Getting a Tummy Tuck

Are You A Candidate ?

You may be a candidate for a tummy tuck if you are close to your ideal weight but have had multiple child births or experienced sudden weight loss which has resulted in excess loose skin around your abdominal area. In the section called Necessary we examine many of the controversies around tummy tucks and look more deeply at the philosophy of changing our bodies for esthetic reasons. However, being unhappy about our physical appearance does not necessarily make us a candidate for abdominoplasty. Oftentimes, there are psychological reasons why we feel unhappy about our body. For example, many women who have had problems with anorexia nervosa sometimes visit plastic surgeons asking for a  tummy tuck when in fact, there is almost no loose skin or underlying lax muscles. These same women sometimes want to have liposuction when there is absolutely no fat to remove. These extreme cases explain the rule; a tummy tuck will not cure the underlying psychological problems that you may have with your body image.

Smoking ?

If you are a smoker, you are not a candidate for a tummy tuck unless you stop smoking for 6 weeks prior to surgery and 6 weeks after surgery.  Taking the patch will not work. Nicotine is a chemical that constricts blood vessels and can lead to poor healing or infections. Although you will be required to sign an informed consent regarding smoking and nicotine, don't be a fool and smoke regardless. Surgeons often take a nicotine test the day prior to surgery and if you fail it, they will not operate and you will lose your surgery deposit. If you're a smoker, this may be the one opportunity to stop! Why spend all this money on a tummy tuck and then continue to smoke? Quit now and you will be able to enjoy the benefits of your tummy tuck when you become the matriarch or patriarch of your extended family.

Know All Your Options

Only a board certified plastic surgeon can give you all your options surrounding a tummy tuck, because there are so many different options to choose. Never consult with a surgeon who has only one option for this procedure. Otherwise, you can be certain that this will be the surgical option they will recommend Also, please look at all possible combinations of procedures to find which option is best for you.

Option 1: Limited Abdominoplasty or Mini Tuck

If your lax stomach skin is just below the belly button, but not above, and when you pinch this loose skin you do not feel fat tissue underneath (when you pinch the loose skin, it feels like there is less than 3/4 inch of distance between the tip of your thumb and the tip of your index finger, imagining a straight line between the two ), you may be a candidate for a mini-tuck. Below is a picture of a mini tuck also called a modified tummy tuck:

Option 2: Liposuction:

This would be the same as above except that you are younger (your skin elasticity is good) and you can pinch more than ¾ inch with the test above. This is the simplest and least expensive procedure but very dependent on how your skin shrinks following surgery.  No plastic surgeon can guarantee that your abdominal skin will shrink enough following surgery but it's definitely worth a try because there is minimal pain and downtime following this option.

Option 3: Mini Tuck with liposuction or de-fating of the underlying tissue:

This is option 2 with so much loose skin and underlying fat that liposuction alone will not work because the resulting loose skin is too abundant to ever be able to shrink back tightly over the abdomen.

Option 4: Mini Tuck with liposuction or de-fating of the underlying tissue and a muscle repair:

This is option 3 with a muscle repair. A muscle repair is normally part of a full abdominoplasty, however, there are isolated cases where a small muscle repair is required, if only your lower abdominal muscles are distended following a pregnancy. The pinch test is more difficult in this situation even for a plastic surgeon and oftentimes, they will not know if a muscle repair will be required until they go in.

Option 5: Full Adominoplasty: 

In this situation, the loose skin extends above the belly button. Liposuction alone is very rarely an option for women who have had multiple pregnancies because that just creates even looser skin because of the larger area covered. With a full abdominoplasty, if de-fatting of the underlying tissues is required, a good plastic surgeon will do it. However, that takes more time so expect to pay more if this is included in the procedure. Also be aware that there are many esthetic considerations involved in this procedure when the skin is re-draped over the abdominal area.  The human body is round, not square, so after the skin is re-draped and sutured, the scar should be curved like in this picture :

And not straight across, like in the picture below:

Both of these methods are acceptable but from an esthetic point of view, you will be much happier with a curved scar that is below your bikini line rather than one that is straight across and visible when you wear a bathing suit. This is probably the most important question to ask your plastic surgeon, "Where will my scar be located?" There are many plastic surgeons who still make an incision straight across because that's the way it was taught years ago, so do not assume that your incision will be below the bikini line unless you ask. Keep also in mind that the length of the scar is dependent upon how much tissue needs to be removed; the scar needs to be longer when more skin needs to be excised. This procedure, done well, tests a surgeon's skills and sense of esthetics.

Experiment With A Beach Ball

If you want to see for yourself how difficult it is to determine where to make the incision, take a vinyl beach ball that is inflated, draw your abdomen on it with a belly button, and prepare your "operation" on this beach ball by drawing a line where you want to make a cut to make this ball smaller. Your drawing on the beach ball should look like the dotted line on the picture below:

Deflate the beach ball, with a pair of scissors, cut along your dotted line. Now, cut out a two inch piece of vinyl above the dotted line, and try and make a smaller beach ball. The smaller your cut, the easier you can "suture" the two pieces together.

Dog Ears

What often happens to less experienced surgeons who do this is that they have some extra skin left over on the two ends of the scar called "dog ears" (dog ears gets its name from what happens when the two distal sides (away from the centerline of the body) of the sutured abdomen come together on both ends of the cut, and the skin lifts and looks like small dog ears). We can assure you that if you try this, you too will get some dog ears.

This is the number one reason for selecting an experienced board certified plastic surgeon to perform this operation. Although every plastic surgeon who has done this operation has experienced dog ears, it happens only infrequently to great plastic surgeons and can be corrected in a secondary operation. This is why the third most important question to ask the plastic surgeon is: "What if a secondary touch-up procedure is required to make a correction; who pays for that?" Usually, a plastic surgeon will not charge for their time but will charge for anesthesia and OR expenses.

Option 6: Full Abdominoplasty with Muscle Repair

This is the most extensive tummy tuck option and required when your abdominal muscles have been so distended that no amount of exercise will get them to tighten up. Some plastic surgeons include this with a full abdominoplasty, others will charge separately for the muscle repair. See Below area covered by a full abdominoplasty.

Finally, there is the issue of deep fat versus superficial fat. Superficial fat can be removed through a tummy tuck or liposuction but deep fat can only be removed through diet and exercise.  Pinch the loose skin and fat around your abdomen. Do your finger tips come up against a hard surface (your abdominal muscles)? If you judge that surface to still be "big" even after the pinched skin and superficial fat is not considered, a tummy tuck is not for you. This is usually more common with men than women.  This deep fat makes it difficult to tighten the abdominal muscles. You will need to diet and exercise until this deep fat has been reduced before you have a tummy tuck, otherwise, if you lose more weight after your tummy tuck, you will need a second tummy tuck after the additional weight loss in addition to a muscle repair. Below is a picture of the abdominal muscles and how they are tightened in an abdominoplasty.

Summary

The ideal patient for a tummy tuck is a non smoker, has no underlying psychological problems, and is close to their ideal weight with loose skin and distended abdominal muscles. Loose skin, distended abdominal muscles, and excessive abdominal fat are the 3 areas that can be corrected with this procedure. Excessive deep fat, lying below the abdominal muscles, is a contra-indication for this procedure. In addition, before you consider this operation, check out the combination procedures that can be done at the same time that will save you recuperation time and money as opposed to doing them separately.