How a Tummy Tuck (Abdominoplasty) Surgery Is Performed

A full tummy tuck or abdominoplasty usually takes between 2 and 4 hours to perform. If you are having additional cosmetic procedures done at the same time such as a breast lift, breast augmentation, or liposuction to your thighs or if your tummy tuck is being performed in conjunction with noncosmetic surgery, such as a hysterectomy or hernia repair, the total time in surgery will be longer. On the other hand, a mini-tummy tuck takes less time than a full tummy tuck.

Abdominoplasty Surgical Markings
One of the first steps you will undergo for your abdominoplasty is marking. Your surgeon will use a pen to mark your abdomen to indicate where the tummy tuck incisions will be. The markings will also note where the center of your torso is, the location of the repositioned navel, and the incisions. If your surgeon will be performing liposuction on your abdomen (or elsewhere), these areas will also be marked

Some abdominoplasty surgeons like to do their marking in the examination room a day before surgery, some draw on you in the operating room with you standing, and still others will mark you up while you are lying on the operating room table. Many surgeons think that marking you while you are standing is the best way to go, but others don't.

There are many variations so the tummy tuck markings I am showing here may look different than the ones you get. Your markings will be specific to the type of incisions your surgeon will use and to your unique needs.

tummy tuck incision markings

Here are two possible marking patterns. The lower half of the trapezoidal area on the left shows the incision line. The skin in this area will be removed. The circles above and below the navel on both figures indicate fat pockets that may be removed by liposuction or manual extraction. In a full abdominoplasty, the skin is pulled down and repositioned around the navel. The right diagram depicts a variation of the markings with a vertical reference line that will assist in making sure your abdomen will be symmetrical. All surgeons' markings vary and where they place the marks will depend on your anatomy and needs, as well as your surgeon's preferences.

Some extensive full abdominoplasties are performed in a hospital and you stay overnight. Others are performed on an out-patient basis (same day surgery) and you go home that day.

Preparing for Tummy Tuck Surgery
You may be asked to lay down on a gurney outside the operating room and you may be hooked up to an intravenous (IV) line before you are wheeled in to the operating room. You may already have been given a sedative tablet by mouth (for example, Valium) before you have reached this stage. If you have been given a sedative already, you usually could not care less that they are prepping you for surgery. If you haven't been given a sedative, the first few minutes until you are anesthetized may be stressful.

Most people have had an IV inserted for some reason or another, but if you haven't, it feels a bit like having blood drawn. Still, the initial placement of the IV catheter may sting a bit. Generally, the first choice for placing the IV line is one of the veins on the inside of your elbow. Occasionally, it is placed in the back of the hand. Sometimes, a bruise develops where the IV goes in. I dislike having the IV in the hand because that is a nasty place for a bruise. At least with an IV into the arm you can hide it. But IV placement depends on your veins and finding the spot that works best. The fluid being dripped in via the line is usually saline (sterile salt water) at first. The line is in place so that medications and fluids can be administered easily during surgery.

After the needle is inserted into the vein, the needle itself is pulled out, leaving behind a tiny tube in the vein. That tube is sometimes referred to as a catheter. However, sometimes the whole IV setup is called a catheter. The catheter acts as an injection port and is taped to your skin to keep it from getting dislodged. Medications can be injected via this port or they can be in a plastic bag connected to the tubing to allow an automatic infusion of drugs and intravenous fluids controlled by a computerized drip system. Sometimes a simple roller clamp controls the drip rate. There may be a small plastic vial on the line that allows you to see the drip rate.

You may or may not receive some medications via the IV to help you relax or feel sleepy at this time. These drugs can also help with preoperative anxiety if you were not given an oral medication.

After you are placed on the operating table, they will hook you up to monitors that will keep track of your heart rate, blood pressure, body temperature, and the amount of oxygen in your blood. One of these devices is an oximeter, which measures oxygen levels in your blood. This clips over one fingertip, and it shines a light through your fingertip. Nail polish interferes with the reading from a fingertip oximeter, which is why you need to remove all nail polish before your surgery. Sometimes the oximeter is clipped onto your earlobe.

You may also have compression sleeves placed on your legs. These will inflate and deflate periodically during surgery to improve your blood circulation and decrease the risk of deep venous thrombosis (DVT), or blood clots in the deep veins of the leg. These clots could lead to a serious condition called pulmonary thromboembolism. Heavier patients may especially benefit from having compression sleeves during surgery.

Anesthesia For Abdominoplasty
The type of anesthesia used depends on factors such as your overall health, the extent of your abdominoplasty, and whether other surgery is also being performed. General anesthesia is almost always used for full tummy tucks.

If you and your surgeon have chosen an IV sedative, it will be administered through the IV line. The anesthesiologist will inject the medications into an injection port along the length of the tubing, or, more commonly, he or she will attach a bag of anesthetic to the line that allows it to drip in at a rate controlled by a computer. The system automatically allows a controlled amount of anesthetic to drip into the IV line.

The effects of this type of anesthesia are felt very soon after injection or the start of the drip, just few seconds in fact. Sometimes, it feels like heat going into your veins and creeping up your arm, then it jumps from your shoulder and becomes a metallic-like taste under your tongue, and then you are blissfully anesthetized.

If you have chosen gaseous anesthesia (also called twilight or gaseous general anesthesia), your mouth and nose will be covered with a mask. As you breathe in the anesthetic gas, you will usually be told to count back from 100. I usually make it to about 96 before falling fast asleep. Once you are asleep, the anesthesiologist will more than likely intubate you. Intubation involves inserting an endotracheal tube down your throat to deliver gas anesthesia directly to your lungs. However, some surgeons may give you a little IV sedation and then intubate you and switch over to gaseous sedation rather than use a mask.

Another option for gas anesthesia is the use of a laryngeal mask airway (or LMA). This mask has a shorter tube and a little balloon the size of your two thumbs at the end. The tube holds your tongue down and out of the way so it does not obstruct your breathing. The balloon inflates and blocks fluid from entering your windpipe either from saliva or stomach fluid and delivers gas to your lungs. You may wake up with an irritated, dry throat because canned or cylinder air is dry! There is absolutely no moisture in those tanks. This dries out your whole body, because your nose actually helps humidify the air you breathe and the more it needs to do that, the more moisture your body needs. However, you will be hydrated while your are under and this dryness is offset by the saline dripping into your arm from the IV.

Sterilizing the Surgical Field
After you have been anesthetized, the operating room staff will scrub your abdomen and torso (and other areas if you are having other procedures) with a special antiseptic soap. The staff then rinses off the area and then paints it with a brownish antiseptic liquid that kills surface bacteria and fungi.

The Abdominoplasty Surgery
You will first be injected with a solution of lidocaine and epinephrine. Lidocaine is a local anesthetic and epinephrine is a vasoconstrictor. A vasoconstrictor helps control bleeding by constricting blood vessels.

Mini tummy tuck incisions

The diagram to the left depicts a "Mini Tummy Tuck" incision, whereas the diagram on the right is an example of a full abdominoplasty incision.

Usually, the main incisions for a tummy tuck are made right above the pubic mound, from one hipbone to the other. Another incision is made around your navel for a full abdominoplasty. If you are having a mini-tummy tuck then you will usually not have the incision around the navel.

In a mini-tummy tuck, the surgeon will use a shorter incision. He or she will remove pockets of fat below your navel and then stretch your skin down and past the incision line. The excess skin that extends below the incision is removed and the incision is then sutured. Before the incision is closed, however, the surgical team will perform a count of sponges and instruments to ensure that none have been left inside you.

Full abdominoplasty scars

In a full abdominoplasty, your surgeon will make a longer incision, usually from hipbone to hipbone, and the incision around your belly button. He or she will loosen the skin from the abdominal wall all the way up to your ribcage (depicted by the darker area on the torso).

At this point, the surgeon will place sutures in the fascia of your abdominal muscles, to pull them into a tighter position. This is the muscle repair portion of the surgery.

tummy tuck incisions

After your abdominal muscles have been sutured, your surgeon will remove excess fat by either liposuction, by extracting it by hand, or both. Your abdominal skin is then stretched down over your incision line, and the excess skin is removed.

Next, your surgeon will mark the placement of your navel. Although the skin around your navel has been moved, the navel itself actually stays in the same place. Very rarely is your navel detached from its internal structures and moved. Your abdominoplasty surgeon cuts a hole through the redraped skin and sutures it around your navel. If you used to have an outtie, you can now have an innie. However if you want an outtie, your surgeon may be able to fashion one for you. After a sponge and instrument count by the surgical team, your incisions are then closed. Your surgeon will use either tissue glue, sutures, staples, or Steri-Strips to close the incisions.

Abdominoplasty scars

In a full abdominoplasty, the surgeon will often insert one or more drains, which are plastic devices that help prevent a build-up of fluid inside you. This build-up of fluids can cause pressure on the incision. The drain consists of a clear plastic tube that is placed through a very short incision below the main incision. This tube leads out of the body to a small oval-shaped bulb that is about the same size and shape as a hand grenade.

Each time a bulb is emptied and before you close it again, you squeeze it so that it has a bit of negative pressure that helps drain the wound. You will be instructed to empty the drains a few times a day and keep track of how much fluid comes out. Drains are usually removed anywhere from 3 to 14 days after your surgery, depending on how much fluid is coming out.

When the surgery is completed, bandages and dressings will be applied. You are then gently woken up.

If you are having breast implants inserted at the same time you are having an abdominoplasty, you can have them inserted through the same incision as your abdominoplasty. This would eliminate an incision under the breasts or in the armpits. This type of insertion is performed endoscopically, like a transumbilical breast augmentation (TUBA), where the implants are inserted through an incision hidden in the navel (depicted below). The blue lines are the "tunnels" of dissection during a TUBA procedure. Not all surgeons offer this option, so ask about it if you are combining breast augmentation with your tummy tuck surgery.

Coming Out of Anesthesia After Tummy Tuck Surgery
Coming awake from anesthesia can be very rough for some people. You may experience nausea, dizziness, anxiety, haziness, etc. You may also feel like crying. Your throat may also feel very sore if you had general anesthesia. I think it is very close to the sensation of drinking a lot of alcohol and feeling drunk, but with even less control over your body's movements at first. You may also be cold and shaking as you come out of the anesthesia. This, too, will pass.

Don't be alarmed if you are feeling out of control or cannot talk coherently. This is normal. If you fight it, you may only feel more uncomfortable or panicky. The surgeon or members of the staff may ask you questions repeatedly. They aren't doing this to annoy you; they are just trying to assess your level of consciousness. Knowing what to expect may help you with the experience of coming out of the anesthetic, but more than likely you will forget everything you are reading now and feel anxious anyway.

The Recovery Room
Usually, you will wake up in a recovery room rather than in the operating room. This room is usually located right by the operating room. You may be in a recliner or in a somewhat inclined position on a hospital bed or gurney. Your IV will more than likely still be in and you will usually still be hooked up to monitors keeping track of your vital signs.

If you feel sick or are in pain, alert the recovery room staff. They can give you a pain reliever, antinausea drugs, or a few sips of cool water to ease your stomach. Sometimes, the antinausea drugs do not work and you may throw up.

If you had light sleep sedation or local anesthesia with light sedation (sometimes used in very minimal tummy tucks), you should be allowed to go home in 2 to 3 hours. If you had general anesthesia, the staff will want to keep you a bit longer. You may have to urinate after surgery because of the amount of fluids you got by IV. In fact, your surgeon may insist that you urinate before he or she will release you. You will need assistance in getting to the bathroom and staying on the toilet, so be prepared for an audience of at least one.

If you are staying in the hospital overnight – and you probably will be after a full tummy tuck with muscle repair – you will be wheeled up to your room after a couple of hours in the recovery room. Usually, you will go home the day after your surgery if you had a full abdominoplasty and no other surgery.

The Drive Home After Tummy Tuck Surgery
If you are going home the same day as your surgery, you must have someone dependable to drive you home. The hospital or surgery center will not let you go home if you do not have a qualified adult to drive you.

Recovery after plastic surgery takes time. You will also need someone to be with you at home to care for you for a few days. You will need this person to help you to the bathroom and in dressing, walking, eating, etc. You have few weeks of recovery time ahead of you. Read our section on preparing your home for more information.

Remember to keep your chin up. You may be very uncomfortable and regret having had your surgery, but in a few weeks it will be at the top of your "Best Things I Have Done For Myself" list!  Please look at our Abdominoplasty Recovery section for more information and recovery tips!