Tummy tuck

Overview

A tummy tuck is a surgery to improve the shape and appearance of the stomach area, also called the abdomen. The medical name for a tummy tuck is abdominoplasty.

During a tummy tuck, a surgeon removes extra skin and fat from the abdomen. Connective tissue in the abdomen called fascia usually is tightened with stitches to narrow the waistline. This brings together the muscles that go down either side of the abdomen if the muscles have become separated. Then the extra skin is removed. The remaining skin is repositioned to create a flatter, more toned look. Liposuction often is done as a part of a tummy tuck to help contour the entire abdominal area.

You might choose to have a tummy tuck if you have extra fat or skin around your midsection. Or you might get this surgery if your stomach bulges due to separated abdominal muscles. That condition is called rectus diastasis, and it may cause low back pain. Sometimes, tightening the core muscles can improve low back pain along with boosting your body image.

Why it's done

There are many reasons you might have extra fat, loose skin or weakened connective tissue in your abdomen, including:

• Large changes in weight.
• Pregnancy.
• Abdominal surgery such as a C-section.
• Aging.
• Your natural body type.

A tummy tuck can remove loose, excess skin and fat. It can repair rectus diastasis — a condition where the stomach bulges due to separated abdominal muscles. The surgery also can tighten weak connective tissue in the abdomen called fascia. A tummy tuck may remove stretch marks and extra skin in the lower abdomen below the belly button.

If you've had a C-section to give birth, your plastic surgeon may be able to remove the C-section scar. The surgeon makes the existing scar part of your new tummy tuck scar.

A tummy tuck can be done along with cosmetic surgeries that reshape other parts of the body. These are known as body contouring surgeries. They include breast surgery and removal of extra skin elsewhere on the body, such as the arms or thighs.

A tummy tuck isn't for everyone. Your plastic surgeon might caution against a tummy tuck if you:

• Plan to lose a large amount of weight.
• Are thinking about becoming pregnant in the future.
• Have a serious long-term condition such as heart disease or diabetes.
• Need to take blood-thinning medicines or are at high risk of blood clots.
• Have obesity, also known as a body mass index of 30 or higher.
• Smoke.
• Have had abdominal surgery that caused lots of scar tissue.

Risks

A tummy tuck poses various risks, including:

• Fluid buildup beneath the skin, also called seroma. Drainage tubes left in place after surgery can help lower the risk of too much fluid building up. Sometimes surgical techniques are used to help lower the risk of seroma and avoid the need for drains. Your plastic surgeon also might remove fluid after surgery using a needle and syringe.
• Poor wound healing. Sometimes areas where the surgeon made a cut, also called the incision line, heal poorly or start to come apart. You might be given antibiotics during and after surgery to prevent an infection.
• Scarring. The incision scar from a tummy tuck is lasting, but it's typically placed along the easily hidden swimsuit line. The length of the scar and how easy it is to see is different for each person.
• Tissue damage. During a tummy tuck, fatty tissue deep within the skin in the abdominal area might get damaged or die. Smoking raises the risk of tissue damage. Depending on the size of the area, the tissue might heal on its own or another surgery may be needed.
• Changes in skin sensation. A tummy tuck can affect nerves in the abdominal area. Less often, it can affect nerves in the upper thighs. You'll likely notice less feeling or loss of feeling in the areas where the nerves are affected. This usually gets better in the months after surgery.

Like any other major surgery, a tummy tuck also poses risks of:

• Bleeding.
• Pain.
• Infection.
• Bad reactions to anesthetics.

How you prepare

You talk with a plastic surgeon about a tummy tuck. During your first visit, your plastic surgeon will likely:

• Review your medical history. Be prepared to answer questions about current and past health conditions. Talk about any medicines you're taking or have taken recently. Also mention any surgeries you've had.

  Tell the plastic surgeon if you're allergic to any medicines. If your reason for wanting a tummy tuck is related to weight loss, talk with the plastic surgeon about that. The surgeon likely will ask detailed questions about your weight gain and loss.

• Do a physical exam. To help decide on your options, the plastic surgeon examines your abdomen. The surgeon also might take pictures of your abdomen for your medical record.
• Ask about your goals. Explain why you want a tummy tuck and how you'd like to look after the surgery. Make sure you understand the benefits and risks of the surgery, including scarring. Keep in mind that past abdominal surgery might limit your results.

Before a tummy tuck you also might need to:

• Stop smoking. Smoking lessens blood flow in the skin and can slow the healing process. Smoking also raises the risk of tissue damage. If you smoke, ask your plastic surgeon how long to stop smoking before surgery and during recovery.
• Not take certain medicines. You'll likely be told not to use aspirin, anti-inflammatory drugs and herbal supplements. These can increase bleeding.
• Stay at a stable weight. Ideally, you'll keep a stable weight for at least 6 to 12 months before having a tummy tuck. If you're very overweight, your plastic surgeon likely will recommend that you lose weight before the surgery. Losing lots of weight after the surgery can change your results.
• Arrange for help during recovery. Make plans for someone to drive you to and from surgery. This person should stay with you for at least the first night of your recovery at home.

What you can expect

A tummy tuck often is done in a hospital or a surgical center.

During

During a tummy tuck, your surgery team gives you medicines to prevent pain. Typically, you receive medicines called general anesthetics. These block pain and put you in a sleeplike state.

Plastic surgeons have various ways to do a tummy tuck. The method that's right for you depends on your goals and the extent of change that you'd like to see.

During a typical tummy tuck, a plastic surgeon removes most of the skin and fat between the belly button and pubic hair. Connective tissue called fascia that lies over the abdominal muscles is tightened with lasting stitches.

The amount of extra skin removed and the type of tummy tuck you have determine the shape and length of the incisions. The incision above the pubic hair is stitched together. It leaves a scar that falls along the natural crease within the swimsuit line.

The plastic surgeon also changes the position of the skin around the belly button. The belly button is brought out through a small incision and stitched in its regular position.

During the surgery you might be given an antibiotic to prevent infection.

Often, the surgery takes less than four hours.

After

After a tummy tuck, your surgery team likely will cover the incisions on your abdomen and belly button with surgical dressing. Small tubes might be placed along the incision site to drain any extra blood or fluid.

Members of your surgery team help you walk as early as the first day after a tummy tuck. Getting up to move lowers the risk of blood clots.

You'll likely be given pain medicine. It's common to have swelling in the surgical area.

Drains might be left in place for a few days after surgery. A member of your surgery team shows you how to empty and care for the drains. You might need to continue taking an antibiotic as long as the drains are in place.

Your surgeon also might prescribe a blood-thinning medicine for a short time after your tummy tuck.

You might wear a garment called an abdominal binder for about 6 to 8 weeks after your tummy tuck. This helps prevent fluid buildup and supports your abdomen while you heal. Your surgery team tells you how to care for your scar.

For the first six weeks after a tummy tuck, you'll likely need to be careful when moving around. Try to not lift, strain or do other strenuous tasks. Also try not to move in ways that strain the incision line, such as quickly bending at the waist. Straining might reopen the wound. Don't play any sports for at least eight weeks after surgery.

Many people who get tummy tucks can go back to work in about 2 to 4 weeks. But the exact timing depends on how physical your job is.

You'll likely need regular follow-up visits with your plastic surgeon. Ask how often you need to be seen.

Results

A tummy tuck can give your abdomen a more toned and slimmer look. The scar may take up to a year to fade as much as possible.

Tummy tuck results are usually long lasting if you stay at a stable weight.