Abdominoplasty (Tummy Tuck)

What the procedure is

Abdominoplasty is an operation to remove loose skin and excess fat from the lower abdomen and, where present, to repair separation of the abdominal wall muscles (rectus diastasis).

The essential difference between abdominoplasty and liposuction is that liposuction treats fat alone and depends on the skin having good elasticity, whereas abdominoplasty addresses loose skin and separated muscle — problems liposuction cannot correct on its own.

The operation is not a method of weight loss and is not a substitute for it. It is usually performed once weight has reached a stable level.

Who is a suitable candidate

• People with loose lower-abdominal skin that does not respond to exercise or diet.
• People with separation of the abdominal wall muscles following pregnancy.
• People who have reached and held a stable weight and are not planning further significant weight loss.
• Non-smokers, or those willing to stop smoking before and for a period after surgery as advised, because smoking reduces blood supply to the skin and raises the likelihood of delayed wound healing.
• People who have completed their family planning, since a pregnancy after surgery can re-separate the muscles and stretch the skin again.

How it is performed

The operation is performed under general anaesthesia and usually takes two to four hours, depending on its extent and whether liposuction is combined with it.

A horizontal incision is made in the lower abdomen within the underwear line, the skin is lifted, and the separated abdominal wall muscles are sutured together to narrow the waist and support the wall.

Excess skin is removed, the navel is repositioned, the layers are closed, and a drain is sometimes left in place for a few days.

Where looseness is confined to the area below the navel, a mini-abdominoplasty may be an option — less extensive with a shorter scar, but it does not treat the area above the navel.

Recovery

• A hospital stay of one or two nights is usual, depending on the case.
• A compression garment is advised for several weeks as directed, to help limit swelling and support the tissues.
• Short walks indoors begin on the first or second day to reduce the risk of clots, with the body bent slightly forward in the early days.
• Return to desk work is commonly two to three weeks; return to physical exertion and sport is usually around six weeks or as advised.
• Swelling settles gradually over weeks, but the final shape may take three to six months to stabilise, and longer in some cases.

Scars

The operation leaves a permanent horizontal scar in the lower abdomen, positioned within the underwear line as far as possible, and a small scar around the navel.

A scar is initially red and raised, then softens and fades gradually, commonly over twelve to eighteen months.

The final appearance of a scar depends on individual factors including skin type and inherited tendency to scar formation, and cannot be predicted precisely beforehand.

Risks and complications

Every operation carries risk. This is an educational list, not an exhaustive one; the risks specific to your case are discussed during consultation.

• Risks of general anaesthesia.
• Fluid collection under the skin (seroma), among the more common complications, which may need drainage in clinic.
• Bleeding or the formation of a haematoma.
• Wound infection.
• Delayed wound healing or separation of the wound edges, more likely in smokers and people with diabetes.
• Numbness or altered sensation in the abdominal skin, which may persist for months and in some cases permanently.
• Thickened or keloid scarring in those predisposed to it.
• Asymmetry or contour irregularity, which may require a corrective procedure.
• Deep vein thrombosis and pulmonary embolism — uncommon but serious, which is why early mobilisation and preventive measures are used.

Combining with other procedures

Abdominoplasty is often combined with liposuction of the flanks to improve overall contour, and may be performed alongside breast surgery in what is described as post-pregnancy body surgery. Combining multiple procedures lengthens anaesthetic time and increases cumulative risk, so it is decided after assessing general health.

Common questions