Abdominoplasty (tummy tuck)

Abdominoplasty, commonly called a “tummy tuck”, is cosmetic or reconstructive surgery used to tighten muscles that have become loose or split, and to remove fat and excess loose skin from the abdomen. It can help restore weakened or separated muscles, ease discomfort, improve the contour of the abdomen, and reduce itching or skin infections caused by folds of excess skin.

In most cases, abdominoplasty changes the shape and tone of the abdomen to create a firmer, smoother profile. It is not a substitute for weight loss or exercise. In many people a flatter stomach can be achieved without surgery, through healthy eating and physical activity, but not always.

Many medical practitioners recommend that abdominoplasty be considered only after dieting and exercise have achieved the right body shape underneath.

If you are concerned about the way you look or are thinking about cosmetic treatments to boost your confidence, there are alternatives. These may include lifestyle changes, or talking to a counsellor or psychologist, which may help you overcome your concerns about your appearance.

Choosing a registered and accredited facility#

In many places, the law requires that all surgery, including cosmetic surgery, be carried out in a registered hospital or licensed day-procedure facility. Procedures such as liposuction, and the use of anaesthesia (including intravenous sedation and anything more than a low dose of local anaesthetic), should only be performed in a properly registered facility.

To check whether a facility is registered, you can ask to see its certificate of registration. This is usually on display where patients can see it easily. Local health authorities can also confirm whether a facility is registered and can receive reports of suspected unsafe or unlawful activity.

Things to consider before deciding to have abdominoplasty#

Before you choose to have abdominoplasty, keep some important points in mind:

• The results of abdominoplasty are considered permanent, but major changes in your weight after surgery can change how you look.
• If you are planning substantial weight loss or considering future pregnancies, it is better to postpone the operation.
• Abdominoplasty is not a treatment for stretch marks, although any stretch marks in the area of skin that is removed will go with that skin.

Think about the financial cost#

Ask your medical practitioner about any out-of-pocket costs you can expect, and whether any rebate may apply. If you have private health insurance, check what your policy covers.

Smoking and surgery#

Smoking increases the risk of complications during and after surgery. To reduce this risk, and for your general health and wellbeing, try to quit smoking before having surgery. Consider asking another medical practitioner for a second opinion.

Finding a qualified medical practitioner#

It is important to have as much information as possible before deciding to have abdominoplasty. This procedure should be done by a medical practitioner who is specially trained to perform it and who has considerable experience with this type of surgery. Ask to see the certificates that show the practitioner is qualified to perform this specialised surgery.

At your first consultation, ask the practitioner about their training and experience. You can also check that any doctor or anaesthetist treating you is properly registered with the relevant medical registration authority in your area.

Your current medical status and abdominoplasty#

If you are considering abdominoplasty, you need to discuss your current health with your medical practitioner. This includes:

• your physical health, including past medical history such as diseases, illnesses, surgeries and immunisations, and your current diet and exercise routine
• a general check of vital signs such as blood pressure, temperature, heart rate and rhythm, oxygen saturation and breathing rate
• your mental health, including any mental illness and its treatment
• medications you are currently taking, including vitamins and supplements
• past reactions to medications and any allergies you have

From this discussion, your practitioner can assess the risks and possible complications of surgery for you, and explain what preparations will help your recovery go as smoothly as possible.

What happens during surgery#

There are two main types of abdominoplasty:

• Full abdominoplasty, which removes excess skin and tightens the underlying muscles across the whole abdominal area, including around the navel.
• Partial abdominoplasty, which removes excess skin below the navel and tightens the lower abdominal muscles only.

The operation is usually performed under general anaesthetic#

The length of the operation depends on the extent of the surgery, but it can take up to three hours. Generally, a full abdominoplasty involves the following steps:

• The practitioner makes a horizontal, curved incision near the pubic hairline, running from one hip to the other.
• The skin and fatty tissue are lifted from the underlying tissue.
• The practitioner stitches and tightens slack or separated abdominal muscles.
• Excess fat is removed.
• Excess skin is trimmed.
• The navel is repositioned.
• The wounds are closed with stitches, tape or clips.

A registered anaesthetist should be present to treat you for any adverse reaction to the anaesthetic.

Immediately after abdominoplasty#

After the operation, you can expect:

• dressings or bandages on your abdomen
• a compression garment to help keep swelling down
• a drain in the wound to help prevent fluid build-up
• bruising and swelling
• probable numbness in the skin between the navel and the wound
• pain and discomfort
• an inability to stand up straight to begin with, and a “tugging” sensation at your abdomen

All surgery carries some degree of risk#

Some of the possible complications of abdominoplasty include:

• visible, prominent scars, including keloid and hypertrophic (raised, thickened) scars over healed incisions
• excess fluid building up under the skin (seroma) around the operated site, which may need one or more drainage procedures with a needle
• wound infection, which may need treatment with antibiotics
• pain and discomfort around the incision sites
• haematoma (a collection of blood around the surgical site that may need draining)
• numbness around operated sites, which in most cases is temporary and improves over many months
• areas of skin that do not heal and may need a skin graft
• difficulty bending forward because of the tightened skin
• the need for a blood transfusion in the unlikely event of major blood loss during surgery
• blood clots, which can become life-threatening if they travel to the lungs
• nausea and vomiting from the general anaesthetic

This is not a complete list. Your medical history or lifestyle may put you at increased risk of other complications. For example, people who are obese and who have abdominoplasty are more likely to develop a chest infection.

Self-care at home after abdominoplasty#

Be guided by your medical practitioner. General self-care suggestions include:

• rest as much as possible
• follow all instructions on looking after your wound
• avoid strenuous exercise or heavy lifting for at least one month
• report any bleeding, severe pain or unusual symptoms to your medical practitioner

Your practitioner may also advise you to wear compression stockings on your legs for seven to ten days after the operation to help prevent deep vein thrombosis, and to wear a compression garment over the surgical site for several weeks.

Long-term outlook following abdominoplasty#

Having an abdominoplasty will not stop you gaining weight in the future. Scarring is permanent but should fade in time. Be patient, as this may take around a year or so. Some puckering on the outside edge of the scar might remain.

Alternatives to abdominoplasty#

Other options include:

• eating a healthy, low-fat diet
• getting regular exercise
• wearing foundation garments to flatten the tummy area
• talking to a counsellor or psychologist, which may help you overcome your concerns about your appearance

Key points#

• People who are obese are at increased risk of complications from any surgery.
• It is important to have as much information as possible before deciding to have abdominoplasty.
• All surgery carries some degree of risk.
• Your medical history or lifestyle may put you at increased risk of other complications.
• Some puckering on the outside edge of the scar might remain.

Where to get help#