Abdominoplasty (tummy tuck) surgery removes loose skin in the abdominal wall. It can only remove the excess skin and the fat just underneath that skin. It cannot remove any fat inside the abdomen deep to the muscle wall. Liposuction is used at the same time to contour the area just below the waist but liposuction is not used for weight loss. The abdominal wall fascia (the “fabric” around the muscles) can be tightened but only the patient can actually improve the strength of the muscles through exercise.
The surgery involves leaving a long hip-to-hip scar and a scar around the belly button. Occasionally a “modified” abdominoplasty can be performed but the only real difference is that there is no scar around the belly button. This “modified” procedure can be just as extensive as a full abdominoplasty. There are a few patients where only a “scar revision” is performed.
Good candidates for abdominoplasty surgery are close to their ideal body weight and they are in good physical shape. The surgery just removes the excess skin and tightens the remaining skin. Some “muscle” tightening is performed at the same time.
Patients who have too much fat inside the abdomen are not good candidates. A compromise may be indicated in patients where there is a significant overhang of skin. If these patients are still too heavy the result will not be ideal.
Liposuction alone will only remove fat and will not remove or tighten excess skin. If a small bulge is what bothers the patient, liposuction may solve the problem. On the other hand, if a patient bends forward and has excess skin folds, liposuction alone will only make these folds worse.
The recovery from abdominoplasty surgery is definitely not easy. Pain is usually well controlled with medication but patients find it difficult to move around and to get in and out of bed.
Patients will want to stay slightly bent over for about a week. They will need to sleep with their waist, hips and knees bent and this usually means lying on their back.
The incisions will be covered with tape and patients can shower two days after surgery. Some form of binder is usually worn for about two weeks.
Patients need to treat this surgery much as they would a hernia repair with no sudden heaving lifting for about 4-6 weeks. Return to work would be about 2-4 weeks for desk work. It will still take about 2 months to get back to full activities. Exercise should start with walking for the first 2 weeks and then walking uphill for the next couple of weeks. Pilates and strength exercises need to wait for 4 weeks.
Expected problems with abdominoplasty surgery are scarring, wound healing problems and numbness in the skin. The scar goes from one hip to the other hip and is often more extensive than the patient would like. Even with this long scar it is sometimes impossible to prevent puckers from forming at the ends. These cannot always be corrected.
Numbness or a lack of feeling in the skin is to be expected. This often covers a wide area above the scar and just below the belly button. Sensation returns over time.
There can be areas of the incision which take longer than normal to heal. These can leave an unsightly or asymmetrical scar.