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 our NYC patients who want to look and feel more trim and fit. Take a look at some of our patients’ tummy tuck before and after pictures to see how dramatically the procedure can transform your shape.
In this post, I’ll also cover a variety of tummy tuck topics, from how we repair diastasis recti after pregnancy to whether insurance will cover hernia repair if it’s combined with tummy tuck surgery. You can use the links below to jump to the topic that interests you, or read through the post to learn more about tummy tuck surgery.
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 upward 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 us 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 through a small hole in the middle of the belly. This is a simplified version; the following video may help you understand better. You can also view this video and others directly on our YouTube channel.
Tummy Tuck After Pregnancy
The classic patients for a tummy tuck are young mothers. After pregnancy’s storm of prostaglandins and hormonal surges, 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 tummy pooch problems. Some women bounce back after pregnancy as if nothing ever happened. 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 stretch marks or bring the abdominal muscles together so that the tummy is flat again. Think of 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 get a flatter tummy.
My patient shown below is a triathlete. Despite her very aggressive exercise regimen, her lower tummy bulged. She also had loose skin, and her breasts had gotten smaller. I performed a mommy makeover for her that included a tummy tuck and modest silicone breast implants.
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, the repair is absolutely not covered by insurance. There isn’t even a billable code for it, and the repair is considered cosmetic.
Still, diastasis recti repair 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.” Nobody wants to look “fine”; we all want to look “hot”!
Tummy Tuck With Hernia Repair
As the photos below show, we can often repair a hernia during tummy tuck surgery. In fact, it is common that a patient will pay an extra fee to the hospital, anesthesiologist, and surgeon to have the procedures combined in order to have a single operation and recovery period. General surgeons love this combination because the plastic surgeon gives them exposure to their hernia that is not possible using standard techniques.
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. Yes, there are times when we have legitimate reasons to perform and bill an insurance company for a tummy tuck performed at the same time as a hernia surgery. Those situations are rare and need to be fairly extreme. Furthermore, some insurance companies will refuse to pay ANY of the charges, including the hernia repair, if the tummy tuck is performed together with the “necessary” procedures.
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 is 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.
Can an Obese Person Have a Tummy Tuck?
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. There is a growing body of literature that correlates a patient’s higher body mass index (BMI) 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. Some ambulatory surgical centers 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. 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 (You can see some of my patients’ lower body lift results in these before and after pictures.) But let’s limit this discussion to tummy tuck patients.
Fleur-de-Lis Tummy Tuck
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. Even though the scar will be visible, many patients accept it because it will help them fit into clothing dramatically better.
Tummy Tuck for Men
While the operation is less common in men, tummy tucks can be a huge asset for them as well. 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, one day looking down at their bellies and deciding it’s time to get in shape. And they do! Unfortunately, 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.
A male tummy tuck incision is shaped differently than a woman’s. The female version has more of a smile; 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.
Many times, these men also have “man boobs,” or what doctors call gynecomastia. Sometimes liposuction of the chest can get rid of this breast-like tissue. It 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. 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.
Recovery After a Tummy Tuck
I have another blog about tummy tuck recovery, so I will keep this to a minimum. Basically, abdominoplasty patients can expect to have a rough few days. The most significant discomfort is usually over by Day 3.
I routinely see my patients on postoperative Day 5. 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 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 where they feel completely like themselves with only minor aches and pains.
Surely there are variations, but what I describe is the norm. They typically are more focused on their drain removal than when they can take their next pain pill. This brings us to …
Do I Need a Drain for a Tummy Tuck?
The short answer is, “yes,” I think you do. Some plastic surgeons are 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 Days 7 to 10 to be safe.
A Tummy Tuck Is a Good Thing
When done for the right reasons, a tummy tuck dramatically improves a patient’s self-esteem and helps them feel more confident. It can make them feel like themselves again and allow them to move on to 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.
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!
New York City plastic surgeon Dr. Thomas P. Sterry serves Manhattan and the surrounding areas. If you’re considering tummy tuck surgery, please request a consultation] using our online form or call us at (212) 249-4020.