What is Abdominoplasty?

Abdominoplasty, also known as a tummy tuck or simply TT, is surgery to remove excess skin and fat on the abdomen that may accumulate after pregnancy, obesity, or age. In a full abdominoplasty, the abdominal muscles and connective tissue (or fascia) that may have become stretched out or lax over time are also tightened. In a mini-tummy tuck, only excess or redundant skin and fat are removed.

A full tummy tuck may give you a new belly button to go with your new, taut stomach! Actually, although people say that the belly button is repositioned with a tummy tuck, it isn't. The belly button stays where it was and the skin is redraped around it. A hole is made through the redraped skin and the skin is then sutured around the original belly button. After the redraping, your abdominoplasty surgeon can adjust the size of the belly button with a bit of nipping and tucking.

Tummy tucks are done on both men and women, but regardless of your gender, it is not a simple procedure. You must be aware of the risks and understand the amount of postoperative care that will be needed for recovery from tummy tuck. You will be laid up for at least 4 weeks after a full tummy tuck. It is not minor surgery.

Indications for Abdominoplasty Surgery
Abdominoplasty can benefit anyone who has excess skin and fat or weakened abdominal muscles due to age, pregnancy or obesity. Sometimes, after pregnancy or weight gain, the two rectus abdominus muscles that run vertically on either side of the center of the abdomen can become stretched out, a condition called diastasis. The first diagram depicts a cross-section of how the  rectus abdominus muscles and their fascia should look. In the next diagram, the blue arrows depict how they look when rectus diastasis exists. The rectus muscles are separated due to the stretching of the sheath/fascia and are unable to regain its former tautness. 

This laxness of the muscles and fascia can be corrected by folding the excess tissue and suturing it.  Abdominoplasty can give you a tauter, slimmer waist and flatter abdomen.

Rectus and rectus sheath cross-section ( click diagram for a larger image )

Some people may not need abdominoplasty with muscle repair and may benefit by liposuction to remove the fatty pooch of the abdomen.  For some people who need more than liposuction but less than a full abdominoplasty, an endoscopic abdominoplasty may be an option.

Am I A Candidate For Abdominoplasty?
First and foremost, you must be in good health and not have any active diseases or serious, pre-existing medical conditions. You also have to have realistic expectations of the outcome of the surgery. Communication with your surgeon is crucial in reaching your goals and in understanding what can realistically be achieved.

You must also be mentally and emotionally stable. This is an operation that requires patience and stability in dealing with the healing period. Recovery after tummy tuck can be tough. There is sometimes a lull or depression after surgery and if you already have an emotional problem, this low period can develop into a more serious issue.  Please consider this before committing to the abdominoplasty surgery.

An ideal candidate for abdominoplasty would have very elastic skin.  But, of course, we human beings are never ideal. For that matter, if we had skin elasticity that good, we wouldn't need the abdominoplasty in the first place, now would we?  Nonetheless, good elasticity certainly helps!

Normally, women decide to have a tummy tuck after pregnancy has stretched out their abdomens. It is advisable to wait until you are finished having children before having a tummy tuck. Your skin and muscles can get stretched out again if you have a pregnancy after the abdominoplasty surgery.

Similarly, if you are considering losing weight you should wait until after you reach your desired weight. If you lose more weight, you may need additional surgery to remove excess skin, which would mean that the money spent on the abdominoplasty would be wasted.

Tummy Tuck Incision Placement and Scars
An abdominoplasty is not a scar-free surgery. The tummy tuck scars can be quite long and severe looking. The length or size of the scars will depend on the amount of skin you need to have removed during abdominoplasty, your body's ability to heal, whether you scar well, the skill of your surgeon, and the tummy tuck technique used. 

Most surgeons try to use tummy tuck techniques that use the smallest incision possible and that leave scars in a place that will be covered by a standard bikini. However, the incision may need to be rather large or be placed higher for reasons outside of your surgeon's control. In most patients with moderate-to-severe redundant skin, there will be a need to create a new navel or move the existing one. Sometimes, the surgeon can perform the surgery using endoscopic techniques, which involves several short incisions. Be sure to discuss the incision types, techniques, and placements with your surgeon at your abdominoplasty consultation .

standard full abdominoplasty scars 

various short-scar and endoscopic scars

Tummy Tuck Techniques Overview

There are several different types of abdominoplasty procedures. The type that is best for you depends on whether you need to have muscles tightened, skin tightened, fat removed, or a combination of any of those factors. Most surgeons do not perform every technique and some may try to 'one-size-fits-all' you for a sale. Be sure to determine all of your option

Endoscopic Abdominoplasty
Endoscopic abdominoplasty could be right for those of you who have weakened muscles of the lower abdomen, excess abdominal fat, but who still have relatively tight abdominal skin. An endoscopic procedure cannot tighten loose skin on your stomach.

Endoscopic surgery is performed using a small camera, called an endoscope, along with several surgical instruments that are inserted through two or more small incisions. The surgeon can tighten muscles and suture with the help of the endoscope. Liposuction can be done to remove fat and then the incision is closed.

Although not as invasive as a full abdominoplasty, endoscopic abdominoplasty does require some recovery time and a surgical drain may be left in the incision for a few days. 

A drain is a small plastic tube that is left in an incision to prevent a build-up of fluid. When excessive fluid builds up and cannot drain properly, it can put pressure on the incision or cause other complications. A surgical drain can help prevent these problems. The tube usually empties into a small plastic bulb that looks a bit like a grenade. This bulb has to be emptied a couple of times a day, depending on how much fluid is draining out. Usually, drains are removed a few days after surgery, depending on how much fluid is draining out.

Some studies found that endoscopic abdominoplasty was more beneficial for men with rectus abdominal diastasis than for women. However, man or woman, if you have generally taut skin, but loose muscles and fascia, you may be a good candidate for endoscopic abdominoplasty. 

Mini-Tummy Tuck; Partial or Modified Abdominoplasty
If you need skin and fat removal only and not tightening of muscles, and if your navel does not need to be repositioned, you are a candidate for a mini-tummy tuck. A mini-tummy tuck usually has a shorter scar than a full one. A mini-tummy tuck is between endoscopic abdominoplasty and dermolipectomy.

Dermolipectomy 
Dermolipectomy is the removal of excess skin and fat, and includes repositioning the belly button. There is no muscle tightening. It is for patients who have a higher level of skin laxity than mini-tummy tuck candidates. It is often done for people who have a lot of excess skin after a large loss of weight, such as those who have had bariatric surgery such as stomach stapling.

Full Abdominoplasty
This technique is the most invasive and is usually reserved for people with very lax muscles and excess amounts of skin to be excised. In a full abdominoplasty, you usually end up with a new navel because skin will be pulled down and redraped over your navel.

Because a full abdominoplasty is so invasive, there is quite a bit of pain  and swelling, as well as bruising. This is caused by the amount of tissue that needs to be removed or rearranged for a proper correction. However, everyone is different and not everyone will experience the same amount of discomfort.

In a full tummy tuck, the surgeon makes an incision across your lower abdomen just above your pubic bone, usually from hip to hip.  This incision is usually placed so that a bikini bottom will hide it. Skin and fat are loosened away from the abdominal muscles up to the bottom of the rib cage. An incision is also made around the belly button. Usually, all the skin and fat below the belly button is removed.

Then, the fascia and rectus abdominus muscles are tightened by folding the fascia along the centerline of the abdomen. This brings the separated muscles together. The skin above the belly button is pulled down toward the pubic bone and sutured into position as the incision is closed. A new hole is made in the skin and the skin is sutured around the belly button.

Usually, one or two drains are placed under the incision to allow fluids to drain for a few days. These drains usually exit through small incisions above your pubic bone.

Reverse Abdominoplasty
A reverse abdominoplasty is not a common procedure. It can be used in conjunction with breast reduction or mastopexy (breast lift) or for people who have a lot of loose skin above the navel. The incision is made just under the breasts in an inverted V. Instead of being pulled down, as in a regular abdominoplasty, the skin is pulled up. Excess skin and fat are removed and the incision is sutured.  Rectus abdominal diastasis can be corrected with reverse abdominoplasty, but not many surgeons commonly perform this procedure.

Vertical Scar Abdominoplasty; or Fleur-de-lis
This technique combines an incision across the lower abdomen with a vertical incision up the center of the abdomen. This technique is usually reserved for people who need substantial amounts of skin removed and a lot of tightening around the waist.

Abdominal Liposuction
Many people only need liposuction of the abdomen.  For those of you who have good skin elasticity and stubborn pockets of fat in your lower abdomen and around your navel, liposuction can reduce the size of a protruding belly.

Liposuction (also called lipoplasty, liposculpture, and suction-assisted lipectomy) is a surgical technique that removes fat through suction. An instrument called a cannula is inserted into a specific area through one or more short incisions. The cannula, which is attached to a suction device, is moved back and forth to break up deposits of fat that are then sucked out. Liposuction can be performed on the abdomen, flanks, the hips, the buttocks, the inner and outer thighs, above the knees, the upper arms, under the chin, and the neck. There are several different liposuction techniques, including tumescent, superwet, ultrasound-assisted, and power-assisted. You can find out more about liposuction and its benefits and risks at our sister website, Liposuction4you.com.

If you are considering liposuction, you have to remember that it is not a substitution for a good diet and regular exercise. Liposuction should be used for those areas of stubborn fat that stay on you no matter how much you diet and exercise.