Abdominoplasty, often called a tummy tuck, can remove loose or stretched out skin from the lower belly while also tightening the abdominal muscles. The result is an overall nicer appearance of the torso with well-toned skin. There are many situations where a tummy tuck is helpful to NYC residents who want to look and feel a bit more trim and fit.
How Is a Tummy Tuck Performed?
Essentially, a long incision is created from one hip across the lower tummy to the other hip like a big “smile.” The skin of the abdomen is undermined as we work along the muscles of the tummy upwards to the belly button. Another small incision is created around the umbilicus (belly button) so that it can stay where it is as the upper tummy skin is also undermined. This gives great exposure to all the muscles of the abdominal wall, which are then sutured closer together like a corset. We then pull all of the upper tummy skin down to the lower tummy where the original incision was made. The excess skin is removed, the wound is closed, and the belly button is brought out through a small hole in the middle of the belly. This paragraph is a simplified version and the following video may help you understand better. If you don’t have flash installed you can follow this link to view it as well: How A Tummy Tuck Is Performed
Tummy Tuck and the Mommy Makeover
The classic patients for a tummy tuck are young mothers. After the storm of prostaglandins and hormonal surges that take place during pregnancy, an otherwise fit woman can be left with a loose abdominal wall and attenuated skin complete with stretch marks. Even the breasts seem to become deflated and “disappear” as glandular volume diminishes.
Exercise and Diet May Not Flatten Your Tummy
There is very little patients can do about some of these problems. Some women bounce back after pregnancy as if nothing ever happened to them. These are the genetically lucky ones among us. Be happy for them, but don’t let them make you feel like you’re not working hard enough to get similar results. For many women, exercise and dieting will not get rid of the stretch marks, grow breast tissue, or bring the muscles back together in the midline so that the tummy is flat again. I tell patients to think about separated abdominal muscles like a broken bone that is not set in place. If the bone isn’t lined up correctly, it will heal in a crooked manner. The same goes for the tummy muscles – if you don’t put them back where they belong, all the exercise in the world won’t help you to get a flatter tummy. The muscles may get stronger, but they will continue to bow outwards. This is of no help to a woman who wants her figure back.
The photo below is one of my patients who is a triathlete. Despite her very aggressive exercise regimen, her lower tummy continued to bulge out of proportion to the rest of her abdomen. She also had loose skin, and her breasts had gotten smaller. The mommy makeover we did included a tummy tuck and modest silicone breast implants that were just the right size to give her back the volume that her breasts had before her 2 pregnancies.
Will Insurance Pay for My Tummy Tuck If I Have a Hernia?
Probably not. A tummy tuck is considered a cosmetic operation that has little to do with the vast majority of hernia surgeries that are performed every year. Yes, there are times when we have legitimate reasons to perform and bill an insurance company for a tummy tuck that is performed at the same time as a hernia surgery. Those situations are rare and need to be fairly extreme. Furthermore, there are some insurance companies that will refuse to pay ANY of the charges including the hernia repair if the tummy tuck is performed together with the “necessary” procedures.
Tummy Tuck and Hernia Repair: a Common Combination
It is much more common that a patient will pay an extra fee to the hospital, anesthesiologist, and surgeon to have the procedures combined in order to make for one single operation and recovery period. The general surgeons love this combination because the plastic surgeon gives them exposure to their hernia that is not possible using standard techniques. I suspect they also love the fact that the plastic surgeons end up taking care of most of the patients needs in the postoperative period, thus relieving the general surgeon of a significant work burden.
My Doctor Said I Have a “Diastasis” After My Twins
There is an actual medical diagnosis for women who have a dramatic separation of their abdominal muscles called “diastasis recti“. However, despite it being acknowledged as a condition, repair is absolutely not covered by insurance. There isn’t even a billable code for it in the medical language known as CPT. In fact, the American Society of Plastic Surgeons has stated in writing that repair is considered to be cosmetic. Still, repair of a diastasis recti is part of a tummy tuck and it is regularly performed for women who simply can’t get their body back no matter how much diet and exercise they do. The patient below said that her husband, close friends, and family all told her she looked “fine”. What I notice is that NOBODY wants to look “fine”. We all want to look “hot”!
Can a Tummy Tuck Be Combined With Liposuction Safely?
This is an ongoing debate in the world of plastic surgery. Every few years there is another article published with hundreds of patients included who either did have liposuction combined with their tummy tuck or did not. These authors take sides and try to justify that their position is the only right one. I have colleagues who will liposuction the abdominal skin flap on a regular basis, but if I press them, they will confess that sometimes there is a “little bit” of trouble with the wound healing in the center of the tummy tuck scar. There are also techniques to avoid raising a large skin flap that will allow for liposuction to be performed in that area safely. I have used them, but I find that the result of the tummy tuck skin pull nor the liposuction are really satisfactory. I prefer to perform a proper tummy tuck with limited liposuction of the upper abdominal groove, flanks, and/or back.
On the rare cases that I need to, I can return to do some good liposuction on the abdomen itself about 3 months later. However, these cases are few and far between. This plan is more common in patients who are significantly overweight.
Tummy Tuck Procedures for Obese Patients
While a tummy tuck can be done in patients who are obese, the procedure is a little more risky and complications are more common. For instance, the incidence of infection, delayed healing, and seroma (a fluid collection under the skin) are dramatically higher in patients who are significantly overweight. In fact, there is a growing body of literature the correlates a higher Body Mass Index (BMI) of patients with a variety of complications.
Today, Mount Sinai Hospital in New York City is just one of a growing number of institutions that require a separate consent to surgery for patients with a BMI over 40. There are also ambulatory surgical centers that simply will not allow surgery on patients who are significantly obese. Make sure your doctor has experience working with this population before you sign on for surgery.
Tummy Tuck Surgery After Weight Loss
One of the more common indications for a tummy tuck is someone who has undergone dramatic weight loss such as after bariatric surgery. In the early 2000s gastric bypass was a popular procedure that helped patient lose over 100 pounds in less than a year. Then the era of the lap band came into play. I now see a lot more gastric sleeve operations being done. No matter how the patient loses weight, they all seem to have one common problem: excess skin. That skin can cause a lot of trouble including rashes, back pain, and trouble ambulating. Many of these folks need more than a tummy tuck, they need a lower body lift operation – but let’s limit this essay to the tummy tuck patients.
Sometimes patients have excess horizontal skin in addition to the excess vertical skin that a standard tummy tuck can address. In these cases I will offer them the option of a vertical scar that will help remove that extra tissue as well. Think of this operation as a tailoring procedure where we are moving the buttons out wider on your shirt in addition to tucking your shirt in. The use of a fleur-de-lis is more common if patients already have a scar on their tummy because they really don’t have to sacrifice much at all. Furthermore, even though the scar will be visible, it is sometimes accepted by patients because it will make them fit into clothing dramatically better. The reasoning seems to be that they already wear a one piece bathing suit, but if they accept the scar, they are going to look a whole lot better in it – or more importantly in regular clothing every day.
Male Tummy Tuck
While the operation is less common in men, tummy tucks can be a huge asset for them as well. Given that men, in very few circumstances, get pregnant – I find it to be most common in men who have lost a lot of weight. Again, this is many times associated with bariatric surgery, but not necessarily so. A lot of men find themselves overweight after years of concentrating on their careers and working some horribly grueling hours. One day they look down at their belly and decide it’s time to get in shape. And they do! Unfortunately, as I’ve described above, they also can end up with some extra skin that just won’t go away. You can tone muscle, but you can’t tone skin.
It is worth noting that the incision on a male tummy tuck is shaped differently than that for a woman. The female version has more of a smile (as I’ve described above) but for men we keep the scar a little higher in the middle and lower on the sides. It’s a bit more of a flat scar.
Men also have many times got other issues including “man boobs” or what doctors call “gynecomastia“. Without exploring this problem completely, I will say here that sometimes liposuction of the chest alone can get rid of the unsightly breast-like tissue of the chest in men and can be combined with a tummy tuck.
The Tummy Tuck Belly Button
Philosophically, I believe that the most important structure in the tummy tuck operation is the belly button. In fact, I routinely spend 20 to 30 minutes on that part of the procedure alone. While some of my colleagues tease me a bit for what seems like an unreasonable amount of time to spend at the end of the operation, I think the attention to detail on the umbilicus is what matters most to the final cosmetic outcome. After all, the belly button is the only part of a tummy tuck operation that the outside world should be able to see. It certainly seems worth the effort.
The lower tummy incision is an area that most of us would normally cover even if we did not have an abdominoplasty. So frankly, even in the event of a bad scar, as long as it is well placed, the only observers are typically dogs and lovers.
Recovery After a Tummy Tuck
I have written another blog about tummy tuck recovery in the past, so I will keep this section to a minimum. Basically, abdominoplasty patients can expect to have a rough few days. It seems that the most significant discomfort is over by day 3. I routinely see my patients on postoperative day 5 in my office in Manhattan. That means they need to travel in from wherever they live – New Jersey, Long Island, Connecticut – wherever. When they arrive and I ask them how they are feeling, they almost universally answer, “better”. Don’t get me wrong, they are not ready to run any marathons just yet, but they are clearly up and about on their own. It seems typical for patients to need 2 to 3 weeks for recovery to reach the point that they are able to feel completely like themselves with only minor aches and pains.
Surely there are variations, but what I am trying to describe is the norm. They typically are more focused on removal of their drain than when they can take their next pain pill. Which brings us to…
Do I Need a Drain for a Tummy Tuck?
The short answer is, “yes”, I think you do. There are plastic surgeons trying to perfect the drain-free tummy tuck, but I think it’s a mistake. The standard of care remains to leave a drain in place when a procedure with this much undermining is performed. The drain keeps you safe from the formation of fluid collection while it is in. On the other hand, it is also an indwelling catheter that can lead to infection. So I try to remove them by day 7 to 10 to be safe.
A Tummy Tuck Is a Good Thing
When done for the right reasons, a tummy tuck can dramatically improve a patient’s self esteem and help her/him feel more confident in general. It can make them feel like themselves again and allow them to move onto more important concerns in their lives. The ability to wear clothing that one likes and enjoy basic niceties that others do without the burden of inhibition really is freedom to a lot of people. Many of my patients don’t realize how these insecurities have held them back until they have their abdominoplasty and later tell me all about how their relationships have changed. So, if you fit into any of the categories of patients I’ve described above, I encourage you to consider a (very safe) tummy tuck operation. Good luck!