An abdominoplasty (commonly known as a tummy tuck) is a very common surgical procedure in my southern New Jersey cosmetic surgery practice. In fact, last year I performed nearly a hundred of these. That’s one or two people every week opting to have surgery to fix their abdominal wall. You are not alone if you hate your post pregnancy belly!

There are two reasons people choose to get an abdominoplasty. They are 1) to restore abdominal contour after pregnancy and 2) to fix the abdomen after massive weight loss. By far the most common reason I see patients is due to the effects of pregnancy of the abdominal wall.

There are three basic insults to the abdominal wall that occur during pregnancy. First of all, skin gets stretched. Some ladies are lucky and the skin just springs right back however many are not so lucky, developing stretch marks and excess skin. Sometimes the skin literally hangs down below the waistline. The second issue is the musculature. The rectus muscles are widely known in the fit individual for giving the six-pack appearance. The muscles are actually two parallel bands of muscles or two sets of three packs. During pregnancy the muscles often separate or make a “diastasis” which then has no way of repairing itself. Once the muscles separate, they stay that way. This gives the barrel shape to the abdominal wall that so many hate post pregnancy. I have had women come in who are literally a size 0 complaining that they still appear pregnant due to this muscle separation. The third component is fat and while fat is the only one of the three that potentially could be fixed with diet and exercise, it is also addressed in a tummy tuck.

Massive weight gain and loss causes similar problems. These days I am seeing so many more patients who have either lost weight with diet and exercise alone or with diet, exercise, and the assistance of a weight loss surgery such as a gastric bypass or lap-band.

So, how is this done? The standard abdominoplasty requires a hip to hip incision which allows for skin removal of all skin between the pubic hairline and the umbilicus (belly button.) The muscles are sutured together in multiple layers much like tightening up a corset. Finally extra fat which is present is removed. The skin from above the umbilicus is pulled down or stretched over the entire abdominal wall and everything is stitched together. Sounds simple?

Well, the recovery isn’t so simple. I tell people that it typically is an average three week recovery. The first week is somewhat miserable. I typically place a local anesthetic pain pump which helps for the first few days and patients take a narcotic such as percocet or vicodin. After the first week most are doing much better and start to regain their strength and mobility. I believe a planned three week break from work is the best plan.

Scars take a year or so to mature. I explain to every patient that an abdominoplasty scar is long and takes time to fade. Scarcare can and should be performed during the healing process but the scar must be understood as a tradeoff for skin removal. No laser or minimally-invasive procedure exists that can tighten or remove skin that has been damaged by stretching it too far. Traditionally excisional procedures work better in my opinion. There are risks of every surgery and things like fluid collections, infections, areas of wound healing difficulty and other potential problems can occur. This is why it is best to meet with a board certified plastic surgeon to discuss your options and become fully educated about the risks. In New Jersey I know of general surgeons, OB-GYNs, and even emergency room docs offering these procedures. While there are many types of doctors offering cosmetic procedures of different training backgrounds relatively few are board certified by the American Board of Plastic Surgery. I am always surprised to hear from patients who have met with some of these other docs and not realized that they were not traditionally trained plastic surgeons. Once again, do your homework….

Well, these are the basics of an abdominoplasty. Please post any questions and start a dialogue!