Abdominoplasty (tummy tuck) explained: what the operation involves, step by step

What abdominoplasty treats, and what it does not

Abdominoplasty, also called a tummy tuck, is cosmetic surgery that improves the shape of the abdomen by removing excess skin and fat and tightening the abdominal muscles (NHS). It is the operation for loose skin and weakened or separated muscle.

It does not replace weight loss or exercise (ASPS). It cannot correct stretch marks, except those that sit on the excess skin that is removed (ASPS). Where the concern is fat alone, liposuction is a different operation: liposuction or tummy tuck sets out which problem each one solves.

The operation in stages

The NHS describes two types, partial and full, both under a general anaesthetic. The operation takes between 2 and 5 hours (NHS). In a full abdominoplasty the stages run in this order:

1. The incision. A horizontal cut is made in the area between the pubic hairline and the belly button (ASPS). In the NHS description of the full operation it runs from hip to hip above the pubic area (NHS).
2. The belly button is freed and the skin is lifted. The skin is separated from the abdominal wall (NHS).
3. The muscles are repaired. With the skin lifted, the weakened abdominal muscles are repaired (ASPS).
4. The excess is removed. Surplus skin and fat are taken out (NHS).
5. The belly button is reset. A new opening is made for it, and it is brought through to the surface and sutured into position (ASPS).
6. The skin is closed. Sutures, skin adhesives, tapes or clips close the incisions (ASPS).

A partial abdominoplasty is the shorter version: an incision across the lower tummy, with the skin below the belly button separated, the excess removed and the remaining skin stitched in place (NHS).

Muscle repair, in plain words

The muscle step is what separates abdominoplasty from the removal of skin alone. In surgery the muscles are repaired and the overlying excess skin is removed in the same operation. How this applies after childbirth, including when physiotherapy comes first and when to wait, is covered in tummy tuck after pregnancy.

Drains, dressings and the garment

After the operation, small thin tubes can be placed temporarily under the skin to drain excess blood or fluid, and dressings or bandages cover the incisions (ASPS). An elastic bandage or compression garment is worn to minimise swelling (ASPS). The NHS describes leaving hospital with dressings and a pressure garment or tummy-control pants, worn for 6 weeks, and keeping the knees bent in bed to avoid putting strain on the stitches (NHS). The NHS gives about 6 weeks for full recovery, with 4 to 6 weeks off work and exercise. The stages week by week are set out in tummy tuck recovery.

These are published ranges for the operation. The timeline for a specific operation is gone through before surgery.

The scar and how it matures

A tummy tuck leaves a scar across the lower tummy, and a full abdominoplasty also leaves a scar around the belly button (NHS). The NHS states that the scars fade over 12 to 18 months (NHS). Thick scars and unfavourable scarring are on the lists of risks published by both the NHS and ASPS, so the scar is one of the things weighed before deciding on surgery. A tummy tuck without a scar does not exist.

Who should wait or avoid it, and the risks stated plainly

The NHS states that abdominoplasty is not a procedure for someone who is overweight (NHS). ASPS advises that people planning substantial weight loss, and women who are considering future pregnancies, postpone a tummy tuck, because significant weight changes can diminish the result (ASPS).

The risks listed by the NHS are thick scars, bulges, fluid collection, haematoma, numbness, breathing problems, infection and blood clots (NHS). ASPS adds anaesthesia risks, asymmetry, bleeding, fat necrosis, poor wound healing, skin loss, persistent pain, recurrent looseness of skin, an unsatisfactory result and the possibility of revision surgery (ASPS). The risks and their likelihood for a specific patient are gone through at the consultation, before any decision to operate.

This is the operation described on the abdominoplasty in Lebanon page, where the practice's patient information sheet is also found.

Questions

FAQ

Sources

• NHS — Tummy tuck (abdominoplasty)
• American Society of Plastic Surgeons — Tummy Tuck
• American Society of Plastic Surgeons — Tummy Tuck Procedure
• American Society of Plastic Surgeons — Tummy Tuck Recovery
• American Society of Plastic Surgeons — Tummy Tuck Safety

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