Abdominoplasty (tummy-tuck)

Both excessive fat and loose skin can accumulate in the abdomen and be resistant to exercise and dieting. In women, this is common after the stretching of pregnancy, and often associated with a separation of the vertical (6-pack) muscles in the midline (this generalized bulge is called divarication or diastasis to distinguish it from a true hernia). In men, this is more common after significant weight loss.

Overhanging tissue (“the apron”) can spill over trousers, get caught in waist-belts, and drag or swing when walking. Personal hygiene can suffer due to odour, rashes or infections where skin rubs against skin (Intertrigo) or when the buried umbilicus (belly button) is difficult to clean. Cosmetic concerns stem from the distracting appearance, from stretch marks, and sometimes from the scars of previous abdominal surgery, which can lead to tethering, contour issues or asymmetry.

tummy tuck picture

Many operations have now been refined for eliminating the surplus tissue and simultaneously improving the muscle tone of the abdomen. It is good to have a basic discussion of all the options available to you, and for the Surgeon to carefully tailor a mutually agreed appropriate operation for your specific condition. Put simply, these procedures in increasing order of complexity include:

Apronectomy Tummy Tuck

For removing an overhanging apron, without touching the rest of the abdomen. The long scar is hidden discreetly in the belt line.

Mini Abdominoplasty Tummy Tuck

For removing moderate excess of tissue strictly confined below the belly button, without working on or above the belly button itself. The aim here is a shorter belt line scar and quicker recovery in an appropriately selected patient.

Full Abdominoplasty Tummy Tuck

For removing excess tissue both above and below the umbilicus. There will be a circular scar around the belly button and a long scar in the beltline. This is the commonest procedure, as it provides the greatest improvement in the majority of people. Rectus plication (tightening the midline gap between the muscles) is a standard part of the operation, in order to improve tone and reduce upper abdominal bulging. However, excessive tightening can potentially interfere with future pregnancies, and it is important this issue is discussed if pregnancy in the future is a possibility.

before and after a full abdominoplasty
Before and After a Full Abdominoplasty Tummy Tuck

T Abdominoplasty (=Fleur-de-lys, Trifoliate or Anchor)

Designed for excessive tissue in both vertical and horizontal planes, as seen after significant weight loss. This pattern removes a vertical wedge of tissue in addition to what is removed in the usual full abdominoplasty. There is thus an additional long vertical midline scar, which is quite acceptable (please see the pictures below) if this is the best way to define an otherwise non-existent waistline.

T-Abdominoplasty
Before and After Results of T-Abdominoplasty to define waist

Liposuction

For mild localized/ general fatty excess Liposuction alone may be appropriate, especially at a younger age. Although it can be combined with the Abdominoplasty operation for a particularly bulky “tyre” of fat, I tend to offer this later as I find this much safer.

Special situations arise after massive weight-loss, and may require more extensive Body Contouring such as Belt Lipectomy and Reverse Abdominoplasty. These situations are best discussed individually. Whichever procedure is selected, one must realize that none of them are a substitute for losing excess weight, and that they need an average 4 weeks off work.

liposuction
Before and After Results of Liposuction alone.
Before and After Results of T-Abdominoplasty after significant weight loss
Before and After Results of T-Abdominoplasty after significant weight loss.

For further details, including illustrations and an awareness of possible complications, please consult the following excellent short descriptive links:
BAPRAS (British Association of Plastic Reconstructive & Aesthetic Surgeons) patient information page at BAPRAS

BAAPS (British Association of Aesthetic Plastic Surgeons) information page at BAAPS