You may notice with the passage of time you formed a tummy. This can be due to many factors: excess or loose skin, excess fat, or stretching of the abdominal fascia and muscles. Significant weight loss and pregnancy can stretch the abdominal muscles and skin beyond the point they can return to normal. A healthy diet and regular workouts may not correct the problem.
An abdominoplasty (tummy tuck) works in two ways.
First, is the deep layer- the stuff you cannot see. Under the skin the abdominal rectus muscles are tightened, like an internal corset. These muscles separate during pregnancy or major weight gain, causing a loosening of the rectus muscles.
Second, an abdominoplasty removes excess skin and fat. Frequently we remove all the skin between the belly button and the pubis.
"You can't have surgery without scars but I know Dr. Greenberg did everything she could minimize the scars and put them low so I can easily hide them." - K.G., Boulder CreekView More Testimonials*Individual results may vary
Abdominoplasties come in all shapes and sizes, just like the women who need them. From biggest surgery to smallest:
Full abdominoplasty. Also called Tummy tuck. This procedure provides maximal tightening of the muscles and skin. It will help the muscle separation and skin laxity from the rib cage all the way to the pubic area. If you have laxity above the belly button, hanging tissue (a pannus), or have had major weight loss, you likely need this.
Mini abdominoplasty. Also called a mini tummy tuck or hybrid tummy tuck. The incision for a mini can be placed as low as you want to go. This is really used for those with changes in the lower abdomen only (below the belly button).
Floating belly button. This is not a common surgery. It involves no scar on the skin of the belly button, just one in the lower abdomen. Your belly button is like a mushroom. During a normal tummy tuck the belly button does not move- the skin does. In this surgery, the stalk of the belly button is cut, and the belly button floats down toward the pubic area attached only to the skin. This allows tightening of the upper abdomen and lower abdomen skin. The issue is a floating abdominoplasty lowers the position of the belly button, so it is only good for those with high belly buttons to begin with, and the belly button is no longer connected to the stalk. If you ever need a laparoscopic procedure, they cannot use the port through the belly button as this connection is gone.
Muscle tightening only. This is for the women who have good skin tone, no fat, but have loosened muscles after babies (When you aren’t sucking it in you look five months pregnant, and when you suck it in you go FLAT.) A lot of my Bay Area women fall into this category. The skin incision can be short when you do this.
NOTE: If when you suck in your belly the skin hangs and is wrinkled, then you likely need some form of skin tightening. The more skin tightening, the longer the scar. See mini tummy tuck description above.
Mommy Makeover: A mommy makeover combining any of the above with breast surgery (like breast augmentation, breast lift, or breast reduction), or other body contouring procedures like full body liposuction or the Brazilian butt lift (fat grafting to the buttock.)
There is no right answer to which is the right surgery for you. Dr. Greenberg strongly recommends you have an evaluation by a plastic surgeon versed in all the different types of body contouring surgery, so they can help you pick the right procedures for you.
There are trade offs. You may prefer some skin laxity to have a shorter scar. How bad is your diastasis? Are you symptomatic? How do you scar? Have you gone through menopause? Do you need to lose weight? Many of my patients are in a “grey” area- they have real changes in their abdomen, but is the fix worth it? Sometimes you have to choose – if I want tight skin, is it worth the scar? Not all women will make the same choice.
Tummy tucks are frequently combined with:
Be careful! Dr. Greenberg has seen many people who try to do less invasive procedures like Coolsculpt or liposuction when they needed an abdominoplasty. These women are left with wrinkled, dimpled skin, and then seek out a plastic surgeon to “fix” it. Some of these issues cannot be fixed. Again, she strongly recommends at least one evaluation by a board certified plastic surgeon before you decide on your course of treatment.
The abdomen is made of three basic components. SKIN. MUSCLE. FAT. Usually, your issue is due to a combination, and it is important to evaluate and address the components.
FAT: If fat is the biggest issue, then liposuction is the best choice. You make a tiny scar, blow the area up with tumescent solution (a mix of saline, numbing medication, and epinephrine to reduce bruising), and remove the fat. But if you have loose skin or muscle, liposuction won’t fix those issues and may make the skin looseness worse. Tightening procedures like abdominoplasty are needed to fix skin and muscle issues.
MUSCLE: Diastasis is the separation of the rectus muscles, usually from pregnancy. You can try to help it with abdominal strengthening exercises, but for many the only fix is to repair the separation surgically. When I do surgery I get to see the separation. For many patients the two edges of muscle are not connected, so no amount of “core” working out will fix that. The fix is to sew the muscles back together.
HERNIA: is an actual hole in the abdominal wall. The most common site is the belly button, and many can be repaired at the time of abdominoplasty.
LOOSE SKIN: The only way we have to tighten skin is to cut it out. Think of your skin as a bathing suit. As you age, have weight changes and pregnancies, and hit menopause, the elasticity in your skin is poorer. Your skin cannot bounce back. There is no effective laser, exercise, or cream to tighten skin. When you see advertisements for procedures which “tighten the skin with no downtime” please be wary. If noninvasive skin tightening worked, we would have no tummy tucks, facelifts, necklifts, or breast lifts.
Recovery after an abdominoplasty is fast and slow.
FAST: You will be back to your normal daily routine usually at 1-2 weeks. You are not “back to normal,” but you are functional. You can go back to a desk job, drive a car, and go out to a movie. But you will be tired faster than normal. You are wearing garments, you have swelling, your skin is numb, your scars are red. You may weigh more than you did before surgery from the swelling. This is normal.
SLOW: The body takes a full year to heal after a surgery. A YEAR. The initial changes are faster, but you continue to improve over the next months in a slow but constant fashion. Scars will fade, tissue will soften, sensation will improve.
When will you feel “normal’? This varies for everyone, as their definition is different. At 3 months most people are back to doing their normal routines, full work outs, and have normal energy levels.
If your rectus abdominis belly muscles are separated, they can cause functional and aesthetic issues. Many of these improve after tummy tuck, with studies showing statistically significant improvement.
FUNCTIONAL ISSUES:
COSMETIC ISSUES
Tummy tucks vary in cost because of two factors:
Cost for just a full tummy tuck is around $17,000-18,000 all in (includes OR, anesthesiologist, surgeon fees, pre and post operative clinic visits). If you are combining it with another major surgery like breast surgery, eyelid surgery, or body liposuction, the cost will go up depending on the other procedure. When you are healthy, there is savings in cost and recovery time to combine the procedures.
Tummy tucks have a lot of things we do on the inside which you do not see. What are differences between doctors?
I have many blogs on tummy tucks. HERE. Please use the search tool bar if you have specific questions. I likely have blogged about it before.
The abdominoplasty procedure is done under general anesthesia. My primary surgery facility is in Palo Alto, called the Plastic Surgery Center, and it is AAAA certified. I have operated there for over 25 years. The surgery is outpatient. For improved comfort, I use a long acting injection called Exparel, ( I prefer this to the pain pump placed during surgery which drips numbing medication internally as it is one less tube/drain.) The Exparel works for about 3 days. I find it reduces postoperative pain significantly.
I frequently combine abdominoplasty with liposuction or other cosmetic surgery procedures such as breast augmentation, breast reduction, breast lift, or eyelid surgery. Abdominoplasty can be combined with non-cosmetic procedures, such as hysterectomy or umbilical and ventral hernia repair. When this is done, the surgery is done usually at Sequoia Hospital. Recovery takes two to three weeks.
Timing of surgery and your health should be optimized prior to surgery. People who are still losing significant weight or who are planning another pregnancy should wait. If you are actively smoking, you need to stop at least one month before doing this surgery. PRESURGERY ADVICE.
TUMMY TUCKS AND THE WEEK AFTER. TEMPORARY BUYERS REMORSE?
COMPARING ABDOMINOPLASTY TECHNIQUES
WHAT SCAR TREATMENTS ARE AVAILABLE FOLLOWING AN ABDOMINOPLASTY?
LIPOSUCTION AND TUMMY TUCK AT THE SAME TIME?
LIPOSUCTION AND TUMMY TUCK DO NOT CAUSE FAT TO MOVE ELSEWHERE ON YOUR BODY
Tummy tucks hurt.The They hurt not because of the big scar, but because of the tightening of your muscles- the diastasis. Frequently surgery is combined with other body contouring procedures like liposuction or fat grafting, or with breast surgery like breast augmentation, lift or reduction for the mommy makeover.
Recovery varies from person to person. Dr. Greenberg has patients who are up and about, fully dressed, driving, in makeup and going to work at a week. She has others who need two weeks. Please plan for two weeks of help. If you have the ability to work from home, take one week off, and then one week at home.
Dr. Greenberg does many techniques to limit pain, lower swelling and bruising, and help your recovery. This is a time to take a *time out* from your life. Read a book, watch Game of Thrones from episode one, work on that Shutterfly photo album you haven’t done. Rest. You will be back to full activity faster if you treat your body well and let it heal. I love my Bay Area overachieving patients who defy all norms, but this is one area where you need to give your body the time to heal.