A protuberant abdomen can be a cause of distress for men and women alike. While some have lost significant weight in a short time and are plagued by excessive loose hanging skin, others have gone through the vagaries of pregnancies and their abdomen never really bounced back to the original shape. Tummy tuck then serves as the only hope for them to look and feel “normal” again. Although the surgery leaves a horizontal scar that is usually hidden in the panty line, it’s only a small price to pay for a flat and taut abdomen. Once stretched by pregnancy or weight gain, the abdomen often fails to return to its original shape. Stretched beyond the capacity to return to normal, these tissues, fail to respond to exercise or diet programs. Apart from body image issues, need to wear pants bigger than the waist size to accommodate all that belly tissue, excessive belly folds lead to frequent intertrigo (an inflammatory condition of the skin) due to trapped moisture and friction between the skin folds. In these cases, abdominoplasty can provide a long-term solution. Abdominoplasty or ‘tummy tuck,’ is a surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the overly stretched muscles of the abdominal wall. Suitable candidates include those with loosely hanging folds of fat and excess skin due to post-pregnancy stretching, chronic obesity and also those who have undergone a massive weight loss in a short period of time – after bariatric surgery or diet regimes - but are left with loose folds of excess skin after the weight loss.
Q. What are the medical benefits of a tummy tuck?
A: After extreme weight loss or multiple pregnancies, abdominal muscles usually become weak, and are often associated with lordosis, or sway back. A tummy tuck helps in tightening these weak muscles, in addition to removing excess skin and fat that had been putting a load on the lumbar spine. After the surgery, therefore, such patients may notice a significant improvement in their posture and relief in certain types of back pain.
Sometimes abdominal muscle weakness leads to a ventral hernia through which the intestine or abdominal tissue protrude and form a pocket or sack. Tummy Tuck and Ventral hernia repair, both require correction of weakened adnominal muscles. If you go in primarily for a Tummy tuck, an incidental finding of ventral hernia can thus be corrected in the same sitting by strengthening the abdominal wall. Alternatively, if your primary concern is hernia repair, your surgeon might consider a combined surgery with a tummy tuck. This combination surgery is safe as well as practical, as it can reduce medical expenses and recovery time.
Q: Who are the best candidates for Tummy Tuck surgery?
A: The best candidates for abdominoplasty are men or women who are in relatively good shape but are bothered by a large fat deposit with loose abdominal skin that won't respond to diet or exercise. The surgery is particularly helpful to women who, through multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where they can return to normal. For those who have experienced a massive weight loss and are left with the excess of loose skin also require this surgery. It is, however, best to postpone this surgery if you are planning to lose more weight until you have achieved your weight loss goals and the same goes for women who are planning future pregnancies. As the tightened muscles can separate again during pregnancy, requiring a tummy tuck again, its best to go for the surgery after having completed the family.
Q: What are the various procedures to get a flat tummy?
A: There are three basic techniques used to flatten a protuberant abdomen. The best technique for you will depend largely on your goals and your specific problem.
If there is a moderate amount of fat and skin tone is good without sagging, Liposuction alone can produce a thin abdominal wall.
If your laxity and excess skin is below your navel, a mini tummy tuck may be right for you.
For those with severe laxity of their abdominal muscle or excessive skin, a full tummy tuck may be their only solution.
Q. What is the difference between a Full Tummy Tuck and a Mini Tummy Tuck?
A: There are two types of Tummy Tuck surgery, and we choose the most suitable one after thorough assessment during the consultation:
Complete Abdominoplasty or Full Tummy Tuck – This is generally employed when abdominal muscles need tightening both above and below the belly button. After removal of excess skin and fat, the abdominal skin is pulled downwards to ensure a taut abdomen, the belly button is moved and repositioned in a natural orientation. Additionally, liposuction is often combined with the procedure to sculpt and contour the flanks.
Mini Abdominoplasty (Mini Tummy Tuck) – It is recommended when excess skin and the loose abdominal muscles are confined only to the lower abdomen, below the belly button. This is a less extensive surgery than the full tummy-tuck and involves a smaller incision to remove excess fat and skin. Since abdominal muscle tightening is required only in the lower half, the naval or the belly button doesn’t need repositioning and is just pulled a bit lower.
Q: What is the difference between Liposuction and Tummy Tuck?
A: Liposuction is a less invasive procedure than Tummy Tuck since it targets only the fat deposits and does not involve removal of excess skin. Liposuction is, therefore, an excellent procedure for patients who have excess fat but still have good tone in the abdominal skin, as the skin will shrink after the surgery. Liposuction, however, does not reduce the stretch marks, but sometimes can even make them worse, with a now lax skin if the skin tone is not that good.
A tummy tuck, on the other hand, is more suitable for those who have excess skin or significant stretch marks. Frequently liposuction of flanks and upper abdomen is combined with tummy tuck surgery. This is recommended for people with excess skin, and fat in patients with excess weight and with the only excess skin after significant weight loss or after bariatric surgery.
During the consultation, we conduct a 360-degree evaluation and suggest the best-suited option for a particular patient keeping the individual needs, wants and goals in mind.
Q: What is a suitable age for a tummy tuck?
A: There is no optimal age for a tummy tuck surgery. We generally do not recommend it for individuals younger than 18 years old. However, women of childbearing age should consider delaying having a tummy tuck until they complete their family.
Q: How is the Abdominoplasty or Tummy Tuck surgery performed?
A: A tummy tuck surgery is always done in a hospital set up and is usually performed under epidural anesthesia combined with either sedation or general anaesthesia. A full tummy tuck involves an incision around the belly button and another incision that runs from hip to hip on the underside of the lower belly. The entire abdominal wall musculature is tightened with permanent sutures and the excess skin and fat from the lower abdomen are removed. If additional liposuction is required for flanks and upper abdomen, it is done at this stage. Finally, the upper abdomen skin is pulled down and sutured at the hip to hip incision line. Small drains are temporarily placed to eliminate any fluid collection. Snug elastic bandages are then applied to the area. The scar of this incision faints over time and is usually hidden in the panty line.
Q: What Happens to the Belly Button after a Tummy Tuck?
A: During a full tummy tuck, a small incision is made around the belly button to release it from the surrounding skin. Once the excess skin and fat are excised and the skin tissue pulled downwards to give a taut belly, the belly button is moved and repositioned on the stomach. Creating the belly button is one of the most important steps in tummy tuck surgery and care is taken to not only position it in a natural spot on the belly but to make it more appealing. Only a surgeon with experience and good aesthetic sense will be able to achieve a most natural result.
In a mini tummy tuck, on the other hand, there is no need to reposition the belly button at all. It is instead pulled a bit downwards.
Q: How long does the tummy tuck surgery take?
A: A full abdominoplasty takes about 3 to 5 hours depending on the amount of fat and skin to be removed and the amount of muscle repair needed. The patient usually needs to spend two nights in the hospital postoperatively.
Q: What are the preoperative considerations that need to be kept in mind?
A: In the preoperative period, you should follow the doctor’s instructions regarding medications to be taken for any co-existing illness or any investigations to be done. You need to follow the instructions given during Pre-Anaesthesia checkup. Other than that you must take light meals and should abstain from alcohol. If you are a smoker, it is advisable to quit smoking at least one month prior to surgery and also postoperatively until complete healing has been achieved. This is because smoking interferes with the natural wound healing mechanisms of our body.
Q: How is the recovery after tummy tuck surgery?
A: Postoperatively, you should follow the doctor’s advice regarding painkillers or any other medication and maintain a good personal hygiene. You will also need to wear a compression garment for the first few weeks. After a bed rest for two to three days is you will be encouraged to walk a little thereafter. Although straining, heavy lifting and bending should be avoided for about six weeks postoperatively, leg exercises should begin on the day of the surgery. The drains usually remain in place for few days until discharge fluids decrease and sutures are removed in 1-2 weeks. We recommend a couple of pillows under the knees and behind the head while sleeping as they will ease the tension on the surgical incision and will help relieve some discomfort. The scar on lower abdomen usually fades significantly over time. Most patients are back to work within one to three weeks, depending on the degree of surgery.
Q: How much pain will I experience?
A: Following a tummy tuck, you will experience some tightness around the abdomen. The soreness is equivalent to the discomfort seen after a high-intensity abdominal workout. This is due to the tightening of the musculature of the abdominal wall and the discomfort is usually a sign of a good tummy tuck job. Additionally, liposuction in the upper abdominal area and love handles area may cause some bruising and swelling. However, these symptoms are usually well tolerated and treated with mild oral medication and subside after a few days.
Q: How long do I need to stay in a hospital?
A: We recommend a minimum stay in the hospital for two nights postoperatively. On the third morning, usually the drains are removed and the incision is cleaned and dressed before discharge. Travel is discouraged for at least a weeks time and preferably until sutures are removed.
Q: When can one begin to work?
A: Patients with jobs requiring significant physical activity need about four to five weeks off before being able to resume their duties comfortably. In case of office work, however, one can return to work after one to two weeks.
Q: When can I restart gym activities?
A: Light workouts that do not involve core strengthening or weight lifting can begin at three to four weeks post-op. Heavier workouts, however, should be restricted for about six weeks.
Q: How bad is the scar after tummy tuck?
A: Although tummy tuck will leave you with a noticeable scar, one should keep it in mind that the incision is placed below the bikini line and hence it is concealed within the undergarments. Initially, the scar may look swollen and red after the surgery, but over time the scar it usually fades to a lighter colour and becomes softer.
Q: What happens if I decide to have another baby after a tummy tuck?
A: A tummy tuck does not prevent a woman from carrying a baby to full term. But one must keep in mind that the results of a previous tummy tuck surgery may not last after the pregnancy as further stretching of abdominal muscles and skin and weight gain occurs. It is therefore recommended to undergo a tummy tuck only once you have planning to have no more children.
If, however, you wish to have another child after a tummy tuck, it is important to discuss this with your plastic surgeon. He might recommend you to wait for some time to allow the abdominal wall to heal before you try for another baby.
Q: Can I have other procedures along with a Tummy Tuck?
A: Many people choose to have a tummy tuck alongside other cosmetic procedures. This is especially true for medical tourists, as they would like to get as many procedures done in a short time. Popular procedures that can be combined with a tummy tuck augmentation mammoplasty, liposuction, mamopexy and arm lift or brachioplasty.