One of the most popular procedures performed by Board Certified Plastic Surgeons is a Tummy Tuck, or abdominoplasty. This is a procedure that almost every plastic surgeon has performed. In fact, recent statistics from the American Society of Plastic Surgeons indicate that over 93% of plastic surgeons report that this is a procedure they routinely perform. This explains why about 200,000 tummy tucks performed each year in the United States. It is a very powerful procedure designed to transform the abdomen and torso.
What is a Tummy Tuck?
A tummy tuck is a procedure that addresses the abdominal skin, fat, and muscles in a one operation. This is why it is such a powerful procedure. The result is a firmer, flatter, and smoother abdomen.
Specifically, a tummy tuck includes:
- Removal of excess abdominal skin
- Tightening of loose or separated abdominal muscles
- Removal of excess fat with liposuction
- Rejuvenation of the belly button
Who is a Good Candidate for a Tummy Tuck?
A tummy tuck is so popular because it offers advantages for so many different people, all in different situations. A tummy tuck may be indicated for people who have lost weight, have skin changes associated with aging, or have abdominal changes from pregnancy
- Weight Changes
Commonly, weight changes results in laxity of the skin. Weight gain will stretch out the skin as the amount of underlying fat increases. Subsequent weight loss that reduces the underlying volume of fat can lead to loose skin, since the skin may remain stretched. It is true that skin can adjust to weight loss and tighten over time. However, the more significant the weight loss or the more rapid the weight loss, the less your skin will be able to tighten. Also, constant up-and-down in weight that constantly occurs with people will likely lead to more loose skin as the elasticity is decreased. After loss, it is common to have a section of hanging skin along the waistline. Think of this like a rubber band. Continuous stretching of the rubber band will eventually lead to its loss of elasticity. The skin acts in a similar way. During a tummy tuck after weight loss, the excess skin is removed. This is not always accompanied by internal muscle repair or liposuction, since these may not be needed.
Aging causes many changes within the skin of the entire body. Advancing age often causes loss of collagen and disruption of elasticity. This is why people get saggy skin as they age. The skin of the face begins to be wrinkled and sags, as does the skin of the body. So, aging will cause the abdominal skin to become loose, and wrinkled which is removed during a tummy tuck. Also, aging affects how your body stores excess fat. As you get older, your body is more likely to store fat in places such as your abdomen and flanks. This is the result of hormonal changes, decreasing metabolism, and decreased activity associated with the normal aging process. This excess fat can be addressed by performing liposuction during your tummy tuck.
Pregnancy is the most common reason why people desire a tummy tuck. There are so many changes that occur within the body during pregnancy. These changes are basically a combination of those described above. The stretching of the skin that happens with a growing baby, plus the rapid loss of volume when the baby is born, results is skin laxity similar to that seen with a rapid weight loss. There are hormonal changes that make the skin thinner and more loose, as well as making stretch marks appear. Also, the weight gain associated with pregnancy can result in storage of excess fat in the abdomen and flanks.
One major change that is unique to pregnancy is abdominal muscle separation, or rectus muscle diasthasis. This is the separation of the abdominal muscles that occurs in the midline from the expansion of the growing baby. When the muscles separate in the middle, the abdominal wall does not work as well at holding in the contents of the abdomen (like the organs). This results in a round belly, oftentimes giving the appearance of still being pregnant. During a tummy tuck after pregnancy, these abdominal muscles are put back together with internal sutures. This muscle repair is one of the most powerful improvements a tummy tuck offers. If the muscles are separated, but a muscle repair is not performed, the abdomen will never be completely flat.
Determining what specific type of Tummy Tuck you need:
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. The reason for the changes in your abdomen is important in coming up with an appropriate surgical plan. 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. This will help your surgeon determine what specific type of tummy tuck you will require.
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. If there is separation of the abdominal muscles as described earlier, the muscles will be repaired using internal sutures. Carefully placed sutures are placed in the abdominal muscles, bring the muscles back to the midline. This 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.
If you are storing excess fat in the abdomen and sides, liposuction is often performed. It may be true that you don’t have any excess fat and your issue is 100% excess skin. If this is the case, then liposuction would be an unnecessary part of your tummy tuck.
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.
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 whether a tummy tuck is right for you, contact Board Certified Plastic Surgeon, Dr. Matthew Schulman.