Abdominoplasty, also known as a tummy tuck or simply TT, is a cosmetic surgery of the abdomen to remove excess skin and fat, and to create a slimmer, more toned appearance. A protruding or saggy abdomen may be the result of pregnancy, obesity and/or rapid weight loss, or simply age. A full abdominoplasty can include the tightening of loose stomach muscles in addition to the removal of excess skin and fat. A surgeon can move or rearrange the navel (belly button) for a more pleasing appearance. Abdominoplasty can be performed on both men and women.
A full abdominoplasty is major surgery. However, there are less extensive procedures, including one called a partial abdominoplasty, sometimes referred to as a “mini-tummy tuck.” This procedure may be done as out-patient surgery, with the patient going home that day.
Am I a Candidate for Abdominoplasty?
A tummy tuck, or abdominoplasty, is a popular type of cosmetic surgery. Abdominoplasty was one of the top five most commonly performed cosmetic surgeries in 2006, with 146,240 performed, according to the American Society of Plastic Surgeons. This is up from 62,713 performed in 2000. Tummy tuck was the fifth most popular procedure in 2006, exceeded only by breast augmentation, nose reshaping, liposuction, and eyelid surgery.
Deciding whether or not to have abdominoplasty should take a lot of thought. The most important factor to consider with any cosmetic plastic surgery is your overall health. You should be free of any active diseases or other pre-existing medical conditions that will complicate the surgery and recovery period. The quality of your skin is also a factor. Having elastic skin — skin that more readily stretches and recovers — will give better results since it can adapt to the new size and shape of the abdomen.
If you are a woman who is still of child-bearing age and or if you are a woman or man who plans to lose a large amount of weight, you should wait to have a tummy tuck. A future pregnancy or weight loss can disrupt the results of the surgery.
You should also be healthy, both mentally and emotionally. Healing after major surgery such as abdominoplasty can be difficult and tedious. It will require patience and mental stability. You may experience a period of depression after the surgery that could aggravate any pre-existing mental health problem.
Before your tummy tuck, you must discuss the results you want with your surgeon. You and your surgeon should examine before-and-after photos of other clients to be sure you agree about your desired appearance after the surgery.
Medical insurance will rarely cover the costs associated with an abdominoplasty. You will be responsible for the cost of the surgery and all the fees associated with it. However, you can arrange financing.
Abdominoplasty Incision Placements, Types and Their Resulting Scars
Tummy tuck surgery will create scars. Depending on the amount of skin to be removed, the elasticity of your skin, the skill of your abdominoplasty surgeon and the techniques used, scarring can be quite extensive. In a full abdominoplasty, the primary incision extends from one hipbone across the abdomen to the other hipbone. In most cases, it is placed low enough on the abdomen to be below the level of standard undergarments or a bikini bottom.
However, in some cases, your surgeon may need to place the incision higher or may need to use a vertical incision. In these cases, the resulting scars will be more visible. If you are concerned about scarring, you should discuss all the available options as well as the incision types and placement during your initial consultation. You should carefully review before-and-after abdominoplasty photos to become familiar with the amount of scarring that can occur before making a decision.
Endoscopic Abdominoplasty
It is possible to perform some tummy tucks endoscopically. Endoscopic surgery uses cameras and other instruments to view the area being operated on. The instruments are inserted through a few small incisions. This type of procedure is an option for clients with weakened muscles in the lower abdomen and excess abdominal fat, but who still have relatively tight abdominal skin. However, clients who have loose skin will not likely benefit from this type of procedure.
An endoscopic procedure is not nearly as invasive as full abdominoplasty surgery, but it still will require ample recovery time. It may also require the use of a drain, a plastic tube and collection device that is left in the incision site to collect fluid and prevent fluid build-up. Excessive fluid build-up in the abdominal area can result in complications and may even necessitate additional surgeries.
There are several procedures that can be used to flatten and improve the appearance of the abdomen. Many clients do not require a full abdominoplasty. If you are considering a tummy tuck, you should investigate all the possible techniques and procedures. These include:
Mini-Tummy Tuck; Partial or Modified Abdominoplasty: This procedure is designed for clients who need skin and fat removed but do not require the abdominal muscles to be sutured back together or repositioning of their belly button.
A mini-tummy tuck is more invasive than an endoscopic procedure, but less invasive than a full abdominoplasty. This procedure usually results in a scar across the lower abdomen, just above the pubic area, that is shorter than the scar from a full abdominoplasty.
Dermolipectomy: This procedure is best for clients who have a lot of redundant skin and excess abdominal fat and need repositioning of the belly button, but whose underlying muscles are in good shape. People who have lost a great deal of weight and have sagging skin on the abdomen are ideal candidates for this procedure, as are people who have skin that is less elastic and will not bounce back from other procedures, such as abdominal liposuction. No muscle tightening takes place during dermolipectomy.
Panniculectomy: This surgery removes hanging fat and skin on the belly, but does not usually reposition the navel and does not tighten the abdominal muscles. A panniculectomy may be done in conjunction with non-cosmetic surgery, such as a hysterectomy, repairs to the abdominal wall or the repair of an umbilical hernia. The procedure is called a panniculectomy because the hanging “tummy” is called a panniculus.
Reverse Abdominoplasty: A reverse abdominoplasty removes excess skin and fat in the area above the navel. It is a relatively uncommon procedure that can be used in conjunction with breast reduction or mastopexy (breast lift). In this procedure, the incision is made along the crease underneath the breasts in an inverted V, and the skin is pulled upward.
Vertical Abdominoplasty (Fleur-de-lis): In some situations, the surgeon may feel it is necessary to place the incision vertically down the center of the abdomen. Another technique combines the use of a horizontal incision over the lower abdomen with a vertical incision on the abdomen, forming a “fleur-de-lis” pattern. This technique is typically reserved for clients such as those who have lost great amounts of weight and who need a substantial amount of skin removed. The length of the incisions will vary and depend on the amount of tissue to be removed.
Full Abdominoplasty: This technique is the most invasive of all abdominoplasty surgeries. It is reserved for those clients who have very loose abdominal muscles and significant excess skin to be removed.
In a full abdominoplasty, the surgeon makes an incision from hipbone to hipbone. This incision usually curves down at the center of the abdomen to just over the pubic region. The surgeon then loosens the skin of the abdomen up to and past the navel (sometimes all the way to the ribs) and makes an incision around the navel to free it from the skin.
The surgeon exposes the vertical muscles that are front and center on the abdomen: the rectus abdominus muscles. These muscles form two vertical bands down the abdomen that are joined at the center line by connective tissue. During an abdominoplasty, the surgeon will suture these muscles and connective tissue together in a seam down the center of the abdomen. This pulls in the loose abdominal tissue and strengthens the abdominal wall.
Once this is done, the surgeon then pulls the loosened abdominal skin down and removes excess skin. He or she then makes a hole in the redraped skin for the repositioned navel and sutures the navel into place.
Liposuction: Liposuction can be used as an alternative to abdominoplasty or in conjunction with it (so called tummy tuck liposuction). In liposuction, areas of fat are loosened and then sucked out using a vacuum-type device. Some people with firm skin that is not sagging may only need liposuction to the abdominal area to achieve a flatter stomach. For more information, see Liposuction.
There are several phases in abdominoplasty:
Preparation: This is the phase when you are “prepped” for the tummy tuck surgery. Before the surgery begins, your surgeon will mark your abdomen to indicate where incisions will be made. The location, length and direction of these incision lines will be dictated by the type of abdominoplasty being performed. During preparation, you will be scrubbed with an antimicrobial agent to minimize the risk of infection. You will also be hooked up to several monitors so that the surgical team can monitor your vital signs.
Anesthesia: The choice of anesthesia should be discussed between you and your surgeon prior to the surgery. After starting the anesthesia medications, your surgeon will test to ensure you are sufficiently anesthetized before beginning the abdominoplasty.
Surgical Procedure: After anesthesia is begun, your surgeon will start the procedure itself. After he or she is done, the incisions are then closed and a dressing is applied to protect the wounds, to keep the tissue in place, and to reduce swelling.
Tummy Tuck Recovery: After the surgery, you are awakened and moved to a recovery room where nurses monitor vital statistics for a couple of hours. As you wake up, you may experience pain, nausea, or uncontrollable shivering. Some clients become emotionally upset as they come out of surgery. The staff can provide you with pain relievers, anti-nausea medications, and warm blankets if you need them.
