Obesity has become a global epidemic, leading to an increase in bariatric surgeries as a compelling option for weight loss in individuals with severe obesity-related comorbidities or for whom lifestyle modifications have proven ineffective. While bariatric surgery offers significant and sustainable weight loss, a common consequence is redundant skin, affecting up to 96% of patients, which can negatively impact physical and psychosocial health. Abdominoplasty, commonly known as a tummy tuck, is a well-established cosmetic surgery procedure that can improve body contour by removing excess skin and fat from the abdominal wall, restoring musculofascial integrity and skin elasticity. This article explores the role of abdominoplasty after weight loss surgery, including its benefits, risks, preparation, procedure, recovery, and expected results.
The Rise of Bariatric Surgery and the Need for Body Contouring
The prevalence of overweight and obese adults is a growing concern worldwide. Long-standing obesity is associated with metabolic, cardiovascular, physical, and psychological problems. Bariatric surgery has emerged as an effective method for treating severe obesity, offering advantages such as maintainable weight loss, improvement or elimination of some metabolic diseases, and improved life expectancy. The frequency of bariatric surgeries is estimated to be around 256,000 each year.
Weight loss following bariatric surgery is significant and sustainable, with the majority of weight loss occurring during the first two years. However, many patients are left with the functional and aesthetic sequelae of massive weight loss, including excess skin that can cause limitations in mobility and exercise, difficulty in performing personal hygiene, skin irritation and infections, psychological and emotional distress, and social discomfort. As a result, many patients desire body contouring operations, such as abdominoplasty, to remove redundant skin.
What is a Tummy Tuck?
A tummy tuck, or abdominoplasty, is a surgical procedure designed to improve the shape and appearance of the abdomen. During a tummy tuck, a surgeon removes extra skin and fat from the abdomen. Connective tissue in the abdomen called fascia is usually tightened with stitches to narrow the waistline. This brings together the muscles that go down either side of the abdomen if the muscles have become separated. Then the extra skin is removed, and the remaining skin is repositioned to create a flatter, more toned look.
Why Choose a Tummy Tuck?
You might choose to have a tummy tuck if you have extra fat or skin around your midsection. Or you might get this surgery if your stomach bulges due to separated abdominal muscles. That condition is called rectus diastasis, and it may cause low back pain.
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A tummy tuck can:
- Remove loose, excess skin and fat.
- Repair rectus diastasis - a condition where the stomach bulges due to separated abdominal muscles.
- Tighten weak connective tissue in the abdomen called fascia.
- Remove a C-section scar, if you've had a C-section to give birth.
A tummy tuck can be done along with cosmetic surgeries that reshape other parts of the body. These are known as body contouring surgeries. Statistics from the American Society of Plastic Surgeons show that 46,577 body contouring procedures were performed after massive weight loss in the USA in a 2020 report.
Types of Tummy Tuck Procedures
There are several types of tummy tuck procedures, each designed to address specific cosmetic issues:
- Full Tummy Tuck: Suitable for those with a moderate amount of extra skin in their midsection. In this procedure, the incision extends from hip bone to hip bone. Surgeons tighten the muscles and use advanced liposuction techniques to remove fat. They then reposition the belly button so it appears natural.
- Mini Tummy Tuck: A smaller incision is made along the lower abdomen. While patients still have some pockets of fat, a mini tummy tuck is not as invasive as a full or extended tummy tuck. The belly button doesn’t need to be modified in this procedure.
- Extended Tummy Tuck: Patients who require major body contouring after weight loss are best suited for an extended tummy tuck. The incision extends beyond the hips and around the navel. The muscles are tightened, excess skin trimmed, and fat removed through liposuction. The belly button is also positioned in a way that looks completely natural.
- Fleur-de-Lis Tummy Tuck: An alternative technique used to address the lax and expanded horizontal component of the abdominal wall. The name comes from the way the pattern is marked (in the shape of a fleur-de-lis), and it has both a horizontal and vertical component. The tissue within the marks is resected, and the incisions are closed in an inverted T formation, at the expense of an additional scar. This allows the surgeon to gather excess horizontal tissue at the flanks and draw it medially, thereby creating an aesthetically pleasing waistline.
- Reverse Abdominoplasty: Targets the upper abdomen, lifting it upwards.
- Circumferential Abdominoplasty (Belt Lipectomy): Addresses laxity of the abdominal wall musculature and fascia, allowing the excess skin from the lateral thighs, hips, buttocks, and lower back to be released and excised. This contributes to a better contour of the torso following major weight loss.
In addition to abdominoplasty, liposuction can be used to achieve better results. It has been proven that adding liposuction to an abdominoplasty does not put patients at additional risk.
Are You a Good Candidate for a Tummy Tuck After Weight Loss Surgery?
Like with most other post-bariatric body contouring procedures, a good candidate for the surgery is:
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- In reasonably good health
- Has some established weight loss
- Has realistic expectations and a positive outlook
- Is not a smoker
The presence of scars from previous surgeries may limit some options. The procedure should also be postponed if an active infection is present. If you smoke, you will be asked to quit smoking two months prior to treatment as well as during recovery to reduce risk of bleeding.
One of the most important criteria is maintaining a stable weight for at least 6 to 12 months after bariatric surgery or weight loss. You may benefit from a tummy tuck if you’re struggling with folds of sagging skin around your abdomen that persist even after weight loss. Candidates should have good physical health and no significant medical conditions that could affect healing. This includes managing conditions like diabetes or heart disease before surgery.
Preparing for a Tummy Tuck
If you're considering a tummy tuck, it's important to discuss your goals and expectations with a qualified plastic surgeon. Here's what you can expect during the preparation process:
- Review your medical history: Be prepared to answer questions about current and past health conditions. Talk about any medicines you're taking or have taken recently. Tell the plastic surgeon if you're allergic to any medicines. If your reason for wanting a tummy tuck is related to weight loss, talk with the plastic surgeon about that.
- Do a physical exam: To help decide on your options, the plastic surgeon examines your abdomen.
- Ask about your goals: Explain why you want a tummy tuck and how you'd like to look after the surgery. Make sure you understand the benefits and risks of the surgery, including scarring.
- Stop smoking: Smoking lessens blood flow in the skin and can slow the healing process. Smoking also raises the risk of tissue damage.
- Not take certain medicines: You'll likely be told not to use aspirin, anti-inflammatory drugs and herbal supplements.
- Stay at a stable weight: Ideally, you'll keep a stable weight for at least 6 to 12 months before having a tummy tuck. If you're very overweight, your plastic surgeon likely will recommend that you lose weight before the surgery.
- Arrange for help during recovery: Make plans for someone to drive you to and from surgery.
The Tummy Tuck Procedure
During a tummy tuck, your surgery team gives you medicines to prevent pain. Typically, you receive medicines called general anesthetics. Plastic surgeons have various ways to do a tummy tuck.
During a typical tummy tuck, a plastic surgeon removes most of the skin and fat between the belly button and pubic hair. The amount of extra skin removed and the type of tummy tuck you have determine the shape and length of the incisions. The incision above the pubic hair is stitched together. The plastic surgeon also changes the position of the skin around the belly button.
Read also: Post-Weight Loss Tummy Tuck
Recovery After a Tummy Tuck
After a tummy tuck, your surgery team likely will cover the incisions on your abdomen and belly button with surgical dressing. Members of your surgery team help you walk as early as the first day after a tummy tuck. You'll likely be given pain medicine. Drains might be left in place for a few days after surgery. A member of your surgery team shows you how to empty and care for the drains.
You might wear a garment called an abdominal binder for about 6 to 8 weeks after your tummy tuck. This helps prevent fluid buildup and supports your abdomen while you heal.
For the first six weeks after a tummy tuck, you'll likely need to be careful when moving around. Try to not lift, strain or do other strenuous tasks. Also try not to move in ways that strain the incision line, such as quickly bending at the waist. Straining might reopen the wound.
Many people who get tummy tucks can go back to work in about 2 to 4 weeks. You'll likely need regular follow-up visits with your plastic surgeon.
Recovery Timeline
The exact timeline of your recovery period will vary depending on the extent of your procedure - but you should prepare yourself mentally for a recovery period with limited activity for a few weeks to months. Although every patient recovers differently, here is a general recovery timeline:
- Weeks 1 and 2: May experience mild to moderate pain, which will be managed through prescription pain medication for the duration of this period. You will not be allowed to drive while taking pain medication and should plan accordingly. Bandages placed on scars will need to be changed in 1-2 days after surgery. Drains and sutures are removed by your surgeon the first 5-10 days, You may also experience bruising, numbness and swelling during this time. Some patients can return to work during this time, provided that their job does not require them to do anything too physically demanding. During the first few days, you may not want to move too much, but you should walk and move around as much as you can to prevent blood clotting. The body compression garment given to you after surgery will help to minimize swelling, and should be worn for the first few weeks.
- Weeks 3 and 4: The pain should subside. Most patients stop taking pain medications by this point, and are able to manage pain with over the counter (OTC) pain medications. You may still experience swelling and numbness, but will be able to return to work if you haven’t done so already.
- Weeks 4-16: You should regain feeling and sensation in the area. Swelling may continue, but the final result should be apparent no later than six months. When you are able to return to exercise, take it slow, gradually working back up to your old exercise schedule. Be sure to ask your surgeon for their recommendations regarding all physical activity including exercise.
Risks and Complications
Although abdominoplasty is a safe procedure, it has been associated with a higher complication rate compared with other body-contouring procedures. It is known that obese patients undergoing abdominoplasty have a significantly increased risk of developing complications compared to non-obese patients.
Possible complications include:
- Fluid buildup beneath the skin (seroma): Drainage tubes left in place after surgery can help lower the risk of too much fluid building up. Sometimes surgical techniques are used to help lower the risk of seroma and avoid the need for drains.
- Poor wound healing: Sometimes areas where the surgeon made a cut, also called the incision line, heal poorly or start to come apart.
- Scarring: The incision scar from a tummy tuck is lasting, but it's typically placed along the easily hidden swimsuit line.
- Tissue damage: During a tummy tuck, fatty tissue deep within the skin in the abdominal area might get damaged or die. Smoking raises the risk of tissue damage.
- Changes in skin sensation: A tummy tuck can affect nerves in the abdominal area. Less often, it can affect nerves in the upper thighs. You'll likely notice less feeling or loss of feeling in the areas where the nerves are affected.
- Blood clots: Including clots in the leg veins (deep vein thrombosis, or DVT).
Factors that increase the risk of complications include:
- BMI ≥ 30 kg/m2 at the time of surgery
- Increasing age
- Male gender
- Resection weight
- Smoking
Expected Results
A tummy tuck can give your abdomen a more toned and slimmer look.
Within a week or two after surgery, you should be standing tall and confident in your new slimmer profile. Your tummy tuck will result in a flatter, firmer abdominal contour that is more proportionate with your body type and weight. Most patients report a significant boost in confidence after their surgery!
Similarly to liposuction, you’ll experience some swelling for one to three months after surgery. When this swelling subsides and your skin tightens around the treated area, you’ll be able to see the full results of your surgery.
The results of your tummy tuck will be long lasting, provided you maintain a stable weight and general fitness.
Scars
A tummy tuck does involve a larger incision - sometimes two. With proper scar care, scars will usually fade as much as they will after about one year. It is important to begin scar care as soon as the wound closes to ensure the scars fade as much as possible. In women who have undergone cesarean section, the existing scars may be incorporated into the new scar. This is a trade-off, but most women feel these are small compared to the large improvement in their self-confidence after surgery.
Cost of a Tummy Tuck
The cost of the tummy tuck procedure varies depending on the extent of your surgery, and whether you decide to undergo other procedures at the same time. The cost of your procedure will include anesthesia fees, surgical facility costs, medical tests, post-surgery garments, prescriptions for medications, and the surgeon’s fee.
Most health insurance does not cover abdominoplasty, but financing options like CareCredit may be available. You might also consider the cost of childcare or other assistance you might need during your recovery period - such as meal delivery, a cleaning service, etc.
The Emotional and Psychological Benefits
The benefits of body contouring are more than just cosmetic. The emotional and psychological improvements can be more dramatic than the physical improvement. Imagine losing a significant amount of weight but still feeling “flabby” because of excess skin. Getting rid of that skin can improve self-confidence and self-esteem. In fact, a recent study showed that bariatric surgery patients who have body contouring surgery experience less weight regain and have an improved quality of life than those who do not have body contouring.