Tummy tuck (abdominoplasty): Better abs through surgery

Regular abdominoplasty usually requires general anaesthesia and lasts between two and five hours. The surgeon makes a horizontal incision just above the pubic bone, curving up at the sides to the hip joints. Another incision may be made around the belly button. The skin is lifted up, the underlying muscle repositioned and tightened, the skin is then pulled down over the flatter tummy, with a new opening made in the skin to accommodate the belly button. The surgeon may then cut off excess skin and fat, and will close the incisions. The surgeon would usually insert drain tubes in the wounds for 2-7 days for better evacuation of fluids.

Tummy tucks come in several different kinds - from the minimally invasive endoscopic and mini abdominoplasty to much more extensive circumferential abdominoplasty (removing excess skin and fat from the flanks, the infamous love-handles, in addition to the conventional frontal tummy tuck). Mini abdominoplasty affects only the lower abdomen and requires only one horizontal incision. Endoscopic abdominoplasty requires a series of small incisions for tightening the muscle and does not involve removal of any skin or fat. In many cases, you may have to stay in hospital for at least one night.

Is tummy tuck (abdominoplasty) right for me?

Tummy tucks (especially the more extensive kinds) are major surgery, with long recovery and significant risk and cost. A standard tummy tuck can cost approximately $5,000 - $10,000 (including anaesthesia, facility, and other associated fees) depending on the region and the surgeon. As an elective procedure, it is rarely if ever covered by insurance (there may be some rare exceptions), but financing plans may be available. So you should consider it very carefully and discuss your options with the abdominoplasty surgeon. A tummy tuck could be right for you if you are:

• generally healthy and fit;
• a non-smoker;
• close to your desired body weight before your tummy tuck;
• not planning any future pregnancies; and
• serious about not gaining weight in the future

Just like most other invasive surgery, a tummy tuck can be a major shock for your body, and healing can be slower and risk of complications higher if your blood vessels are constricted by smoking, starving your body tissues of oxygen essential for quick healing. If you are overweight, you should try to lose weight with diet and exercise first, and keep it down for several months before going ahead with a tummy tuck. And while future pregnancies and weight gain are not significantly more dangerous after a tummy tuck, they will likely undo its results and you may need a repeat abdominoplasty in the future.

Liposuction can be a less costly alternative but it removes fat only while excess skin, if any, remains. Endoscopic abdominoplasty is another relatively affordable alternative; it can tighten the muscle but again does not remove any excess skin. Mini abdominoplasty can remove both fat and excess skin, but only from the lower abdomen. Nonetheless, depending on your sitation, one of these alternatives may fit your specific needs quite well.

Recovery and results

Many patients stay overnight in hospital and have to take it very easy for several weeks. They should avoid taking showers while the drain tubes are in place (up to a week after surgery), and refrain from strenuous activity for up to six weeks. However, mild exercise - as simple as walking around the room - is a very good idea after the first couple of days because it prevents blood clots in leg veins and helps recovery. Keeping knees bent is also a good idea, because it helps avoid strain on the healing wounds. Pain will usually linger for several days, and patients will need painkillers. Patients should wear compression garments for several weeks to encourage healing. Skin sutures are removed after about 5-7 days; deeper stitches in the muscle should generally stay in place for 2-3 weeks. Bruising should subside after about four weeks, but swelling would remain for several months. Scars will look worse several months after the surgery, but will become less prominent within a year, and the best results should be evident by that time. The scars will never fade entirely, but their position makes them easy to hide under the bikini bottom. These are all normal effects of abdominoplasty; if you notice any additional effects or experience great discomfort, you should contact your surgeon or physician immediately.

The results of abdominoplasty - a flatter abdomen and tighter belly skin - are long-lasting but can be undone by another pregnancy or weight gain, and the surgery may have to be repeated.

Risks and complications

Risks include those usual for general anaesthesia and invasive surgery and include blood clots (a natural reaction to blood loss during surgery), hematoma, numbness due to nerve damage, infection, and complications affecting the heart and the lungs. Elastic stockings worn for several days after the operation reduce the risk of deep vein thrombosis, while breathing exercises help avoid problems with the lungs. Patients should monitor their condition closely and contact their doctor at the first sign of infection for an antibiotic prescription. In addition to health risks, aesthetic risks are also possible, although rare: asymmetry and belly button misalignment. About 30% of the patients develop complications, mostly minor. Complications are most common among obese patients (up to 80% incidence) but are also more common among smokers as well as individuals with diabetes and certain other pre-existing conditions. However, major complications occur in less than 1.5% of all cases. You can further reduce the risk of complications if you choose a qualified and experienced tummy tuck surgeon, and follow his advice and recommendations.

Bottom line

Tummy tuck (abdominoplasty) is an effective aesthetic procedure which can help create a trimmer, flatter belly. About 97% of tummy tucks are performed in women. Expectations should be realistic - you are likely to have an improvement, but that ideal body may still be out of reach. While the risk of serious complications is relatively low, a tummy tuck is an invasive surgery, recovery takes weeks, and the best results may come as much as 10-12 months later. And yet, tummy tuck is one of the five most popular plastic surgery procedures in the US, with the number of abdominoplasties tripling between 2001 and 2007 to nearly 150,000, with a majority of patients (more than 85%) happy about having gone through with it.