduces the post–surgical pain during the time when it can be the worst. After three days, the ON–Q is removed and the remaining pain can be controlled with a combination of prescription and non–narcotic oral pain medicine like Tylenol. In sum, you should not feel excessive pain; it will be more of an ache or soreness. Only a few patients may find it necessary to take pain medication for two to three weeks after an abdominoplasty or tummy tuck to keep the discomfort under control. However, you may experience an occasional twinge, pain, or muscle spasm for as long as 2 to 3 months or even 4 to 5 months after surgery.
But remember, don't overdo it. Be sensible in the level of activity you engage in. Overdoing it can cause the pain to be worse for a day or two.
Are there risks associated with a tummy tuck or abdominoplasty?
There are risks associated with any surgery. There were 185,000 abdominoplasties performed in the US in 2007, so it is generally a safe procedure when done by a qualified plastic surgeon who is trained in body contouring. There is always a small percentage of risk, however, that a complication can occur. You can help reduce your chance of complications by following closely the doctor's advice.
Although rare, there are various complications that can occur, including postoperative blood clots, fat clots, infection, dead skin or necrosis, pooling of fluid or blood under the skin, or tearing of the wound. Infection can be treated with drainage and antibiotics and blood clots can be minimized by moving around as soon after surgery as possible. Poor healing may result in excessive scarring which could require a second operation to correct. The scar normally heals straight, but in some rare cases, the skin can be pulled so that the scar is not straight. Some patients bleed excessively and the doctor would need to take extra steps during the surgery to control the bleeding. Some people have an unexpected reaction to general anesthesia. Dr. Pittman–Waller always operates with an anesthesiologist, a medical doctor trained in administering anesthesia, in order to make sure the anesthesia is properly administered and the chance of a complication is minimized. In the most recent survey of some 500 plastic surgeons who had performed 7000 abdominoplasties, none reported any deaths due to abdominoplasty surgery. Older surveys have reported a few deaths, but the percentages were tiny, on the order of hundredths of a percent.
Smoking significantly increases the risk for complications, so if you smoke, you should stop a month before surgery and a month afterwards.
Do I really have to stop smoking if I want a tummy tuck or abdominoplasty surgery?
In a study of complications among abdominoplasty patients, almost 50% of smokers developed wound healing problems compared to 15% of non–smokers. In other words, smokers were more than three times as likely to develop wound healing problems as non–smokers. In addition, hospital stays were longer for smokers. Another study enrolled 84 tummy tuck patients. Post–operative infections occurred in 13 of the patients. All but one of them were smokers (PRS 121:305e).
Nicotine, carbon monoxide, and many other toxic tobacco by–products interfere with normal wound repair. Hormones that actually retard the production of new skin and wound repair may also be produced. Vasoconstriction, the constriction of blood vessels, reduces blood flow and oxygen delivery to the skin and extremities. Binding of toxins to hemoglobin in the blood further enhances this oxygen deficient state. Numerous cellular functions, critical to wound healing, are altered by the presence of tobacco by–products. Delayed healing, wound dehiscence or tearing, postoperative infections, and poor scarring are, therefore, at an increased risk of occurring in the patient who smokes tobacco (PRS 108:1064–1065).
The risks are too great to take. That is why Dr. Pittman–Waller asks that her patients stop smoking for 30 days prior to surgery and for 30 days afterwards.
Will I lose feeling in my tummy after an abdominoplasty or tummy tuck? Will it go numb?
Right after surgery, there is generally a temporary loss of feeling between the navel and the pubic area. As the body heals, the numbness will be replaced by a pins and needles sensation as the nerves heal, which indicates the healing is progressing properly. Most patients recover their normal feeling within 6 to 18 months, depending on the patient. Larger operations can leave patches of permanent numbness near the navel or the incision. In rare instances, some patients can be left with large areas of permanent numbness.
How much swelling is there after an abdominoplasty or tummy tuck?
Swelling varies with the size of the operation and the individual patient. The larger the operation, the more swelling there tends to be. A simple scar revision causes very little swelling while a major abdominoplasty will cause much more swelling. The doctor will put drains in place to help drain fluids from the body and you need to be sure to wear the abdominal binder after surgery to help reduce swelling. Most likely, there will be some swelling as there is after most surgeries.
What are dog ears? Do you always get them from a tummy tuck or abdominoplasty?
Dog ears occur where small amounts of tissue bunch up at the ends of the scar as the wound heals and the swelling subsides. Not everyone gets them, they occur in about 12% of patients. A minor surgical procedure in the office will correct them if they do occur.
Can my problems return after a tummy tuck or abdominoplasty?
The fat and folds cannot return unless you gain weight. The fat cells in the abdominal region that were removed are no longer there. However, there are still some fat cells in the abdomen that were not removed, so you can gain fat there. It's more likely that if you gain weight back, the fat will be more evenly distributed over the body. Pregnancy after surgery, of course, may cause many of the original problems to return.
There will be the normal changes associated with aging. The skin continues to grow and gravity continues to pull it down, so there will be some additional sagging with age as with all people. However, you will have a better body contour as you age than you would have had without the surgery.
You will minimize the possibility of problems returning if you manage your weight through a proper diet and regular exercise.
Can I have liposuction surgery instead a tummy tuck or abdominoplasty?
Liposuction removes fat, it does not remove loose skin. If you have tight skin and a moderate amount of fat, then you might want to consider liposuction. Those patients seeking a tummy tuck or an abdominoplasty usually have loose or hanging skin that they want removed. If your problem is removing fat, Dr. Pittman–Waller will be able to help you decide which procedure would work better for you.
Can exercise tighten my skin without an abdominoplasty?
Unfortunately, exercise won't tighten skin. It will certainly strengthen muscles and it might help tone and firm up your abdominal muscles so that they appear to be held in, but it won't remove loose or hanging skin. If you do a lot of exercise and build up your muscles in a particular area, it might help fill out your skin somewhat in that area. But there's no such thing as a spot exercise you can do to tighten loose or hanging skin. Only surgery can do that.
Will a tummy tuck or an abdominoplasty remove cellulite?
Cellulite is fatty deposits just under the skin that cause an uneven, dimpled, or rippled appearance of the skin. A tummy tuck or abdominoplasty will remove the skin and most of the fatty deposits from the area covered by the skin, but it is difficult to eliminate it entirely. There is no guaranteed way to control cellulite. Some patients have reported success in reducing cellulite through a weight loss program, but others have lost weight without affecting their cellulite.
Will a tummy tuck or an abdominoplasty remove stretch marks?
Stretch marks are caused when the underlying skin tissue is stretched to the point that it tears and causes minute scars in the skin. Stretch marks from pregnancy are often located in the lower abdomen, the area from which skin is removed in an abdominoplasty. Those stretch marks will certainly be removed along with the skin. Pulling the remaining skin tighter across the abdomen may help make any remaining stretch marks less noticeable.
How long do the results of tummy tucks or abdominoplasties last?
The length of time you maintain the benefits of your abdominoplasty is primarily determined by two factors: whether you maintain your weight and whether or not you have another pregnancy. Both factors will cause your skin to stretch out again and could necessitate additional surgery to correct. If you maintain your weight and don't have another pregnancy, you should be able to retain the results of your surgery for your lifetime—with the understanding that as you age, your body will undergo the normal effects of aging, which includes additional sagging of the skin.
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