Abdominoplasty can occasionally be combined with other surgeries of the abdomen such as a hysterectomy, but most commonly are done either alone or in combination with other body surgery such as breast augmentation or liposuction. Breast surgery done in combination with a tummy tuck is often referred to as a “mommy makeover”. The surgery is done under a general anesthetic and depending on other surgeries to be done at the same time, can take as little as two hours or upwards of six hours in combination with other procedures. The incision is usually hidden low in the bikini line and stretches from hipbone to hipbone, though an “extended” tummy tuck can extend further to the side. A fleur-de-lis tummy tuck involves a vertical midline incision extending around, above and below the belly button to remove excess skin in the vertical as well as horizontal direction (most commonly done after massive weight loss and occasionally instead of a lower body lift). The surgery is done as an outpatient surgery.
Although the patient is released home the same day of surgery, it is important for a recovering patient to be up and moving after surgery as quickly as possible (even on the day of surgery) to avoid developing blood clots in the legs. A compression garment is used for at least 2-3 weeks after surgery; upwards of six weeks if tolerated. This helps to decrease postoperative swelling and fluid accumulation. A drainage tube most commonly exits through the pubic area and is present for 1-2 weeks after surgery, occasionally longer. Most patients will take 1-2 weeks off surgery and a 6-week recovery period is necessary before beginning strenuous exercises or maneuvers that will place tension on the incisions. Most patients will require help around the house for 4-6 weeks since a recovering patient is unable to lift/push/pull more than about 5-10 pounds.
If a patient is able to maintain postoperative weight control, the results will be permanent. The incision should be low and hidden in the waist or panty line, easily hidden within a bathing suit or underwear. The scar can be somewhat thick or prominent due to tension placed on the incision for maximal postoperative contour, but scar treatment systems such as Embrace or Biocorneum can help the scar to fade maximally with time. Occasionally scars are injected with steroids to help calm thickness or redness, sometimes adding laser treatments or micro needling to help the scar remodel. While the abdomen will relax slightly with time, it should not regain the preoperative laxity and skin excess. Patients may experience tightness of the abdomen that prevents standing completely upright for a few days or weeks after surgery. Although abdominoplasty is not indicated for back pain, tightening the core abdominal muscles of the patient may help to strengthen the core and support the back resulting in partial relief of back pain.
What is the appropriate age to have a tummy tuck?
There is no right or wrong answer when it comes to the timing of a tummy tuck. Patients can benefit from this surgery even into their 70’s if they are active and have good health. In general, younger patients should have either stabilized/finished their weight loss journey or finished having children if female. Postoperative mobility will be an important part of the recovery process so patients need to be in fit ambulatory condition.