A flabby abdomen is caused not only by the accumulation of fat, but also by the poor elasticity of the skin, excess skin, and the stretching of the inner girdle of connective tissue (abdominal fascia) and abdominal muscles that extends from the ribs to the pubic bone. This inner girdle, which holds the internal organs in place, is responsible for the tone and appearance of the abdomen.
Your abdomen is more likely to protrude after your abdominal fascia has been stretched during pregnancy or significant changes in your weight. A tummy tuck can remove loose, excess skin and fat, and tighten weak fascia. A tummy tuck can also remove stretch marks and excess skin in the lower abdomen below the bellybutton. However, a tummy tuck won't correct stretch marks outside of this area.
You might consider a tummy tuck if:
- You have excess skin that's accumulated around the area of your bellybutton
- You have a weak lower abdominal wall
- Liposuction didn't adequately improve the appearance of your abdomen
- You previously had a C-section and have retracted scarring
If you've previously had a C-section, your plastic surgeon might be able to incorporate your existing C-section scar into your tummy tuck scar.
A tummy tuck can also be done in combination with other body contouring cosmetic procedures, such as a buttock lift (belt lipectomy).
A tummy tuck isn't for everyone. Your doctor might caution against a tummy tuck if you:
- Plan to lose a significant amount of weight
- Might consider future pregnancy
- Have a severe chronic condition, such as heart disease, diabetes or irritable bowel syndrome
- Have a body mass index that's greater than 40
A tummy tuck poses various risks, including:
- Fluid accumulation beneath the skin (seroma). Drainage tubes left in place after surgery can help reduce the risk of seroma. Your doctor might also remove fluid after surgery using a needle and syringe.
- Poor wound healing. Sometimes areas along the incision line heal poorly or begin to separate. You might be given antibiotics during and after surgery to prevent a resulting infection.
- Scarring. The incision scar from a tummy tuck is permanent, but is placed along the easily hidden bikini line. The length and visibility of the scar will vary from person to person.
- Tissue necrosis. During a tummy tuck, fatty tissue deep within your skin in the abdominal area might get damaged or die. Smoking increases the risk of tissue necrosis. Depending on the size of the area, skin might heal on its own within weeks or require a surgical touch-up procedure.
- Changes in skin sensation. During a tummy tuck, the repositioning of your abdominal tissues can affect superficial sensory nerves in the abdominal area, and infrequently, in the upper thighs. You'll likely feel some reduced sensation or numbness. This usually diminishes in the months following the procedure.
Like any other type of major surgery, a tummy tuck poses a risk of bleeding, infection and an adverse reaction to anesthesia
Initially, you'll talk to 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 medical conditions. Talk about any medications you're taking or have taken recently, as well as any surgeries you've had. Tell your doctor if you are allergic to any medications. If your desire for a tummy tuck is related to weight loss, your doctor will likely ask detailed questions about your weight gain and loss.
- Do a physical exam. To determine your treatment options, the doctor will examine your abdomen. The doctor might also take pictures of your abdomen for your medical record.
- Discuss your expectations. Explain why you want a tummy tuck, and what you're hoping for in terms of appearance after the procedure. Make sure you understand the benefits and risks, including scarring. Keep in mind that previous abdominal surgery might limit your results.
Before a tummy tuck you might also need to:
- Stop smoking. Smoking decreases blood flow in the skin and can slow the healing process. In addition, smoking increases the risk of tissue damage. If you smoke, your doctor will recommend that you stop smoking before surgery and during recovery.
- Avoid certain medications. You'll likely need to avoid taking aspirin, anti-inflammatory drugs and herbal supplements, which can increase bleeding.
- Maintain a stable weight. Ideally, you'll maintain a stable weight for at least three months before having a tummy tuck. If you're severely overweight, your doctor will recommend that you lose weight before the procedure. Significant weight loss after the procedure can diminish your results.
- Take medication to prevent complications. Shortly before your tummy tuck, you'll need to begin taking an anticoagulant to prevent blood clotting.
- Arrange for help during recovery. Make plans for someone to drive you home after you leave the hospital and stay with you for at least the first night of your recovery at home.
A tummy tuck is done in a hospital or an outpatient surgical facility. During a tummy tuck, you'll be asleep and comfortable with the aid of general anesthesia — which renders you unconscious. In some cases, you might be given an analgesic and be moderately sedated (partially asleep).
During the procedure
Your plastic surgeon will make incisions to remove most of the skin and fat between your bellybutton and pubic hair in a horizontal oval or elliptical shape. The fascia, which overlies the abdominal muscles, will be tightened with permanent sutures.
Your plastic surgeon will then reposition the skin around your bellybutton. Your bellybutton will be brought out through a small incision and sutured in its normal position. The incision from hip to hip above the pubic hair will be stitched together and will leave a scar that falls along the natural crease within the bikini line.
During the procedure you might be given an antibiotic to prevent infection.
The procedure typically takes about three hours.
After the procedure
After a tummy tuck, your abdominal incision and your bellybutton will likely be covered with surgical dressing. Small tubes might be placed along the incision site to drain any excess blood or fluid.
Your bed will be positioned to keep your upper body slightly raised and your knees at an angle for the first few days after surgery. Members of your health care team will also help you walk as early as the first day after a tummy tuck to help prevent the formation of blood clots.
You'll likely feel moderate pain, which will initially be controlled by intravenous pain medication. It's normal to have swelling in the surgical area for about six weeks. In some cases, swelling might take up to three months to resolve. Drains might be left in place for a week or two after surgery. Your doctor or a member of your health care team will show you how to empty and care for your drains. You might need to continue taking an antibiotic and anticoagulant for 10 days after your tummy tuck.
You'll wear a supportive abdominal garment (abdominal binder) for about six weeks after your tummy tuck. This will help prevent fluid buildup and provide abdominal support while you heal. Your doctor will explain how to care for your scar.
For the first three months after a tummy tuck, you'll need to take care when moving and avoid positions that strain your incision line — such as quickly bending at the waist — to prevent the re-opening of the wound. In addition, you'll need to schedule follow-up visits with your doctor for the next year.
By removing excess skin and fat and restoring your abdominal wall, a tummy tuck can give your abdomen a more toned appearance.
Tummy tuck results are usually long lasting. Keep in mind that maintaining a stable weight is crucial for retaining your results.