Abdominoplasty, a.k.a. “tummy tuck,” can be one of the most dramatic procedures for body sculpting. When the belly is too prominent for one’s wishes, we first need to figure out what is actually causing this in order to get a procedure that gives the most dramatic result.
The “usual suspects”
There can be 3 completely different causes that can give that look of a bulging tummy. Loose skin, excess fat, and a bulging muscle wall in any combination can look the same. Determining the most appropriate corrective procedure reaches a fork in the road…a suck (liposuction) or a tuck (abdominoplasty). These are very different procedures in surgery time length, intensity of recovery and postoperative limitations, and even scar size. Also smoking is an absolute contraindication to an abdominoplasty but not necessarily for lipo, although I am not condoning it. Smoking inhibits healing….period!…but can cause a large area of tissue loss and/or months of secondary healing time when things are tightened from a tuck! As far as those 3 suspects mentioned above, excess fat and some skin laxity may be best served by lipo while a bulging muscle wall causing most of the fullness, with or without excess fat and loose skin, will require a tuck. This is usually the case after c-sections or prior abdominal surgery.
Not all tummy tucks are created equally
There are variations in tucks, depending on the findings. These are basically removal of skin and fat with muscle repair, skin only (with underlying fat), or even muscle wall without skin removal through a fairly small scar. This last type is the rarest because there are very few people that have no fat, no loose skin, and a bulging muscle wall. This was originally done as an endoscopic procedure through a small pubic area scar, but can now be done without the scope. Another variation is often called a “mini tuck.” This can be confusing because there are different surgical methods that are called this. Usually, this is a shorter scar in the underwear line but only removes looseness below the umbilicus (belly button) as compared to a full abdominoplasty, which goes all the way up. Again, it is much less frequent to find loose skin only below the umbilicus.
Changes after pregnancy is not the only condition leading to abdominoplasty
Men are also getting tummy tucks and often need the muscles repaired too. The usual situation after significant weight loss, such as after bariatric surgery like a lap band, is something more extensive. There is usually looseness all the way around the trunk and a more extensive circumferential tuck will be needed, which is usually called a “belt lipectomy,” even though it is really a tuck.
Can this be combined with another procedure?
The “mommy makeover” often combines rejuvenation of the breasts with the tummy and can be safely done together. This could be a lift and/or augmentation. Breast reductions are a bit more intense of a procedure, but are sometimes done with the belly.
This used to be a hospital procedure, but is now mostly done as an outpatient in a free-standing facility such as in our office. Many of us switched over nearly 20 years ago, so the safety of doing this as an outpatient has long term proof.
No matter which procedure is done, seeing the final result is months to a year, so you need to be patient.