What is an abdominoplasty (tummy tuck)?

One of the most satisfying procedures in plastic surgery for both men and women is an  abdominoplasty, commonly known as a “tummy tuck.” This procedure addresses two specific goals in achieving a more slim figure: 1) to eliminate excessive fat and skin of the abdomen, and 2) to tighten the internal fascia (or, “girdle”) of the abdominal wall. The abdomen has historically been the most difficult area to improve with simple diet and exercise. In addition, certain life changes such as pregnancy and rapid weight loss may weaken the internal support of the abdominal wall or cause excessive redundancy of skin. Liposuction is usually unhelpful in these types of individuals. However, liposuction is frequently combined in order to shape and define the torso. In the correct patient, the satisfaction rate can be quite high. However, it is important to understand that the trade-off is a relatively long scar in the lower abdomen which is usually covered by underwear or a swimsuit.

Schematic of tummy tuck (abdominoplasty) before and after.There are variations of a tummy tuck that may be more amenable to different patients. A common alternative is the “mini-tummy tuck.” This is not indicated in all patients and typically is best used in patients who have a stubborn lower abdominal “pooch” between the belly button and the pubis. Another variation on an abdominoplasty is the panniculectomy. This usually addresses a large, overhanging section of skin and fat below the belly button and occurs most often in overweight patients or those who have experienced rapid weight loss such as following gastric bypass surgery. The goal of this type of surgery is to relieve the pain, weight, and infections that can result from such a large mass folding over the beltline.

An abdominoplasty may be combined with other procedures, such as breast augmentation, breast reduction, or breast lift. These combined breast and body procedures are frequently referred to as a “mommy makeover.”

During Dr. Panossian’s consultation, the various options for abdominoplasty will be reviewed, with particular focus on each individual’s best option.


How is an abdominoplasty performed?

Schematic of tummy tuck (abdominoplasty) incisions.

An abdominoplasty typically takes between three and four hours to complete, depending on the degree of work required. A “mini–tummy tuck” may take two hours or less.

A long incision is made from hip to hip, dipping just above the pubic area. A second incision is made around the navel to allow the abdominal skin and fat to slide downward. 

The skin is then separated from the tough outer lining of the abdominal wall (fascia) all the way up to the level of the ribs. This simultaneously exposes the rectus muscles and the midline of the abdominal wall around the navel. These muscles are then tightened in order to flatten the overall abdominal contour much like a girdle. This has the effect of narrowing the waistline and creating a more firm abdomen. The skin flap is then advanced and the excessive portions of both fat and skin are removed. The new position of the navel is then created and the flap is inset with sutures. Drains may or may not be used.

In a mini-tummy tuck, the process is much more simple. There is usually no muscle work required and only the skin between the navel and incision is addressed. And a panniculectomy, only the portion of skin and fat overhanging the beltline is addressed. This may or may not be combined with tightening of the abdominal muscles.


What is the recovery?

Following an abdominoplasty, use of a specific compressive body garment or abdominal binder will be required. Use of this support garment will be required for approximately 6 weeks. Your abdomen will be swollen and feel tight. An “old lady” type posture with flexion at the hips will be required for the first week following surgery. Walking is encouraged on the first postoperative day. A short course of antibiotics may also be provided.

Stitches on the skin will be removed within 7 days, while deeper sutures will be removed in 2 to 3 weeks. Special tape may be used on the incision itself for several weeks following surgery. If drains were placed, they will be removed between 2 and 7 days following surgery.

You will start feeling like your old self 3 to 6 weeks after surgery. A minimum time off from work of 2 weeks is highly recommended. Light exercise is recommended, however, aggressive exercise, heavy lifting, or sports are to be avoided for 6 weeks.

The actual scars may appear to worsen over the initial month following surgery. However, this is normal and can be expected to improve over the course of 6 to 9 months. Scars sometimes require up to a year or more to flatten and fade, but they are typically concealed under most clothing, including bathing suits. Dr. Panossian’s unique scar management protocol will help you achieve the best possible results.


What are the risks and complications?

As with other surgical procedures, there are inherent risks such as bleeding, infection, or difficulties with anesthesia. In addition, there are known risks of developing blood clots in the legs. Thankfully, this is a rare complication, and the risk can be minimized by walking and moving around in the early postoperative period. Dr. Panossian also uses leg compression garments and an additional compression device on the legs during surgery to greatly decrease the risk of blood clots.

Poor healing can include problems such as keloids or a small opening in the incision line. Although it is difficult to determine who develops a thick scar or a keloid, delayed wound healing or partial wound dehiscence is more commonly associated with smokers or diabetic patients. 

Your risk of developing complications is greatly minimized by closely heeding Dr. Panossian’s instructions before and after surgery, especially with regard to activity restrictions. Dr. passings staff is available at all times to clarify instructions and to address any problems that might arise.