Tummy Tuck (Abdominoplasty)

Abdominoplasty surgery, commonly known as a tummy tuck, is an operation to remove extra skin, scars, stretch marks and fat from the tummy, and sometimes to tighten the tummy muscles. What is the alternative treatment? Losing weight and exercising to tighten up the tummy muscles may help. For some younger patients, liposuction (where fat is sucked out through a tube inserted into small cuts) can help. This can be done on its own, or with a tummy tuck.

The abdominal reduction or "tummy tuck" is a surgical procedure to tighten the skin of the abdominal wall, frequently performed following childbirth and weight loss.

Plumper patients will require liposuction to reduce the fat following the procedure and, where the muscles are stretched, some tightening of the fascia that holds them together will be required.

There are four main different abdominoplasty procedures:
- The Cadogan Clinic Brazilian tummy tuck.
- Mini or partial abdominoplasty.
- Full Abdominoplasty or traditional tummy tuck is now obsolete at the Cadogan Clinic.
- Cadogan Caesar Correction (CCS) - post C-section scar revision

There are other techniques used in particular situations and these are described elsewhere on this website.

As the name suggests, this is a lesser procedure than the Full or Brazilian Abdominoplasty and is designed to treat a lesser problem. A mini-abdominoplasty focuses on rejuvenating the abdominal wall below the umbilicus (tummy button), the area most commonly affected by pregnancy.

The procedure consists of liposuction of as much of the abdominal wall as is required and excision of surplus skin. Frequently, the recti muscles will need to be tightened to give a taut, flat tummy. Unlike the Brazilian or full abdominoplasty, the umbilicus (tummy button) is not moved and is therefore unscarred.

There is only a single scar running across the lower abdomen. The longer the scar, the more skin is removed and the tighter it is. Very often it is not much longer than a caesarian section scar and easily hidden. We should remember that transverse scars are of better quality than vertical ones. This scar can be kept low through the pubic hair. In this case, the skin removed can include pubic hair extending upwards towards the tummy button. The downside is that patients who tend to make bad scars may form keloid scars where the incision passes through hair follicles.

The mini-abdominoplasty is particularly appropriate for patients who have had a caesarian section, and are left with a fold of skin above the scar visible through clothing.

The mini-abdominoplasty can be carried out under Local or General Anesthesia as a day case without drains.

A Brazilian abdominoplasty – or Brazilian tummy tuck – is similar to the traditional abdominoplasty technique, in that the same amount of surplus skin is removed and the tummy button or umbilicus is repositioned; however, all the undermining is achieved by very careful liposuction, avoiding cutting blood vessels and nerves. This procedure therefore avoids multiple drains and can very often be carried out as a day case.

The full abdominoplasty is the traditional Tummy Tuck or Abdominal Reduction. At the Cadogan Clinic, we consider it to be obsolete. It is, however, the common procedure carried out countrywide to remove excess skin and fat. All the skin and underlying fat of the abdominal wall from the umbilicus (tummy button) is removed allowing the muscles beneath to be tightened. The skin of the upper abdomen is freed up as far as the ribs and pulled down and stitched leaving a long scar across the lower part of the abdomen to be hidden beneath panties or bikini. The freed-up tummy button is brought through at the appropriate level.

This is a big procedure requiring several nights in a hospital and, because of the undermining (freeing up) of all the skin and soft tissues of the abdominal wall, carries risks of blood and serum collecting under the wound. This issue is solved to some degree by using multiple drains, which remain in place for some days. These drains are uncomfortable, inconvenient and only partially reduce these risks.  This is the traditional Abdominoplasty.

At the Cadogan Clinic, we can produce a tight, slim contoured abdomen without using drains and allowing patients to walk out of the clinic the same day. The risk of blood and serum collecting under the wound is small. The key is liposuction used both to thin and contour the abdomen, but also to mobilize the skin without cutting its blood supply.

There are three main candidates of people who require tummy tucks.

People with good skin elasticity - no loosening inside the abdominal walls and only sub-dermal fat accumulation that they want to have removed. Often times it is possible to achieve the desired results for these patients using liposuction or laser liposuction.

People whose skin elasticity is intact, but they have an enlarged abdominal wall. For these patients, the desired result is obtained by making an incision of 3 to 4 cm and entering to do an endoscopy in order to repair the abdomen wall.

People with loose and sagging skin. For these patients, it is necessary to remove the loose skin and then repair the deformed muscles.

A tummy tuck operation may be required for various reasons when patients have a deformation in their abdomen. This operation is often needed for women who gain and lose large amounts of weight frequently during and after pregnancies.

There are several ways to perform a tummy tuck, and your surgeon will determine during your consultation what the best method of surgery is for your case. If your skin is fairly tight, without too much sagging, then an endoscopic tummy tuck may be all that is needed. This can be performed with an endoscope just by narrowing the abdominal wall from the inside. For patients with excess loose and sagging skin, a mini tummy tuck will be enough for the lower parts of the tummy. If there is a hernia in the abdomen, then it will be necessary to perform a full tummy tuck.

People have this surgery to take away extra skin and fat, or get a flatter tummy, often after pregnancy or gaining and losing weight. It can help re-join the muscles of the abdominal wall if they have been pulled apart in the middle (known as ‘divarification of the recti’). Stretch marks can sometimes be cut away or tightened to make them less obvious. Ideally, your weight will be normal before the surgery. A tummy tuck is not for people who are very overweight, or carried out in order to lose weight. For the right person, a tummy tuck can make a big difference to their confidence and quality of life.

As with all surgical procedures generally,  patients must abstain from taking blood thinners, limit drinking alcohol and smoking as much as possible and ideally, stop altogether in the last couple of days preceding surgery.

The tummy tuck operation is best undertaken after pregnancy if possible. So if you are planning to have more children, it may be best to wait until afterwards to have a tummy tuck. There are no upper age limits in this surgery. It is possible to operate on people who are healthy and take good care of themselves, at any age.

The right time for a tummy tuck operation for those who have given birth is the end of the first year. At the end of this period, the patient can lose as much extra weight as she can and the degree of sagging and stretchmarks settle. Ideally, any weight-loss should reach completion before the tuck since they are performed to correct the end results of a weight loss program. Best results are achieved if the patient has reached their ideal weight.

There is no harm in getting pregnant one year after a tummy tuck surgery. If the person does not gain too much weight during pregnancy, the tummy will return to how it looked right after abdominoplasty.

During the tummy tuck operation, the abdomen is narrowed and an inner corset is built. Patients usually lose weight after the surgery, but in the case of weight gain, the abdomen area does not return to its shape before the operation in any way, but maintains its proportion.

Yes. For the right patient and with the correct planning, a tummy tuck and liposuction can be carried out simultaneously.

The belly-button is extracted from the skin without any change, so the shape stays the same. A replacement belly-button is made that will look the same as you had before. 

If there is sagging in the skin, especially any excess under the tummy, the preferred size and location for the abdominoplasty scars is 4 cm on both sides, left and right of the caesarean scar line. This scar can usually be hidden behind bikini bottoms and turns into a thin, white line after the healing period, similar to a caesarean scar. 

After the abdominoplasty surgery, the patient comes to the hospital room dressed in a compression garment. We recommend this compression garment is used for three weeks. Light walks can commence immediately after surgery but it is wise to wait one and a half months before undertaking heavy exercise or returning to the gym or working out. You should refrain from lifting anything heavy for 4-6 weeks following the surgery as well.

Recovery time after an abdominoplasty can vary from patient to patient. Whether you're having a partial or complete tummy tuck, the area that's operated on will have stitches and bandages, so it's very important to follow all your surgeon's instructions on how to care for the bandage in the days following surgery.

Your Cadogan Clinic surgeon will also instruct you on how to best position yourself whilst lying in bed at least for a few days following your abdominoplasty, usually on your back or side with your knees bent. The procedure is carried out as a day case and you will be able to walk out of hospital, usually slightly hunched as the skin is now very tight. By the next day, you should be able to straighten up and walk around the house. The day after you will be using your computer, but we would recommend you do not travel to work for about 10 days. You should seriously limit any strenuous activity over the next 6 weeks and if the muscles have been tightened then this should be extended to 3 months. Your surgeon will advise you on what is appropriate for you.

Pain is moderate after surgery and will if necessary be controlled by simple analgesia. It may be advisable to arrange for a friend or relative to stay with you during the first day or two of your tummy tuck recovery time at home. 

There is no particular preparation for you to do other than what you would expect, that is washing generally and particularly the genitalia and tummy button.

Immediately before surgery, your surgeon will mark up the skin with you standing as you will be lying down to have the operation. He/she will mark the incisions and areas of liposuction. There will then be a photograph so that both you and the surgeon can refer back to check that you have achieved the expected improvement. We expect this to be an interesting and happy moment.

Tummy tucks are usually carried out under Total Intravenous Anaesthetic (TIVA) and therefore the procedure can be carried out as a day case. The operation usually takes about three hours, and when you wake up from your operation you may have a drip to give you fluid while you are not drinking. You might be given antibiotics to keep the wound clean. Also, you may have drainage tubes in your lower tummy to drain away any fluid or blood. These tubes will be taken out when the fluid or blood has stopped draining, usually before you go home. Drainage tubes are not required in a Brazilian Abdominoplasty. You are safe to go home the same day, but a responsible adult should stay with you for the first night to ensure you come to no harm as movement may be restricted. Your tummy will feel tight and a little sore. Simple painkillers should be enough to keep you comfortable.

Dressings - You will have some dressings on your tummy. You may need to wear a well-fitting support garment, usually for weeks after the operation. You will be asked to keep your knees and hips bent whenever possible to take the strain off your stitches.

Recovery - You will be out of bed on the same day as your surgery, and doing light activities after 10 days. You should be back to normal exercise in six weeks. If the abdominal muscles are repaired then severe exercise should be limited for three months. Whilst you are in hospital, you may be given blood thinning injections, and support stockings, to reduce the risk of a clot in the leg (DVT) or the lung (PE). Most patients take up to two weeks off work post operation, depending on their job. Your tummy will be sore and swollen for weeks to months after the operation. Do not lift heavy things for several weeks, and avoid sex for at least three weeks. With all activities, start gently. Do not drive until you feel safe and are comfortable wearing a seatbelt. Check your insurance documents if you are not sure.