A standard tummy tuck involves removing a large transverse ellipse of excess skin on the lower abdomen extending from hip to hip horizontally and from the belly button down to the pubic area vertically. It also includes tightening the abdominal muscles in the midlne from the rib cage down tot he pubic area with stitches to create a flatter stomach. A small, circular incision is also made around the belly button so that it stays in place but is brought out through a new opening once the skin has been moved around it and tightened.
2. What is a mini-tummy tuck?
With a mini-tummy tuck, less skin is removed from the lower abdomen than what is removed with a standard tummy tuck and no incision is made around the belly button. Liposuction of the abdomen is normally performed first, which is not generally done with a standard tummy tuck and only the lower abdominal muscles below the umbilicus are tightened with a mini compared to a full tuck where the muscles are tightened from top to bottom. A mini-tummy tuck usually leaves a shorter scar that is typically lower on the abdomen than with a full tummy tuck.
3. How do I know if I need a standard tummy tuck or a mini-tummy tuck?
The decision between a standard tummy tuck and a mini-tummy tuck is made together with your qualified plastic surgeon. If you have a lot of extra skin along with stretch marks, you would probably be more of a candidate for a standard tummy tuck as a mini would not likely provide you with much benefit. Those with minimal extra skin, loose lower abdominal muscles and extra fat usually do better with a mini-tummy tuck. There are other variations as well and an experienced plastic surgeon should be able to discuss those options with you. Liposuction alone may also be an option for those with good skin and muscle tone and only extra fat.
4. How do I know if my surgeon is qualified to perform an Abdominoplasty?
There is no way to get a guarantee of results. You should, however, at least make sure that your surgeon has had adequate training. There are many physicians, some not even surgeons, masquerading as plastic surgeons with very little or no training at all in plastic surgery. Neither the internet nor the phone book care about the truth, honesty, training or credentials. They’ll let almost anyone advertise as a plastic surgeon! Make sure your surgeon is certified by the American Board of Plastic Surgery. It is the ONLY legitimate plastic surgery board. It is the only one that evaluates a surgeon’s prerequisite training, plastic surgery training, practice performance and requires passage of rigorous written and oral examinations. One way to find out if your surgeon is truly board certified is to see if he or she is a member of the American Society of Plastic Surgeons, Inc. (ASPS). All members of the ASPS are certified by the American Board of Plastic Surgery. Visit their website at www.plasticsurgery.org or call 1-888 4PLASTIC.
I would also recommend that you go one step further. To make sure that your surgeon specializes in aesthetic surgery and, therefore, is not only well trained, but is also very experienced, make sure that he or she is also a member of the American Society for Aesthetic Plastic Surgery (ASAPS). Surgeons that are members of ASAPS are all certified by the American Board of Plastic Surgery, members of ASPS, and have a practice that is dedicated to aesthetic surgery. You can visit their website at www.surgery.org.
Would you let a plumber do the electrical work on your house? Would you have a mechanic do your taxes? How about an orthopedic surgeon operate on your heart? Then why have an untrained physician, maybe not even a surgeon perform cosmetic surgery on you? If you wind up in someone’s office that doesn’t have the above credentials, don’t walk but run out of that office. And forget the consultation fee. They don’t deserve to be paid for trying to deceive you.
5. I had bariatric surgery (gastric stapling or gastric bypass) and have lost over 100 lbs so I have a tremendous amount of extra skin. Is there a special tummy tuck for me?
Patients who have lost a tremendous amount of weight, either through bariatric surgery or through diet and exercise, often have more extra skin than what a standard abdominoplasty will correct. In addition to extra skin up and down, they also have extra skin circumferentially around their trunk that may persist after a standard abdominoplasty. For them, an additional inverted “V” shaped wedge of skin taken from the rib cage down to the standard abdominoplasty incision can be removed. The down side, of course, is that an additional scar is left in the midline running down from the rib cage to the pubic area. Some patients who have had bariatric surgery already have a scar in that area anyway, so it’s just trading one scar for another. This is known as a fleur-de-lis tummy tuck.
Another option is to perform a belt dermatolipectomy, sometimes called a lower body lift or a circumferential abdominoplasty. In this procedure, excess skin and fat is removed from the lower abdomen, flanks and lower back just above the buttocks; it is a circumferential removal of excess tissue. The abdominal muscles are tightened just like in a standard abdominoplasty. The removal of skin on the flanks and back can provide a lift of the lateral thighs and buttocks.
Also refer to Body Contouring after Massive Weightloss
6. Are drains used with a tummy tuck, and if so, how long do they stay in?
Yes, typically two drains are put in for a standard tummy tuck and one with a mini-tummy tuck. This is to prevent the unwanted collection of fluid and blood from building up under the skin after surgery. During a tummy tuck procedure, a large raw surface is created in the abdominal wall over the top of the muscle in order to remove excess skin. This will initially ooze blood and, eventually, serum (blood without blood cells). If this is allowed to accumulate, the risk of infection increases, it delays the healing process and the fluid can be very uncomfortable. The drains are removed when the drainage slows down. I usually take out one drain 3-4 days after surgery and the other 3-4 days after that. Some fluid will accumulate after the drains are removed but not normally enough to cause a problem. For a lower body lift, there are also usually two drains in the back.
7. Should I try to lose weight prior to having a tummy tuck?
If you are significantly over weight, absolutely. The more weight you lose prior to surgery, the more skin can be removed and the better result you get. You don’t have to get down to your ideal weight, just reasonably close to it. Many times, those final 5-10 pounds are removed with the surgery. Some patients who have lost some weight but still have an extra 25-30 lbs have a dramatic improvement with their tummy tucks. Losing extra weight before surgery also reduces some of the risks of complications.
Check out our blog on Weightloss prior to Surgery
8. Can other procedures be performed at the same time as a tummy tuck?
Depending on your health, it is certainly possible to do other procedures under the same anesthetic. It is not uncommon to do some liposuction, a breast lift or put in breast implants at the same time as getting a tummy tuck. There is typically a significant cost savings in doing more than one procedure at the same time as opposed to doing them separately.
9. I've had several abdominal surgeries, can I still have a tummy tuck?
Fortunately, most abdominal surgeries do not preclude having an abdominoplasty. Some surgeries, such as the old gall bladder removal through an open incision, transect some of the blood supply to the abdominal skin. Since an abdominoplasty also transects some of the blood vessels to the abdominal skin, the combination can result in skin loss due to inadequate blood supply. A mini-abdominoplasty, however, could still be performed. Fortunately, most gall bladders are now removed with an endoscope, which does not interrupt the blood supply to the skin. In some cases, depending on the position and length of the scar, a full abdominoplasty can still be done with some modification to salvage critical blood vessels.
10. Do I have to quit smoking before having an Abdominoplasty?
Absolutely. Nicotine causes constriction of blood vessels which can result in skin death due to loss of blood supply when combined with a tummy tuck. Any procedure where the skin is undermined and pulled tight, such as a facelift, breast reduction, breast lift or tummy tuck, can result is skin loss if smokers don’t quit prior to surgery. Even secondary smoke can cause a serious problem. Smoking and secondary smoke must be strictly avoided for at least three weeks prior to surgery and for at least one month after surgery. This also includes nicotine patches, gum and e-cigarettes.
11. I’m thinking about having more children, but I really want to have a tummy tuck, what should I do?
It is strongly advised that you wait to have your tummy tuck until after you have had all of your children. An abdominoplasty is not a small or an inexpensive procedure. It is very likely that much of what you gained from your surgery would be lost with a subsequent pregnancy. There are those, however, who don’t plan to have children for a while who would like to get rid of extra skin from significant weight loss and would like to enjoy their new figure for several years before bearing children. It is then okay to proceed with having a tummy tuck and have children later. I have had many patients do this and have been pleasantly surprised as to how well their abdomens looked even after having children.
12. Is it possible to have your tubes tied at the same time as having a tummy tuck?
Yes. Arrangements can be made to have a gynecologist available to tie your tubes at the start of your tummy tuck. That may even provide you with some cost savings if the tubal ligation is covered by your insurance.
13. Is a catheter put in my bladder during a tummy tuck?
In my 27 years of experience and performing a lot of tummy tucks, I’ve had a few patients wind up in an emergency room or an urgent care because they were unable to empty their bladder the night of surgery even though they were able to void prior to leaving the surgery center. This can happen for a variety of reasons such as muscle pain, anesthetic effect, or tension on the urethra from tightening the skin. I now routinely have a nurse insert a catheter after anesthesia induction and recommend that you leave it in for two to three days until you are comfortable. It is very easy to take out yourself. The catheter eliminates this as a problem and can save you money and a lot of discomfort.
14. Other than the obvious improvement in appearance, are there any other benefits to a tummy tuck?
I have had several women who suffered from stress incontinence prior to their abdominoplasty tell me that it went away after their surgery. This may be because of the same reasons that some patients initially have difficulty voiding after a tummy tuck (see question 13). After obtaining IRB approval to perform research on this topic, I sent questionnaires to 250 of my tummy tuck patients obtaining 100 responses. Of those 100 patients fifty had preoperative stress incontinence and thirty of these (60%) and substantial or complete relief of their symptoms after their tummy tuck. This was published in The Aesthetic Surgery Journal in 2014 and remains the largest series published on this topic to date.
15. How much pain is there with a tummy tuck?
Pain, of course, is subjective and everyone responds differently to surgery. This is one of the more painful procedures that plastic surgeons do and still allow patients to go home. It has been shown in clinical studies that if you reduce a patient’s pain initially after surgery, they take much less pain medication in the long run. I spend several minutes at the start of the surgery and near the end, infiltrating the abdominal wall and the muscle with both long and short acting local anesthetics. This helps to numb up the area of surgery, so that when you wake up, rather than being in a lot of pain, most patients are pretty comfortable. This reduction in pain means that you need less anesthesia and fewer narcotics which are the primary cause of nausea after surgery. It also allows you to get out of the recovery room sooner, go home and get into a comfortable position where you can start taking your medications as needed. I also like to give my patients a muscle relaxant which cuts down on the pain medication that they need and it helps to reduce anxiety. I have actually several patients take nothing but Tylenol after a tummy tuck.
16. Is there much risk of infection with a tummy tuck?
There is a risk of infection with any operation. Fortunately, the risk with a tummy tuck is less than one percent and, when one does occur, it is usually a relatively minor problem. The drains that are inserted during a tummy tuck help to cut down the risk of infection as do antibiotics, which I prefer to put all of my patients on starting the day before surgery and continue them for several days after surgery.
17. How bad are the scars from a tummy tuck?
Although the scar from tummy tuck can be a relatively long scar, it is usually not a bad scar. I spend a lot of time meticulously placing many sutures under the skin to reduce spreading of the scar and to prevent marks from the stitches. All of the skin stitches that I put in are absorbable and are buried under the surface of the skin. I do not believe in using external staples instead of stitches to speed up a surgery. The scar around the belly button is usually a fairly fine line. Some patients have a tendency to form thick, hard scars regardless of how careful the surgeon is.
18. What is a “dog ear” and what can be done to prevent it?
A “dog ear” is a fold or pleat of skin that can occur at the end of a scar when skin is removed. In general, when removing skin, the shape of the skin removed is the shape of an ellipse with a length to width ratio of about 4:1. If it is less than this, a “dog ear” may develop. It is prevented by proper design of the incisions. If I see a “dog ear” start to develop when I am closing the incisions, I simply take out a little more skin.
19. Will my stretch marks be removed with a tummy tuck?
Most of the stretch marks between the belly button and the pubic area are removed with a standard tummy tuck. Those that start out above the belly button are frequently moved down below it and, therefore, may be less noticeable. Very few stretch marks are removed with a mini-tummy tuck.
20. How long does it take for the sensation in the skin to come back after a tummy tuck?
Much of the skin on the abdomen loses sensation initially after a tummy tuck, especially on the lower abdomen. The sensation gradually comes back over time but usually takes several months. It is possible to have some areas of permanent loss of sensation; however this is generally only a small area just above the middle of the scar. It is important to be careful with the skin after surgery to avoid any damage to it, much like how a dentist tells you not to bite your lip when it is numb. This means strictly avoiding heating pads to the skin on the stomach. You could cause a severe burn to the skin and not know it because the skin has very little, if any sensation. Heating pads should be avoided until all sensation returns.
21. How soon can I exercise after a tummy tuck?
Like most abdominal surgeries, if you try to perform strenuous activities or do heavy lifting too soon, you could tear out the stitches in the muscle and wind up with a hernia, or at least lose some of the benefit of the tummy tuck. There is a six week limitation on lifting more than 15-20 lbs or performing any strenuous activity after surgery.
22. What is the best position for me after my tummy tuck?
The most comfortable position for most patients after a tummy tuck is in a reclining chair so that you are slightly bent at the waist. After a full tummy tuck, most patients are not able to stand straight up or lay flat for about one week.
23. What type of anesthesia is used for a tummy tuck?
Most patients who have a tummy tuck have general anesthesia, however, it can also be done with epidural or spinal anesthesia. This can be discussed with the anesthesiologist prior to surgery.
24. Do you have to have the muscle repaired with a tummy tuck?
Most patients, particularly women who have had several children and anyone who has lost a lot of weight, benefit significantly from having a muscle repair resulting in a flatter stomach. Some patients, who work out extensively and have very tight abdominal muscles, can skip the muscle repair part of a tummy tuck and still get a very nice result.
25. I am having a cesarean section with my last pregnancy, is it possible to have a tummy tuck at the same time?
It is not recommended that you have a C-section and a tummy tuck at the same time. It would be very difficult to determine how much skin to remove and you have too much to deal with having a new baby; you don’t want to make your life more complicated by having elective surgery at the same time.
26. What can I do to reduce the risk of blood clots forming in my legs?
Blood clots can form in the large veins of the legs or pelvis following any surgery and their prevention is critical to a safe recovery. If you have a personal history or a family history of blood clots forming in the legs, you should inform your surgeon prior to surgery. The best prevention is to walk as soon as you can after surgery and move your feet and legs frequently while you are sitting or lying down. Your surgeon may recommend that you be placed on a blood thinner (not aspirin!) around the time of surgery. If you have pain in your legs or swelling in your ankles after surgery, you should notify your surgeon.
27. Can hernias be repaired at the same time as a tummy tuck?
I look for hernias at the time of you evaluation so that we can plan a repair at the time of surgery. These are generally covered by insurance and can reduce the cost of anesthesia and the facility a little if it is approved. When a more complicated hernia is present, we may make arrangements for a general surgeon to do the repair at the time of the tummy tuck. Sometimes small hernias are found during the procedure and these are repaired when the muscle is tightened.
28. What is a ‘Reverse’ tummy tuck?
In a reverse tummy tuck, the incision is made along the crease under the breasts rather than on the lower abdomen. The skin is elevated down to the belly button and no muscle repair is performed. The skin is pulled upwards rather than downwards and typically less skin is removed than with a standard abdominoplasty. This is done in patients who only have excess upper abdominal skin and don’t require muscle repair or in someone who has already had a tummy tuck or a fleur-de-lis tuck where the lower abdomen is tight but there is still loose skin above.
29. What is a panniculectomy?
A panniculectomy is a procedure where a fold of skin is removed from the lower abdomen. It does not include liposuction, muscle repair or translocation of the umbilicus. This procedure is sometimes covered by insurance. It can be done at the same time as a tummy tuck but the remainder of the surgery including anesthesia and the facility are paid as a cosmetic procedure by the patient.
30. What is an ‘Umbilical Float’ procedure?
Most patients who come in for a consultation for a tummy tuck are clearly better candidates for a standard tummy tuck or a mini procedure. Occasionally, a patient will have too much excess skin for a mini-tuck but not enough for a full abdominoplasty. These patients may benefit from a mini-abdominoplasty with an umbilical float; particularly if the have a relatively high position of their belly button to start with. In this surgery, the incision is more similar in position and length to a mini-tuck but the umbilicus is transected internally and is elevated with the abdominal skin with no external umbilical scar. The muscles are tightened starting 10-14 centimeters above the belly button, which is then pulled down a centimeter or two to take up some excess skin on the upper abdomen.
31. Will my insurance cover a tummy tuck?
Tummy tucks are virtually never covered by insurance. A panniculectomy may be covered by insurance and can be done as an isolated procedure or at the same time as a tummy tuck. In these cases, the patient is still responsible for the surgery, anesthesia and facility fees during the cosmetic portion of the procedure. Insurance will typically cover the cost of a hernia repair done at the same time as a tummy tuck but must be approved as a covered procedure prior to surgery.
32. What will my belly button look like after my tummy tuck?
I have seen many otherwise good abdominoplasty results ruined by a bad or large scar around the belly button. I believe that it is critical to look at the umbilicus in before and after photos when choosing your surgeon. It takes more time and effort to make a nice, natural looking umbilicus when performing an abdominoplasty and some surgeons just don’t feel like it is worth the time and effort. Others may simply not know how to do it. I like to spend that extra time to get the best result possible.
33. What are ‘Progressive Tension Sutures’ and are they necessary?
Progressive tension sutures (PTS) are stitches that are placed between the superficial fascia (Scarpa’s fascia) under the skin and the fascia on top of the muscle. These are placed to help tighten the skin pull downwards and to eliminate the potential space between the fat and muscle where fluid can accumulate. I believe that they are particularly helpful in preventing seroma formation and I prefer to take the extra time to put these in with all of my abdominoplasty procedures.
Do you have a question that hasn’t been answered? Please email me @ firstname.lastname@example.org and I will respond as soon as I can and may add it to my list of FAQ’s.
The answers to the above questions are my personal opinions based on years of legitimate general surgery and plastic surgery training and extensive experience in plastic surgery private practice. They are intended to give you, the patient, as much knowledge as possible in making your decision about plastic surgery and who performs that surgery. They are not intended to be derogatory or demeaning towards any individual physician or group of physicians. I firmly believe that physicians should only practice within their field of training and expertise, except in life-saving, emergency situations.
James D. McMahan, M.D., F.A.C.S.