Tummy Tuck Surgery: Everything You Need to Know
Abdominoplasty, or a tummy tuck, is a cosmetic procedure that tightens the abdomen’s appearance by surgically removing fat and skin, and (in most cases) improving the integrity of the abdominal muscles. This elective surgery is one of several some may consider when looking to slim their midsection, such as may be desired after significant weight loss. Results are not guaranteed to be long-term, but avoiding excess weight gain post-tummy tuck helps maintain a flat stomach.
What Is Tummy Tuck Surgery?
A tummy tuck surgery flattens the appearance of the abdomen by cutting away excess skin and fat and sewing the skin back together. The procedure might also include surgically fastening the underlying abdominal muscles to give the look and feel of a taut core.
This major surgery uses either a minimally invasive laparoscopic technique (with one or more small incisions and the assistance of a camera to visualize the structures) or a more extensive open method (involving one or more incisions that provide the surgeon with visibility and access to the abdominal fat and underlying muscles).
A complete abdominoplasty typically involves a large abdominal incision, extensive removal of fat and skin, and possibly the creation of a new belly button.1
A partial abdominoplasty may involve a smaller incision, less extensive tissue resection, and might not involve an incision around the belly button.2
A reverse tummy tuck is a partial abdominoplasty in which loose skin is removed from the upper portion of the abdomen. Sometimes partial abdominoplasty is used to remove skin and fat that’s only localized to the lower abdominal area.
When the paired rectus abdominis muscles that run down the front of the abdomen are separated, this is described as diastasis recti. These muscles can be sewn together to tighten the appearance of the stomach as part of a complete or partial tummy tuck procedure.3
You will need to have intravenous sedation or general anesthesia for any tummy tuck surgery.
Because a tummy tuck is cosmetic, most health plans don’t pay for this procedure.
You will be advised against having this procedure if you have a high risk of surgical complications. You may be at risk of post-surgical problems if you have a major chronic illness, a bleeding disorder, or an immune deficiency. Smoking is also associated with postoperative infections after tummy tuck surgery.4
Sometimes, issues like a major infection or newly detected kidney disease would entail postponing surgery until the health problem is under control, even if these problems are discovered on the day of surgery.
It’s important to know that anyone who anticipates significant weight gain or loss, or women who are planning to become pregnant, might experience skin, fat, or muscle changes that alter the cosmetic effects of abdominoplasty. So while the procedure is not prohibited in these individuals, it may not result in the desired outcome.5
A permanent post-surgical scar will be visible when you are completely undressed, but it should follow along with a natural crease that runs along the lower abdomen, along the pelvic bone. If you are very concerned about this, you may not want to have a tummy tuck. (Discuss the incision and potential scaring with your doctor in advance so you can make an informed decision in your case.)
In general, outcomes of this procedure are good and most people are satisfied with the results.6 Be aware that this surgery results in a scar along your lower abdomen.
That said, along with the usual risks associated with surgery and anesthesia, abdominoplasty can lead to additional post-operative problems.
You might develop health complications or an appearance that is different from what you expected or discussed with your doctor prior to your surgery.
Complications of abdominoplasty can include:7
Asymmetry of the shape of the abdomen
Severe scarring or discoloration of the skin
Numbness or pain in the surgical region
Unsatisfying cosmetic results
A complete procedure is more likely to cause complications than a partial procedure.1
Bad Plastic Surgery: The Complications and Realities
Purpose of Tummy Tuck Surgery
Abdominoplasty is done for purely aesthetic reasons: to have a flatter and more toned abdominal area. You might consider this surgery if your abdomen appears larger or when the skin is sagging, especially when it’s due to stretching.
You might have diminished tone and elasticity of your skin and muscles if you used to be overweight or if you gained and then lost significant weight with multiple pregnancies. Major weight loss, including after weight loss surgery, might result in extra skin that feels lax and flabby.
This procedure can improve your quality of life if it makes you more satisfied with your physical appearance, but it cannot improve your physical health.2
Abdominoplasty is not a replacement for diet and exercise and doesn’t result in substantial weight loss.
Tummy tuck surgery is not weight loss surgery. You might consider whether another type of surgery would be a better fit for you as you are deciding if you want to go ahead with abdominoplasty.
Other procedures your doctor may discuss with you include:
Liposuction involves the removal of fat without surgically remodeling skin or muscle, and it isn’t limited to the abdomen. Like tummy tuck surgery, liposuction is a cosmetic procedure.
Panniculectomy is a surgical procedure in which excess skin is removed from the abdominal area without surgical intervention to fat or muscle.
Bariatric surgery is a type of weight loss surgery that involves surgically restructuring the digestive system to prevent overeating and absorption of excess calories. It is typically done to prevent medical complications of obesity rather than for cosmetic reasons.
Questions to Ask Before Plastic Surgery
You will need some pre-operative testing to ensure that you can safely have this procedure, including preliminary lab evaluation such as including a complete blood count (CBC) and electrolyte tests, to evaluate for health problems.4
Additionally, your doctor might also do some other pre-operative tests to ensure that you can safely have an abdominoplasty if you have a pre-existing medical issue that puts you at risk of surgery, such as heart disease or pulmonary disease.
How to Prepare
Often, the decision to have a tummy tuck is a process that takes months or longer. You might try weight loss and exercise strategies before deciding to go ahead with this procedure to see if you can achieve the look you want without having to undergo surgery.
You will want to make sure that you are at a relatively stable weight before you schedule your abdominoplasty so you can maximize the benefits of the procedure.4
Your procedure will be done in a surgical suite or operating room at a hospital or a surgical center.
You will likely have to stay for at least one night after your procedure. If you are having a less invasive or partial procedure, you might be able to go home on the same day as your surgery.
Your doctor will explain your anticipated length of stay when discussing your surgical plan.
What to Wear
You will need to change into a hospital gown for your procedure, so you can wear whatever you would like to your surgery appointment.
Food and Drink
You will have to abstain from food and drink after midnight the night before your tummy tuck surgery.
Your doctor might ask you to stop taking blood thinners several days before your procedure. If you take oral steroids or medications for diabetes, you might need to follow an adjusted dosing regimen in the days before your tummy tuck surgery.
Be sure you are clear about the instructions in your case and follow them exactly.
Blood Thinners Before, During, and After Surgery
What to Bring
Bring a form of identification, your health insurance information, and a method of payment when you go to the appointment for your tummy tuck surgery.
Pack comfortable clothes that you can change into when you head home. It’s a good idea to wear loose clothes that allow access to a post-operative drain, if one is placed.
Pre-Op Lifestyle Changes
You will need to be at a healthy weight and maintain good nutrition prior to your procedure so you can maximize the chances of a good recovery.6
In the weeks prior to your surgery, your doctor or a nutritionist may discuss dietary issues with you. If you have a tendency to gain weight or diet excessively, you might start on a nutrition plan to ensure that you are getting the nutrients and calories you need to stay healthy for a better recovery.
Since smoking hinders recovery, your doctor may also ask you to quit smoking if you are a smoker.
What to Expect on the Day of Surgery
When you arrive at your appointment, you will sign consent forms and check-in. You will be guided to a pre-op area, where you will change into a gown and have your vital signs—temperature, blood pressure, pulse, oxygen level, and respiratory rate—checked.
You might have some blood tests, including a CBC and electrolyte tests, to make sure you don’t have an acute health problem or infection.
Your vital signs will be continuously monitored before, during, and for at least a few hours after your surgery.
Before the Surgery
When it’s time for your surgery, you will go to the operating room or surgical suite. You will have an intravenous (IV) line placed. You may also have a urinary catheter placed so your bladder can release urine, especially if you will have general anesthesia.
You might have general anesthesia or IV sedation (monitored anesthesia care) during your procedure:
IV sedation might be used for a partial abdominoplasty. If this is the case, an anesthetic medication will be injected into your IV to make you sleepy.
Generally, a more extensive surgical procedure will require general anesthesia. You will have anesthetic medication inserted in your IV, and it will paralyze your muscles to the extent that you won’t be able to breathe on your own. For this reason, you will be intubated with a breathing tube so you can breathe with mechanical assistance during your surgery.
Your surgical team will place a drape around your abdomen, exposing the area where you will have your incisions. Your skin will be cleansed with an antiseptic solution. Your surgeon may measure or mark areas on your abdomen prior to making incisions.8
Types of Anesthesia Used During Surgery
During the Surgery
An abdominoplasty procedure can take from two to five hours, and this largely depends on the technique used.
With complete abdominoplasty, your surgeon will begin by making two incisions: one from the hip bone on one side to the hipbone on the other side of the body, close to the pubic area; the other incision around the navel.9
If you are having a partial abdominoplasty, your surgeon will make one or two smaller incisions. This will be done laparoscopically or via an open procedure.
For a laparoscopic procedure, your surgeon will make a few small incisions. Then they will insert the laparoscope, which has surgical instruments on the end of it, to cut and remove the excess fat and skin.
After the incisions are made, the skin will be separated from the abdominal muscles. Excess fat will be removed from the abdominal area.
If they are separated, the abdominal muscles might be pulled together and stitched into place.
The separated flap of skin is then stretched over the abdominal area; excess skin is removed for a tighter appearance. If your surgeon included the navel in the incisions, it will be reconstructed in a position where it looks natural.
A surgical drain may be inserted under your skin to collect excess fluid. This will stay in place for several weeks before it’s removed.
The incisions are then closed with sutures and a sterile dressing is applied over the area.
After the Surgery
After your surgery is complete, your anesthesia will be stopped (IV) or reversed (general). If you have a tube in place to help you breathe, this will be removed so you can breathe on your own before you leave the operating room.
You will be taken to a post-operative area where your vital signs will continue to be monitored. Once you are awake and considered stable, your nurse might collect urine from your catheter or ask you if you can urinate in a bedpan.
It takes several hours before you can get up and walk with assistance. Generally, you will go home or stay in the hospital according to the plan you had prior to surgery.
While you recover in the post-operative area or during your post-operative hospital stay:
Your medical team will take care of your surgical wound and drain and show you how to do so at home.
You will receive pain medication and your doctor will give you instructions for managing postoperative pain.
You will resume (or be instructed on when to resume) taking any prescription medications.
Your medical team will make sure that you can comfortably and safely walk, eat, and use the toilet before you are discharged to go home.
If you develop signs of complications such as a fever or severe pain in the hours after your recovery, you might need to stay in the hospital for longer than planned as your medical issue is evaluated and treated.
Recovery from any type of abdominoplasty take two weeks to two months. Generally, however, if you have a large wound and/or had a substantial amount of skin and fat removed, you should expect a longer recovery than if you have a small wound and had a small amount of tissue removed.7
Careful post-operative management helps prevent complications.
How Do You Recover From a Tummy Tuck?
Keeping the area clean and dry, and be sure to care for your wound and drain according to the instructions you received in the hospital. Be sure you are clear on how to replace your dressing when needed and whether or not the dressing is waterproof, so you take any necessary precautions to keep the area dry while bathing.
The visible abdominal scar from your tummy tuck procedure may not significantly fade until one year post-surgery. Keeping it protected from the sun can help healing.10
You will need to wear a compression garment over your bandage and underneath your clothes during your recovery period to keep swelling in check.
If you develop pain, redness, drainage, pus, fevers, or chills, call your doctor promptly. The same is true if fluid coming from your surgical drain (if you have one) increases in quantity or begins to look bloody or cloudy.
In the weeks after your tummy tuck surgery, you should avoid strenuous activity and avoid lifting heavy objects. When you have your doctor’s permission, you can return to work and start to exercise.5
How to Care for Your Incision After a Tummy Tuck
When you go to your follow-up appointments with your doctor, your drain and wound will be examined. When the drain is no longer needed, it will be pulled. A suture or steri-strip may be placed to close off the opening in the skin.
Your surgical wound will be inspected and any non-absorbable stitches will be removed once it has healed.
You shouldn’t need any specific long-term care after recovering from a tummy tuck surgery.
Possible Future Surgeries
Generally, tummy tuck surgery doesn’t need to be followed up with other procedures and doesn’t typically cause medical issues.
If you are unhappy with your post-surgical scar, you can consider discussing a scar revision procedure with a plastic surgeon. Your scar might be different than expected if you had a problem with healing or a wound infection after your surgery.
Any future abdominal surgical procedures for any medical or cosmetic reason will need to be planned with consideration of your incisions.
Can Bad Plastic Surgery Be Fixed?
Weight gain might reverse the effects of surgery by adding fat to your abdominal area and allowing the muscles to separate. Weight gain followed by weight loss can cause the skin to become saggy again.
Exercising and following a healthy diet are necessary for weight management and optimal long-term benefits after tummy tuck surgery.
If you are prone to extreme dieting, be sure to discuss this problem with your doctor. Anorexia nervosa and bulimia are dangerous for your health and are potentially life-threatening.
A tummy tuck surgery is an elective cosmetic surgery that you might consider if you want to have a flatter, firmer appearing stomach. There are many issues you needed to keep in mind when deciding if this would be the right treatment for you—including concerns about the recovery period and scars. Have an open conversation with your doctor about the pros and cons of this surgery.