There are three major sources of cosmetic dissatisfaction at the abdomen: loose skin, extra fat, and muscle weakness. These problems most often result from pregnancy, but also can develop as a function of aging or weight loss in men or women. Abdominoplasty (or tummy tuck) can correct much of this damage by tightening the skin, reducing the extra fat, and repairing the muscle weakness. Candidates include almost everyone with these problems, since diet and exercise are usually ineffective in correcting them.
After pregnancy, no woman is immune to the changes that can occur in the abdomen. Even in those who are physically fit, skin elasticity can dramatically worsen, creating stretch marks and crinkly, loose or overhanging skin. Fat deposits often develop in a violin shape at the central abdomen and may not go away even at ideal body weight. The rectus abdominal muscles that connect from the ribs to the pubic bone may splay to the sides leaving a gap referred to as rectus diastasis. The gap can contribute to a rounded appearance of the abdomen that mimics the bulge of pregnancy and squares off the waistline. Despite diet and exercise, the cosmetic appearance of the abdomen is often a dramatic disconnect from the rest of the otherwise youthful body. Frustration fitting into clothing, reliance on spanx garments to improve contour, or self-consciousness about exposing damaged skin in a bathing suit often prompts treatment.
The procedure itself is customized to address the areas of concern. Skin laxity is treated with skin removal and tightening. A ‘full’ tummy tuck removes skin from the level of the belly button down to near the pubic hairline. The upper abdominal skin is window-shaded down to close the gap producing a low hip-to hip scar that is strategically designed to fall under most undergarments or bathing suits. A ‘mini’ tummy tuck removes a smaller amount of loose skin above the pubic region resulting in a shorter scar. Few women are candidates for a ‘mini’, however, since skin laxity around the belly button and upper abdomen is not addressed. Through either a ‘full’ or ‘mini’ approach, the rectus diastasis when present is repaired with sutures that function as an internal corset to flatten the abdominal contour and define the waistline. Fat beneath the remaining skin of the upper abdomen is either directly excised or removed with liposuction.
A well-performed tummy tuck restores aesthetic balance. The skin appears tighter and more youthful, the fat beneath the skin is proportionate to the rest of the body, and the abdomen is flatter with preservation of the natural, gentle convexity of the lower abdomen. Particular care is taken to recreate a natural-looking belly button with minimal visible scarring to avoid the telltale signs of surgery.
Full recovery varies from a few weeks to a few months if muscle repair is required. Since childcare is often an issue, it is necessary to find support from a parent, husband or nanny for at least a week and preferably two. One can resume driving and running basic errands at this time, but it is important to limit heavy lifting and core work for at least two months to allow the muscle repair to heal. Results are immediate, but some swelling can persist for a few months. The scar itself softens and fades over 6 to 12 months. The procedure is not a substitute for exercise and weight loss. In fact, the most impressive results often are seen when the surgical result motivates one to lose any extra weight and strengthen the core.