What is a Tummy Tuck?

Also known as a tummy tuck, abdominoplasty is a surgical procedure in which excess skin and fat in the abdominal area is removed and the abdominal muscles are tightened.

Who is a candidate for a Tummy Tuck?

Abdominoplasty is a cosmetic procedure that treats loose or sagging abdominal skin, leading to a protruding abdomen that typically occurs after significant weight loss. Good candidates for abdominoplasty are individuals in good health who have one or more of the above conditions and who have tried to address these issues with diet and exercise with little or no results.

Women who have had multiple pregnancies often seek abdominoplasty as a means of ridding themselves of loose abdominal skin. While in many cases diet and exercise are sufficient in reducing abdominal fat and loose skin after pregnancy, in some women these conditions may persist. Abdominoplasty is not recommended for women who wish to have further pregnancies, as the beneficial effects of the surgery may be undone.

Another common reason for abdominoplasty is to remove excess skin from a person who has lost a large amount of weight or is obese. A large area of overhanging skin is called a pannus. Older patients are at an increased risk of developing a pannus because skin loses elasticity as one ages. Problems with hygiene or wound formation can result in a patient who has multiple hanging folds of abdominal skin and fat. If a large area of excess tissue is removed, the procedure is called a panniculectomy.

In some instances, abdominoplasty is performed simultaneously or directly following gynecologic surgery such as hysterectomy (removal of the uterus). One study found that the removal of a large amount of excess abdominal skin and fat from morbidly obese patients during gynecologic surgery results in better exposure to the operating field and improved wound healing.

How common is this procedure?

Certain patients should not undergo abdominoplasty. Poor candidates for the surgery include:

Women who wish to have subsequent pregnancies.
Individuals who wish to lose a large amount of weight following surgery.
Patients with unrealistic expectations (those who think the surgery will give them a "perfect" figure).
Those who are unable to deal with the post-surgical scars.
Patients who have had previous abdominal surgery.
Heavy smokers.

Demographics

According to the American Academy of Plastic Surgeons, in 2001 there were approximately 58,567 abdominoplasties performed in the United States, relating to 4% of all plastic surgery patients and less than 0.5% of all plastic surgery procedures. Female patients accounted for 97% of all abdominoplasties. Most patients were between the ages of 35 and 50 (58%), with patients under 35 accounting for 20% and patients over 50 accounting for 22%. Eighty-two percent of all plastic surgery patients during 2001 were white, 7% were Hispanic, 5% were African American, and 5% were Asian American.

Description

The patient is usually placed under general anesthesia for the duration of surgery. The advantages to general anesthesia are that the patient remains unconscious during the procedure, which may take from two to five hours to complete; no pain will be experienced nor will the patient have any memory of the procedure; and the patient's muscles remain completely relaxed, lending to safer surgery.

Once an adequate level of anesthesia has been reached, an incision is made across the lower abdomen. For a complete abdominoplasty, the incision will stretch from hipbone to hipbone. The skin will be lifted off the abdominal muscles from the incision up to the ribs, with a separate incision being made to free the umbilicus (belly button). The vertical abdominal muscles may be tightened by stitching them closer together. The skin is then stretched back over the abdomen and excess skin and fat are cut away. Another incision will be made across the stretched skin through which the umbilicus will be located and stitched into position. A temporary drain may be placed to remove excess fluid from beneath the incision. All incisions are then stitched closed and covered with dressings.

Individuals who have excess skin and fat limited to the lower abdomen (i.e., below the navel) may be candidates for partial abdominoplasty. During this procedure, the muscle wall is not tightened. Rather, the skin is stretched over a smaller incision made just above the pubic hairline and excess skin is cut away. The incision is then closed with stitches. The umbilicus is not repositioned during a partial abdominoplasty; its shape, therefore, may change as the skin is stretched downward

Aftercare

The patient may remain in the hospital or surgical facility overnight, or return home the day of surgery after spending several hours recovering from the procedure and anesthesia. Before leaving the facility, the patient will receive the following instructions on post-surgical care:

For the first several days after surgery, it is recommended that the patient remain flexed at the hips (i.e., avoid straightening the torso) to prevent unnecessary tension on the surgical site.

Walking as soon as possible after the procedure is recommended to improve recovery time and prevent blood clots in the legs.

Mild exercise that does not cause pain to the surgical site is recommended to improve muscle tone and decrease swelling.

The patient should not shower until any drains are removed from the surgical site; sponge baths are permitted.

Work may be resumed in two to four weeks, depending on the level of physical activity required.

Surgical drains will be removed within one week after abdominoplasty, and stitches from one to two weeks after surgery. Swelling, bruising, and pain in the abdominal area are to be expected and may last from two to six weeks. Recovery will be faster, however, in the patient who is in good health with relatively strong abdominal muscles. The incisions can remain a noticeable red or pink for several months, but can begin to fade by nine months to a year after the procedure. Because of their location, scars should be easily hidden under clothing, including bathing suits.

Risks

As with any surgery, there is always the risk of complication. Heavy smokers, patients who are overweight and patients with diabetes and/or other health problems are more susceptible to complications. Risks inherent to the use of general anesthesia may include nausea, vomiting, sore throat, fatigue, headache, and muscle soreness. In very rare cases, the use of general anesthesia may cause blood pressure problems, allergic reaction, heart attack, or stroke.

Risks associated with abdominoplasty may include bleeding, infection, skin or fat necrosis, hematoma (collection of blood in a tissue), seroma (collection of serum in a tissue), blood clotting or numbness to the abdominal region.