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Tummy Tuck

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A tummy tuck, or abdominoplasty, is a procedure that removes loose, excess skin from the abdomen and tightens the abdominal muscles to create a flatter and slimmer midsection. If you are not happy with the way your stomach looks, a tummy tuck may be an excellent solution. In fact, in 2019, more than 118,000 people had tummy tuck surgery. [1]

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Pregnancy, aging, genetics, and weight loss can affect the tissues of the abdomen, and often surgery is the only way to resolve the aesthetic and functional problems that patients experience. Abdominoplasties are tailored to a patient’s unique anatomy and concerns, and there are various tummy tuck techniques that can be performed to address different levels of skin laxity or muscle weakness.[2]

If you are interested in learning which tummy tuck method would work best to reach your cosmetic goals, you can contact our office at www.stevenwallachmd.com in New York to schedule your consultation with Dr. Steven Wallach. You can reach his Manhattan office by calling (212) 861-6400. 

Contents

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  1. About
    1. Tummy tuck with liposuction
  2. Benefits
  3. Candidates
  4. Personal Consultation
  5. Preparation
  6. Procedure
    1. Endoscopic abdominoplasty
    2. Mini abdominoplasty (mini tummy tuck)
    3. Modified full abdominoplasty
    4. Full abdominoplasty (traditional tummy tuck)
    5. Extended abdominoplasty
    6. Circumferential abdominoplasty (lower body lift)
    7. Reverse abdominoplasty
  7. Recovery
  8. Results
  9. Corresponding and Complementary Procedures 
  10. Cost
  11. References
  12. FAQs

About

Tummy tuck surgery is a highly versatile procedure that can slim down the abdomen, firm up abdominal muscles, and generally enhance the appearance of the midsection. During the procedure, incisions on the lower abdomen allow the surgeon to remove excess skin and fat as well as address the abdominal muscles. Pregnancy and aging can lead to a condition called diastasis recti, in which the rectus abdominal muscles become separated. This can impact the appearance of the midsection, as well as cause other uncomfortable symptoms as a result of the weakened muscles. A tummy tuck can repair this muscle damage, but can also have considerable aesthetic benefits for those without the condition.[2]

For massive weight loss patients or for those with severe skin laxity, more extensive skin excision along the hips and buttocks may be required.  This is referred to as an extended tummy tuck or a circumferential tummy tuck. The goal of any tummy tuck surgery is to provide the best contours with the least amount of scarring.

TUMMY TUCK WITH LIPOSUCTION

Liposuction can be combined with these techniques to improve the contour further. This combination treatment is known as lipoabdominoplasty. Patients often request liposuction alone to treat their abdominal contour problems, but if they have significant skin laxity and/or weak abdominal muscles, then an abdominoplasty will also need to be performed. For more information regarding abdominoplasty, and the other procedures that Dr. Wallach performs, you can also visit our blog.

“I believe true confidence comes from a feeling of self-assuredness from one’s inner self. However, I also believe that it is heavily impacted by a lack of confidence with one’s outside appearance as well. Plastic surgery can help improve confidence in this way.”

– Steven Wallach, MD

Benefits

A tummy tuck procedure is customized to individuals’ specific interests, needs, and conditions. Dr. Wallach has presented at national meetings and published journal articles on abdominal contour procedures, so patients have the advantage of a leading authority when they choose Dr. Wallach for their abdominoplasty.

Candidates

A good candidate for a tummy tuck is healthy and desires a functional or aesthetic improvement in their abdominal region. People who are unhappy with excess skin, fat, or weakened muscles after significant weight loss or pregnancy are often good candidates for tummy tuck surgery. 

Ideally, you want to have a tummy tuck after your last pregnancy, but we have had a few patients that went on to get pregnant after a tummy tuck, and still enjoyed their results after giving birth. Candidates for any plastic surgery procedure should be generally healthy, be at a stable weight, and have reasonable expectations for their tummy tuck results.

If your BMI is over 30, you are at higher risk for complications. You do not have to be “skinny” to have a tummy tuck, however having a lower BMI will likely give you a nicer result.

It is always best to get down to your ideal weight prior to having a surgical procedure. The results of an abdominoplasty are better and the surgical risks are lower for healthy patients. That being said, if you are close to your ideal weight you will also have considerable advantages.

Personal Consultation

During a tummy tuck consultation, you will spend extensive and valuable time with Dr. Wallach reviewing your surgical goals. An exam will be performed and a surgical plan will be discussed with you at length, including preparation, recovery, and results.

If you would like more information about Dr. Steven Wallach and his success with New York City tummy tuck (abdominoplasty) procedures, don’t hesitate to contact our Manhattan office at (212) 861-6400 or use our online contact form to request additional details or to schedule your consultation appointment.

Preparation

Patients should not take anti-inflammatory medication or smoke for the weeks leading up to their surgery. NSAIDs can thin the blood and lead to unnecessary bleeding during surgery, and nicotine products impede the proper circulation necessary for healing. Antibiotics will be prescribed for you to eliminate the risk of infection, and a prescription for pain medication will be provided to ensure a smooth recovery. [3] Individualized preparatory instructions will be provided to each patient as well as information about what to expect during their recovery. 

Procedure

A tummy tuck is typically performed under general anesthesia. Incisions are made just above the pubic hairline, and around the umbilicus, or belly button, which will stay in its natural location and attached to the abdominal wall. The abdominal skin above the incision is separated from the muscle fascia and excess skin is removed. Sometimes liposuction is performed as well to remove excess fat. Muscle weakness can be treated by suturing the inner edges of the rectus abdominis muscles together to strengthen the core. The skin is then redraped, and if necessary, a new opening for the umbilicus is made in the overlying skin. The incisions are closed with absorbable sutures, and drains may be placed as well to prevent fluid buildup in the treatment area.

Most of the abdominoplasty procedures described take between two and three hours to perform with a recuperation time of one to two weeks. The circumferential abdominoplasty is more involved, and can take four to six hours to perform. 

Below are the different tummy tuck methods performed:

ENDOSCOPIC ABDOMINOPLASTY

Indications

Endoscopic abdominoplasty is for a patient that has very little to no skin laxity or subcutaneous fat and has mainly midline muscle laxity.

Procedure

Endoscopic equipment equipped with a small camera is used to gain access to the treatment area through two or three small incisions. This allows Dr. Wallach to visualize the area between the muscle fascia and the overlying subcutaneous tissue so that the midline muscular laxity can be treated. Liposuction can also be performed in conjunction with this procedure if desired.

Advantages

  • Two to three very small limited incisions are used for more favorable scarring. Liposuction of the entire abdomen can be performed at the same time.

Disadvantages

  • This procedure is performed on very few patients. It can repair separated abdominal muscles, but it cannot treat skin laxity.

MINI ABDOMINOPLASTY (MINI TUMMY TUCK)

Indications

A mini tummy tuck is for patients who have excess or loose skin and some subcutaneous fat in the area between the belly button and the pubic region. The procedure is often best for thinner patients. This does not address muscle tightening in the area above the belly button.

Procedure

A small ellipse of skin and fat is removed from the lower abdomen. The final incision is not much larger than that of a cesarean section. The belly button is not usually detached from the surrounding tissues. The musculature from the belly button down to the pubic region can be easily tightened. Because of the limited undermining of soft tissue, liposuction can be performed on the entire abdomen and hips.

Advantages

  • A short incision is used. Liposuction of the entire abdomen can be easily performed in conjunction with this procedure.

Disadvantages

  • The musculature from the upper midline to the umbilicus can be difficult to tighten with this incision technique. 
  • A mini tummy tuck does not treat the upper abdomen and skin laxity above or around the umbilicus.

MODIFIED FULL ABDOMINOPLASTY

Indications

A modified full tummy tuck is indicated for patients in Manhattan that require a full abdominoplasty but have abdominal incisions from other surgical procedures that may impact the viability of the tissues elevated (i.e. an open gallbladder surgical incision). Most full tummy tuck patients have a lot of skin laxity and may have a significant amount of abdominal subcutaneous fat. There may also be midline muscle laxity. This technique is used when there are previous surgical scars that would impact performing a full abdominoplasty safely.

Procedure

An ellipse of skin and subcutaneous fat is removed from the lower abdomen. Undermining of the upper abdominal tissues is performed in a limited fashion to maximize the blood supply to the tissues that may have diminished circulation due to the previous surgical incisions. Treatment of muscular laxity is performed. Liposuction can also be done selectively. The belly button is detached from surrounding loose skin and is re-inserted after the upper abdominal skin is re-draped and sutured to the lower abdominal incision.

Advantages

  • The incision may be shorter than a full tummy tuck. Lax skin can be treated better than a mini tummy tuck or endoscopic abdominoplasty. Lax midline muscles can be tightened easily. Laxity around the umbilicus can be treated.

Disadvantages

  • A longer incision than used for a mini abdominoplasty or endoscopic abdominoplasty is needed, resulting in longer tummy tuck scars. There may be residual skin redundancy because of limited undermining. Liposuction has to be performed selectively to avoid compromising the blood supply to the skin and subcutaneous tissue.

FULL ABDOMINOPLASTY (TRADITIONAL TUMMY TUCK)

Indications

A full abdominoplasty, or traditional tummy tuck, is indicated for a patient who has a lot of skin redundancy in both the lower and upper abdomen. The patient also has midline muscular weakness and may or may not have significant subcutaneous abdominal fat.

Procedure

An ellipse of skin and subcutaneous fat is removed from the lower abdomen. The upper abdominal skin and subcutaneous fat are elevated more extensively than during a modified full abdominoplasty. The midline muscular weakness is tightened. The umbilicus is reinserted into the upper abdominal skin flap after the flap has been re-draped and sutured to the lower abdominal incision. Liposuction can be selectively performed if desired.

Advantages

  • Lax skin from above and below the belly button can be treated successfully with this technique, thus making it a more comprehensive procedure than other approaches. Lax or separated muscles can be tightened easily. Laxity around the belly button can also be treated.

Disadvantages

  • It requires a long incision along the lower pubic region. Liposuction needs to be performed selectively to maintain the blood supply to the abdominal flap and subcutaneous tissue.

EXTENDED ABDOMINOPLASTY

When a patient has had massive weight loss (more than 100 lbs) through either diet and exercise or surgery, oftentimes their skin is very loose. In some patients, a full abdominoplasty is an option. But if the laxity of the tissues is more severe, extended abdominoplasty may be more prudent and give a better result. An in-office evaluation is always best to perform a proper exam and review a patient’s goals.

CIRCUMFERENTIAL ABDOMINOPLASTY (LOWER BODY LIFT)

A circumferential abdominoplasty or lower body lift is a procedure often reserved for patients who have undergone bariatric surgery and have experienced massive weight loss, and thus have a significant amount of excess skin. This is just one of the post-bariatric surgeries that Dr. Wallach performs for patients who have completed a weight loss journey.

REVERSE ABDOMINOPLASTY

A reverse abdominoplasty is exactly what it sounds like. Instead of elevating the tissue from an incision in the lower abdomen by the pubic hairline, the incision is made under the breast creases and the excess skin is brought out through this region. This is a procedure that is performed in patients that have isolated laxity in the upper abdomen. This may occur after a mini tummy tuck or even after a full tummy tuck. If the patient has had a previous breast procedure leaving an incision under the breast folds then using these same incisions may be possible.

Recovery

Most of the pain from a tummy tuck will diminish significantly after about 7-10 days. You can have a regular diet after the first night. Patients usually wear a binder for about 3-6 weeks. Usually, patients can start light aerobics after about 3 weeks and heavy lifting at about 6 weeks. Most patients can go back to wearing regular clothes within a few weeks after surgery.

Results

Patients will see a significant improvement in their midsection once the swelling subsides. The incision is usually low on the abdomen just about at the level of the pubic hairline. A tummy tuck will give a long-lasting result, but please remember increasing age and weight fluctuation can affect long-term results.

Corresponding and Complementary Procedures 

Liposuction is very often performed with tummy tuck procedures. In fact, it is often easier to do at the same time as other surgical procedures, because the incision allows Dr. Wallach access to the treatment areas. Fat for injection to the face can be harvested from the discarded tissue during the abdominoplasty. Sometimes, breast augmentation can be performed through the abdominoplasty incision to avoid incisions on or near the breast. Liposuction of the outer thighs and flanks can be performed through this area as well.

The best candidate for liposuction is someone who is not heavy but has isolated areas of fat that they want to remove to improve the contour. Usually, younger patients have better quality skin than older patients. That being said, those patients that do better with abdominal liposuction are those with good skin quality and who are not very heavy. Just like a balloon, if the skin has been stretched out too much, due to air, or in this case fat, the tissues may not retract well. Like a balloon’s rubber that becomes stretched and wrinkled after being maximally extended, the abdominal skin may become loose after liposuction because of the decrease in volume. In most cases, if a patient has had multiple pregnancies or large fluctuations of weight and has loose skin, and/or has a diastasis with weak abdominal muscles, then more than likely liposuction should be performed with a full tummy tuck.

Cost

The cost of a tummy tuck in New York will vary based on the method used and whether you opt to receive liposuction as well. The cost of a tummy tuck starts at about $10K and goes up from there based upon the complexity of the procedure. Dr. Wallach will be happy to provide you with an itemized quote during your personal consultation.

References

  1. American Society of Plastic Surgeons. 2020 National Plastic Surgery Statistics.; 2021. Accessed September 15, 2022. https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-report-2020.pdf
  2. Klinger M, Klinger F, Giannasi S, et al. Aesthetic and Functional Abdominoplasty: Anatomical and Clinical Classification based on a 12-year Retrospective Study. Plastic and Reconstructive Surgery Global Open. 2021;9(12):e3936. doi:10.1097/GOX.0000000000003936
  3. Regan JP, Casaubon JT. Abdominoplasty. PubMed. Published 2022. Accessed September 16, 2022. https://www.ncbi.nlm.nih.gov/books/NBK431058/#article-17029.s8

FAQs

Are tummy tucks dangerous?

A tummy tuck is not a dangerous procedure.

Can you get pregnant after tummy tuck?

Ideally, you want to have a tummy tuck after all your pregnancies. I have had a few patients that went on to get pregnant successfully after a tummy tuck.

Can a tummy tuck cause stomach issues?

A tummy tuck should not cause stomach issues.

Can you lose weight after tummy tuck?

Yes, you can lose weight after a tummy tuck.

Can I walk after tummy tuck?

Yes, it is encouraged to be up and around after a tummy tuck.

Can you get a tummy tuck if youre obese?

If your BMI is over 30, you are at higher risks for complications.

Do tummy tucks work?

Tummy tucks can improve the appearance of your abdomen.

Do you get a scar from a tummy tuck?

Yes, an incision is usually low on the abdomen just about at the level of the pubic hairline.

How can I lose my stomach fat?

Stomach fat can be decreased by diet and exercise, by liposuction, and by tummy tuck surgery.

Do you have to be skinny to get a tummy tuck?

You do not have to be skinny to have a tummy tuck although having a lower BMI will likely give you a nicer result.

How dangerous is a tummy tuck?

A tummy tuck is not a dangerous procedure.

Does a tummy tuck tighten muscles?

A tummy tuck can include a muscle plication to in effect tighten the muscles.

How do I prepare for a tummy tuck?

I tell patients to eat healthily, exercise regularly, and avoid medications or supplements that can cause bleeding.

How are tummy tucks done?

Tummy tucks are often done as an outpatient and patients go home the same day.

How long after a tummy tuck can you drink?

I tell patients that they can have a drink about a week or so after surgery provided that they are healing well and are no longer using pain medications.

How long is pain after tummy tuck?

Most of the pain from a tummy tuck will diminish significantly after about 7-10 days.

How long do tummy tucks last?

A tummy tuck will give a long-lasting result. Increasing age and weight fluctuation can affect long-term results.

How long do you wear a binder after surgery?

I usually have patients wear a binder for about 3-6 weeks.

How long does it take to lose weight after a tummy tuck?

You will likely see a weight improvement once the swelling subsides.

How many sizes do you lose with a tummy tuck?

It is hard to predict what size you might change to after surgery.

How much does it cost for a tummy tuck?

The cost of a tummy tuck starts at about $10K and goes up from there based upon the complexity of the procedure.

What are the side effects of a tummy tuck?

Tummy tucks are very safe.

How much weight can you lose having a tummy tuck?

It is hard to predict how much weight you can lose after a tummy tuck. One kilogram of fat is about 2.2 pounds.

What do you eat after tummy tuck?

You can have a regular diet after the first night.

How painful is a tummy tuck?

Pain from tummy tuck surgery is similar to a c-section.

What does a tummy tuck usually cost?

The cost of a tummy tuck starts at about $10K and goes up from there based upon the complexity of the procedure.

Is it easier to lose weight after a tummy tuck?

You will likely see a weight improvement once the swelling subsides.

What is the best girdle to wear after a tummy tuck?

I use a standard abdominal binder after a tummy tuck.

What qualifies you for a tummy tuck?

A tummy tuck is a procedure to improve the loose skin of the abdomen and to tighten the muscles.

Why would you need a tummy tuck?

A tummy tuck is a procedure to improve the loose skin of the abdomen and to tighten the muscles.

When can I start working out after tummy tuck?

Usually patients can start light aerobics after about 3 weeks and heavy lifting at about 6 weeks.

Will a tummy tuck make my stomach flat?

A tummy tuck can make your stomach flatter by removing the excess skin and by plicating or sewing the muscles closer together.

When can I wear regular clothes after tummy tuck?

Most patients can go back to regular clothes within a few weeks after surgery.

Who is a good candidate for tummy tuck?

A good candidate is someone who needs to improve the loose skin of the abdomen and to have their muscles tightened.

How big of an incision will I need?

This is individualized based upon the extent of the work needed. Sometimes a mini- tummy tuck can be performed. LIPOSUCTION is performed and residual loose skin from the lower abdomen is removed through a small incision in the pubic region (4-6 inches long). If the lower muscles of the abdomen need to be tightened, then it can be performed as well through this small incision. Patients with more laxity of the tissues and greater weakness of the muscles require a longer incision to accomplish the surgery.

Can I have other procedures at the same time?

Yes, in fact it is often easier to do other operations at the same time. Harvesting fat for FAT INJECTION TO THE FACE can be obtained from the discarded tissue during the ABDOMINOPLASTY. Sometimes, BREAST AUGMENTATION can be performed through the abdominoplasty incision to avoid incisions on or near the breast. Liposuction of the outer thighs and flanks can be performed through this area as well.

What is a mini-abdominoplasty?

A mini-abdominoplasty is a procedure that treats abdominal contour issues mainly of the lower abdomen. This is best suited for a patient who does not necessarily need muscle plication above the umbilicus and has a slight protuberance below the umbilicus along with some loose skin of the lower abdomen. Because of the limited undermining of soft tissue, liposuction can be combined with the procedure. Sometimes surgeons will float or detach the umbilical stalk to move it lower to remove more skin. The incision is often shorter than what one would have with a full tummy tuck. This is often best for thinner patients. A disadvantage of this procedure is that it does not adequately treat the upper abdomen and skin laxity above the or around the umbilicus.

Can I have liposuction instead of a tummy tuck?

The best candidate for liposuction is someone who is not heavy but has isolated areas of fat that they want to remove to improve the contour. Usually younger patients have better quality skin than older patients. That being said, those patients that do better with abdominal liposuction are those with good skin quality and who are not very heavy. Just like a balloon, if it is stretched out too much, due to air or in this case fat, the tissues may not rebound well. Like a balloon’s skin that shrinks after being maximally extended, the abdominal skin may become loose as well after liposuction or decreasing the volume. In most cases, if a patient has had multiple pregnancies or large fluctuations of weight and has loose skin, and/or has a diastasis with weak abdominal muscles, then more than likely a full tummy tuck would be best. There are some patients that are in between the two extremes and sometimes these individuals may be happy with liposuction.

I have had three children and I am not going to have anymore. What is the best procedure for me to improve the appearance of my abdomen?

In all likelihood, for someone who is unhappy with the appearance of their abdomen after having children they will more than likely do best with having a full abdominoplasty. The loose skin and fat is removed from the region usually between the umbilicus to the pubic region leaving the remaining incision along the lower abdominal region usually in the bikini of bathing suit line. The muscle weakness is corrected by suturing the midline internally. The laxity in the upper abdomen is usually improved as well from the redraping of the abdominal flap. Liposuction of the flanks can be performed at the same time as well when indicated.

I have loose skin around my umbilicus, how can you correct this?

If one has isolated loose skin around the umbilicus, it can be difficult to treat this area in an isolated fashion. I have seen a few isolated excisions of skin around the umbilicus that has caused a very spread out scar around the umbilicus. Sometimes treating the skin can be performed with a mini-tummy tuck, but often it is best treated with a full abdominoplasty.

Should I lose weight before a tummy tuck?

It is always best to get down to your ideal weight prior to having a surgical procedure. The results of a full abdominoplasty is often better and the surgical risks are reduced as well. That being said, if you are close to your ideal weight that is reasonable as well.

What is a reverse abdominoplasty?

A reverse abdominoplasty is exactly what it sounds like. Instead of elevating the tissue from an incision in the lower abdomen by the pubic hairline, the incision is made under the breast creases and the excess skin is brought out through this region. This is a procedure that is performed in patients that have isolated laxity in the upper abdomen. This may occur after a mini-tummy tuck or even after a full tummy tuck. If the patient has had a previous breast procedure leaving an incision under the breast folds then using these same incisions may be possible.

I lost more than a 100 lbs and everything is loose; what procedure should I have done?

When a patient has had massive weight loss (more than 100 lbs) through either diet and exercise or surgery, often times their skin is very loose. In some patients a full abdominoplasty is an option. But if the laxity of the tissues is more severe, an extended abdominoplasty, or even a full body lift procedure may be more prudent to give a better result. An in-office evaluation is always best to perform a proper exam and review a patient’s goals.

Can you perform aggressive liposuction of the abdomen along with a full tummy tuck?

Aggressive liposuction can be performed in some cases when performing a full abdominoplasty. This is most commonly done when full undermining of the abdominal flap is not performed. The undermining of the abdominal flap stops by the lateral row of perforator arteries that feed the overlying abdominal flap. It is undermined just enough to allow for muscle plication in the midline. The abdominal flap is usually separated a bit more around the vessels using a liposuction cannula as well.

What does floating an umbilicus mean?

Floating an umbilicus refers to the concept of detaching the umbilical stalk from its underlying abdominal wall attachments but keeping it attached to the surrounding skin to preserve its blood supply. This is most commonly performed during a mini-abdominoplasty when there is some loose skin superior to the umbilicus and the surgeon wants to treat this by pulling it down a bit.

Do men get tummy tucks?

Yes, some men do undergo tummy tucks.

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