One of the most popular procedures performed by Board Certified Plastic Surgeons is a Tummy Tuck, or abdominoplasty. There are almost 200,000 tummy tucks performed each year in the United States. This is a procedure performed by 93% of all Board Certified Plastic Surgeons. The reason for it’s popularity is how powerful it is at transforming the body and erase years off someone’s appearance.
What is a Tummy Tuck?
A tummy tuck is a procedure that addresses the abdomen and mid-section. It simultaneously addresses skin, fat, and muscles in a one operation. The result is a firmer, flatter, and smoother abdomen, Specifically, a tummy tuck includes:
- Removal of excess abdominal skin
- Tightening of lax or stretched abdominal muscles
- Removal of excess fat with liposuction
- Rejuvenation of the belly button
Who is a Good Candidate for a Tummy Tuck?
Because a tummy tuck addresses many aspects of the abdomen and mid-section, it is an operation appropriate for a variety of people. If you have skin that has been stretched out from weight fluctuations, aging, or pregnancy, a tummy tuck may be right for you. If you have a lot of stretch marks on your abdominal skin, a tummy tuck will help. If pregnancy has left you with separation of your abdominal muscles, called rectus diastasis, a tummy tuck will tighten those muscles with the use of carefully placed internal sutures. Because of the wide variety of things that this operation addresses, it can be appropriate for both women and men, young and old.
If any of the following applies to you, you may want to consider exploring a tummy tuck:
- Your abdomen sticks out despite diet and exercise
- Your belly has the appearance of you being pregnant
- There is loose of hanging skin from your belly
- Your skin has significant stretch marks
Preparation for Your Tummy Tuck
The first step is an evaluation by a Board Certified Plastic Surgeon, experienced in a tummy tuck procedure. During your evaluation, your surgeon will take your medical history and perform a physical examination. He or she will specifically examine your abdomen, looking carefully at the amount of excess skin, the quality of that skin, underlying muscle separation, and the presence of excess fat. Your surgeon will also examine you for any underlying hernias, or holes in the abdominal wall.
If you are an appropriate candidate for the procedure, your surgeon will discuss specific details about the anesthesia, recovery, and scars. He or she will also discuss the risks associated with this tummy tuck procedure. You will also be sent for medical clearance with your primary medical doctor. This will include a physical examination, bloodwork, and an EKG, along with any other tests required to make sure you are healthy enough to undergo the surgery.
Where is the Procedure Performed?
A tummy tuck is a surgical procedure that needs to be performed in an accredited ambulatory surgery center or hospital. These are regulated facilities with the appropriate safety standards and appropriately trained staff. The procedure is usually performed on an out-patient basis, meaning, you are able to go home the same day. In situations where other procedures are being done at the same time, you may be required to stay overnight for monitoring.
- The Anesthesia
The procedure is performed under intravenous sedation or general anesthesia. This anesthesia is administered by a Board Certified Anesthesiologist and you will be monitored the entire time. You breathing and heart rate will be monitored, as well as your oxygen level.
- The Incision
A tummy tuck is performed using a low incision the curves beneath your underwear of bikini line. This incision is used to lift up the skin and expose the muscles of the abdominal wall. The incision also allows removal of the excess skin. A lot of effort is made to keep this incision well hidden beneath clothes, since the incision is what creates the scar. During your pre-operative visit, your Plastic Surgeon may ask you to bring in underwear and bikini bottoms. This helps to determine the best placement of the incision, since modifications of the incision can be made depending the type of clothes you prefer to wear.
The length of the incision, and ultimate scar, will depend on the amount and distribution of excess skin. If your excess skin is mostly in the front of your abdomen, you may require a shorter incision than if you had extra skin more on the sides by your flanks. Of course, everyone prefers a short scar, but the shorter the incision, the less skin that can be removed. There is a balance. Your surgeon will draw the planned incision on you so you can visualize where the scar will be located and how long it will be.
- Repairing the Muscles
After the incision is made, the skin of the abdominal wall is lifted. This exposes the underlying muscles. Very commonly after pregnancy, aging, and weight fluctuations, the abdominal muscles separate in the midline. This is called a rectus muscle diastasis and can make the abdomen appear to bulge outward. The muscles are normally responsible for keeping a flat, tight abdomen, but when they are separated, they cannot hold back the internal organs. This can give the appearance of being bloated and pregnant.
Carefully placed sutures are placed in the abdominal muscles, bring the muscles back to the midline. This is the most powerful part of a tummy tuck and serves as an internal corset, flattening the belly and narrowing the waistline. This muscle tightening, or plication, is done all the way form the breast bone to the pubic bone.
- Removing the Skin
After the muscles are tightening, the skin of the abdominal wall will be pulled downward. The excess skin will be marked and then cut off. Usually all the skin between the initial incision and the top of the belly is removed. Any stretch marks on this skin is also removed. Multiple layers of sutures will be placed connecting the remaining skin back together, resulting in a low, smooth scar.
- The Belly Button
Up to this point, the belly button was left attached to the abdominal wall. The next step is to bring your old belly button out through a new opening. The location of your belly button is marked and a small opening is made. The belly button is then brought through this opening and secured in place with meticulous sutures. The creation of the belly button is a critical step in your tummy tuck, since it is essentially the only scar anyone will see. Overly large or overly round belly buttons tend to appear “surgical” and are a tell-tale sign of a tummy tuck. The ideal belly button tends to be a vertically-oriented oval belly button that is not too large.
In a well-crafted tummy tuck, liposuction is the icing on the cake. It allows the surgeon to perform the final contours. Specifically, any residual fat can be removed. Usually, liposuction is done on the flanks, bra rolls, and upper abdomen. Careful grooves can be made in the midline, creating highlights that accentuate the natural contours of the underlying muscles.
After a few hours in the recovery room, you will be allowed to go home with your escort. You will have pain medication and antibiotics. The first few days is usually the worst, since you will be “hunched over” and in pain, but it will be manageable. After about a week, most people feel better, but not great. You should plan on having help at home for a few weeks. You are encouraged to walk throughout this process to promote good circulation. While everyone is different, most patients will require about 3 weeks off from work and 6 weeks off from heavy exercise.
Scars never go away, but they will fade. Special care is taken during your surgery to promote good healing and the best possible scar. However, everyone’s skin is different and creates different scars. Some scars are thin and flat, while others are raised and dark. Your Board Certified Plastic Surgeon should be able to assess your skin before surgery in order to determine the types of scar you are likely to produce. In general, the darker the skin, the higher the possibility of thick and dark scars. If you have a history of making “bad” scars, be sure to let your surgeon know about that so proper precautions can be made. There are some things that can be done after the surgery to help your body create better scars These include the early use of silicone scar gels or tapes, and laser treatments. Your scar will continue to evolve over the next 9-12 months. During this time, you should limit the exposure to the sun since UV rays can make the scar appear more red and irritated.
Combining a Tummy Tuck with Other Procedures
It is very common to combine a tummy tuck with other procedures. Most commonly, tummy tucks are combined with breast implants, breast lifts, or breast reductions. This is because breasts, like the abdomen, are very susceptible to changes associated with aging, weight fluctuations and pregnancies. Breast and tummy procedures combine well together and can be performed in a single operation, assuming you are healthy. Combining multiple procedures together is commonly called a Mommy Makeover. Other procedures commonly combined with a tummy tuck include a Brazilian Butt Lift, where your own fat is used to increase the size and improve the shape of your butt and hips.
If you would like to learn more about slimming your abdomen and gaining back the confidence, contact Board Certified Plastic Surgeon, Dr. Matthew Schulman. During your consultation, you can find out if a tummy tuck is right for you.