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Tummy tuck or abdominoplasty is a surgical operation to remove excess skin and fat from the middle and lower area of the abdomen and to tighten the muscles of the abdominal wall to reduce the appearance of a saggy or sticking out stomach. The abdomen (stomach area) is one of the most difficult places on the body for both men and women to lose weight. Women whose skin and muscle has been stretched by pregnancy, or those who have experienced weight gain followed by a significant weight loss can be good candidates as the abdomen becomes rounded with loose and sometimes overhanging skin. Tummy tucks are usually performed under a general anaesthetic. Some people return to work after two weeks, while others take three or four weeks to rest and recover from the surgery. It is unlikely that anyone considering a tummy tuck would be able to access this free of charge on the National Health Service (NHS). Private costs for an abdominoplasty can range from approximately £3,000 - £6,000.
As many of us know, the abdomen, or stomach area, is one of the most difficult places on the body for both men and women to lose weight. Even if you are in relatively good shape, many people are bothered by a large fat deposit and loose skin in this part of the body. This can be especially so for women whose skin and muscle has been stretched by pregnancy, making it extremely difficult, in some cases, to return to the same shape that they were before giving birth.
Weight gain followed by a significant loss in weight can be another reason why the abdomen becomes rounded with loose and sometimes overhanging skin.
Depending on the amount of fat, shape of the abdomen, looseness of the skin, and strength of the muscles underneath the skin, a less aggressive procedure known as liposuction may be recommended by a surgeon. Liposuction simply sucks the fat out from underneath the skin. However, if the skin is loose, and muscles are weak, a "tummy tuck" or abdominoplasty may help to restore your body shape.
This is a surgical operation to remove excess skin and fat from the middle and lower area of the abdomen and to tighten the muscles of the abdominal wall to reduce the appearance of a saggy or sticking out stomach.
According to 2017 statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), 140 834 tummy tucks (abdominoplasties) were performed in 2017 in the U.S., marking an increase of 4.8% on 2016 figures and making them the fifth most popular surgical treatment.
No official figures are yet available for the U.K., but tummy tucks are becoming increasingly popular in this country too.
If you are considering an abdominoplasty, the following information will give you a basic understanding of the procedure. It can't answer all your questions, since a lot depends on the individual patient and the surgeon. Please ask your surgeon about anything you don't understand.
Your first discussion with a surgeon should clearly set out your expectations and whether the operation can give you the results you desire.
Careful discussions regarding the reasons for wanting a tummy tuck and your suitability for this type of surgery are very important at this stage. Make sure that you obtain as much information as necessary to enable you to make a fully informed choice and make sure you receive satisfactory answers to all your questions.
If, for example, your fat deposits are only in the area below the navel, you may require a less complex procedure called a partial abdominoplasty, or “mini-tummy tuck”. You may, on the other hand, benefit more from partial or complete abdominoplasty done at the same time as liposuction to remove fat deposits from the hips, for a better bodyshape. Or maybe liposuction alone would create the best result for you.
A medical history should also be taken to make sure that there are no reasons why you shouldn’t have this operation. You would normally be asked to sign a consent form which means that you have understood the potential benefits and risks associated with an abdominoplasty.
Photographs may also be taken by the practitioner as a "before and after" comparison at a later date.
The surgeon may also wish to write to your G.P. giving details of the operation so that if there are any problems associated with surgery in the short or long-term, your doctor is aware of the procedure and can help you to recover.
Tummy tucks are usually performed under a general anaesthetic. Alternatives include an epidural anaesthetic injection (sometimes used in childbirth) which will numb the area from the waist down, combined with a sedative to make you drowsy, so that you remain awake but feel very little discomfort.
Please take into account that a general anaesthetic carries more potential risks – this should be clearly explained by the surgeon before you make any decisions about the anaesthetic.
If you make a decision to go ahead with a tummy tuck, the actual procedure may take place in an outpatient surgical clinic, but most surgeons and patients prefer a hospital setting where you can recover overnight.
An abdominoplasty usually takes two to five hours, depending on the extent of work required, and whether any combined procedures such as liposuction are involved. Partial abdominoplasty may take an hour or two.
During the operation, a large cut is made which runs across the lower abdomen, just above the pubic area. The skin is then separated from the abdominal wall between the incision above the pubic hair right up to the navel. Fat deposits are removed and the skin is stretched down to the incision line, with the excess skin removed before it is restitched. If the navel is not repositioned, it can be pulled into an unnatural shape as the skin is tightened and stitched.
During the operation, a large cut is made which runs across the lower abdomen, usually from hipbone to hipbone, just above the pubic area. A second incision is then made to free the navel (tummy button) from surrounding tissue. Next the skin is separated from the abdominal wall all the way up to the ribcage to reveal the abdominal muscles.
The muscles are then pulled and tightened and stitched into position to provide a firmer abdominal wall which provides the foundation for a slimmer waistline. Fat deposits may also be removed. The skin is then stretched down, with the excess skin again being removed. A new hole is then usually cut for your navel. Next, the navel is stitched back into place and the original incision is closed as the tightened skin is stitched back into place.
After an abdominoplasty, dressings will be applied, and a temporary tube may be inserted to drain excess fluid from the area of surgery. Firm elastic bandages are then applied to support the area.
Depending on the extent of the procedure, you may be released to go home after a few hours, or stay in hospital for 1 or 2 days.
An abdominoplasty is a major surgical procedure, so expect to be out of action for a while. Some people return to work after two weeks, while others take three or four weeks to rest and recover.
Side Effects and Risks
For the first few days following surgery, the abdomen will feel swollen and tight with some pain and discomfort.
At first you may not be able to stand up straight without feeling a tugging sensation, but you should start walking as soon as possible.
Bruising after the surgery is usually quite light but swelling is substantial and it can take up to three months to disappear. Risks also include numbness of the abdominal skin and it may take several months for the sensation to return.
Like all surgical procedures, there is always a possibility of complications or side effects and, although rare, these can include infection, a reaction to the anaesthesia, blood or fluid collection underneath the skin, nerve damage, blood clots, and an irregular or a “lop-sided” appearance after the operation.
The surgery does produce a permanent scar which, depending on the extent of the procedure, may extend from hip to hip. Your scars may actually appear to worsen during the first three to six months as they heal, but this is normal. Expect it to take nine months to a year before your scars flatten out and lighten in colour. While they'll never disappear completely, abdominal scars will not show under most clothing.
It may take you weeks or months to feel like your old self again. If you start out in top physical condition with strong abdominal muscles, recovery from this procedure will be much faster than if you are out of shape when you have the operation.
It is very important that you follow the advice of your surgeon carefully after an abdominoplasty.
Post-surgery advice may include:
There are few absolute medical reasons why you should not undergo an abdominoplasty as long as you are in good general health and have realistic expectations of this treatment.
A tummy tuck, however, is not an alternative to losing weight. In fact, many surgeons will suggest alternatives to surgery for patients who are more than 15 percent over their ideal body weight.
Also, if you are considering losing weight, you should wait until after your desired weight is met before having a tummy tuck. You may need additional surgery to remove the excess skin after you have lost the desired weight which would mean that the money spent on the previous abdominoplasty would be wasted.
If you have experienced healing problems with any past surgical treatments or if you are prone to keloid (red, angry, raised) scars, your surgeon may not recommend an abdominoplasty or may caution you that scars could be raised and very visible.
If you are a woman planning a future pregnancy, you may also be a poor candidate for a tummy tuck because the vertical muscles in the abdomen that are tightened during surgery can separate again during pregnancy.
Who Can Do It
Only fully trained and qualified surgeons should perform an abdominoplasty or tummy tuck procedure.
For more information about practitioner training, qualifications and relevant medical organisations please view the information contained within the Legislation section of the Consulting Room.
It is unlikely that anyone considering a tummy tuck would be able to access this free of charge on the National Health Service (NHS).
However certain regions do make special cases for free plastic and cosmetic surgery and we would always recommend that you visit your General Practitioner before embarking upon a major cosmetic procedure. As well as their advice and guidance they may also be able to refer you to a local NHS Hospital who can treat you.
The NHS has set out the following guidelines on how to get cosmetic surgery through the NHS:
"To qualify for surgery on the NHS you must meet specific criteria as set out by your local health authority. The NHS will not pay for surgery for cosmetic reasons alone. Reconstructive and cosmetic surgery to correct, or improve, congenital abnormalities and injuries will usually be carried out free of charge.
NHS reconstructive surgery is performed by plastic surgeons who have had extensive training and belong to the British Association of Plastic Reconstructive and Aesthetic Surgeons. Surgeons who carry out cosmetic surgery through the NHS also belong to the British Association of Aesthetic Plastic Surgeons.
To receive cosmetic surgery from the NHS, you will normally need a referral from your GP. You will have a consultation with a plastic surgeon and an assessment by a psychiatrist, or psychologist. It will then be decided whether there is enough social, psychological, or physical benefit to be gained to justify surgery."
Prices for a private abdominoplasty can range from £3,000 - £6,000.
Thousands of abdominoplasties are performed successfully each year. When done by a qualified plastic surgeon who is trained in body re-shaping, the results are generally quite positive.
However, because tummy tucks are major procedures, they carry an increased risk of complications, and longer recovery times than other forms of cosmetic surgery.
It is also very important for you to describe exactly how you envisage the final cosmetic result with an experienced surgeon who also performs liposuction so that they can assess you properly and recommend the most appropriate procedure, or combination of procedures for you.
The longevity of results is difficult to predict, and depend upon maintaining good control over excessive weight fluctuation causing the skin to stretch, following the procedure. Your surgeon will discuss predicted duration of results with you from their own experience and the experience of their colleagues.
Before and After Pictures
Please note that results of cosmetic surgery vary enormously, depending upon both the patient and the skill of the individual surgeon, so outcomes for procedures will always be more variable than those for less invasive non-surgical treatments.
(All before and after photographs featured are real patients treated by highly experienced surgeons, your results may differ).
Front and side views of female abdomen with stretch marks before abdominoplasty (tummy tuck) surgery and 6 months after.
Tummy Tuck (Abdominoplasty) Before and after pictures courtesy of Consultant Plastic Surgeon, Mr Christopher Inglefield, BSc, MBBS, FRCS (Plast) at London Bridge Plastic Surgery.