Best of Ask Dr. Pane! Your Complete Guide to Tummy Tuck Surgery

Abdominoplasty, or tummy tuck surgery as it’s more popularly known, is one of the most perennially popular cosmetic surgery procedures in the United States of America. This surgery helps eliminate loose skin caused by cycles of weight gain and loss resulting from lifestyle adjustments like diet and exercise, childbearing, childbirth, bariatric treatments, procedures, or illness. It can be done as a standalone procedure for people of all genders or as part of a so-called “mommy makeover” package which may include breast reduction or lift/augmentation as well as other procedures.. 

Over the years, Dr. Thomas A. Pane has answered many questions about tummy tuck surgery from followers on Facebook, Instagram, Twitter, Google Hangouts, and LinkedIn as the founder and chief medical officer of Atlantic Coast Aesthetics. 

Now, we’ve decided to use those answers to create a comprehensive guide to everything you need to know to decide if tummy tuck surgery is right for you! We’ll cover everything from how a tummy tuck works and who it works best for, to postoperative aftercare and how to manage complications in the unlikely event they arise.

Within this guide, you will find links to relevant answers given previously by Dr. Pane on various aspects of tummy tuck surgery, including both text and video. We hope you will use these links to gain a more complete understanding of how abdominoplasty works and its uses and limitations, so you can better advocate for yourself and the care you need to look and feel like your best self.

Let’s dive into your complete guide to tummy tuck surgery!

I. What is a tummy tuck surgery?

A tummy tuck, or abdominoplasty in medical terminology, is a procedure to correct and tighten moderate to severe loose, lax, or sagging excess skin and the underlying musculature in the abdominal area. The loose skin is excised, along with lingering pockets of subcutaneous fat, using liposuction or other fat removal methods. In nearly all cases, the abdominal muscles are also be surgically tightened to present a sleeker profile and more aesthetically pleasing appearance and toned feel. The result is a more sculpted abdomen, and patients overwhelmingly report feeling more confident in their appearance after tummy tuck surgery. 

Tummy tuck surgery has a very low incidence of post-op complications and is generally well tolerated by patients. 

In fact, some patients incorrectly judge how fast they are healing after a tummy tuck and injure themselves by overextending too early in the healing process! In most cases, when possible, the horizontal incision from a tummy tuck procedure is placed below the bikini line and above the pubic hair region for maximum scar concealment, even in revealing swimwear or lingerie. As mentioned earlier, a tummy tuck surgery procedure can be performed by themselves or as part of a more comprehensive body revision in most cases, although no two patients are alike, and your results may vary. 

How is a tummy tuck surgery done?

There are several variations and varieties of tummy tuck surgery, ranging from a so-called “mini tummy tuck” to more extensive versions designed specifically for post-bariatric procedure patients or to correct umbilical hernias. For purposes of this guide, we will focus on a “standard” tummy tuck surgery. Please note that you may need more or less than a standard tummy tuck depending upon your situation, medical history, age, and long-term goals, so your treatment path may differ slightly to significantly from the basics in this guide.

In a “standard” tummy tuck, the area of loose or overhanging skin to be excised is identified and marked. 

The patient is placed under anesthesia, and the cosmetic surgeon removes the skin along a horizontal incision in the lower abdomen just below the bikini line. The skin above the incision is then pulled down to meet the incision, leaving enough to create a safe margin for secure reattachment. Liposuction is used to remove lingering fat deposits which may compromise the end result. This fat may be eliminated entirely or transferred to other areas of the body to enhance their size and shape as part of a combination procedure, including the breasts, buttocks, or hips. If necessary, for example, to correct diastasis recti or spreading of the abdominal muscles as a result of pregnancy, these muscles may be surgically tightened to further support the overlying skin. Finally, the surgeon reattaches the skin and sutures the resulting wound closed, using temporary wound drains to allow fluid within the wound to safely exit the body. At this point, the procedure is over, and the patient can begin the recovery process. This typically takes around six weeks from surgery to full healing and function, depending upon the patient’s adherence to aftercare protocols and natural healing ability.

Tummy tuck surgery is normally done as an outpatient procedure in an ambulatory same-day surgical center. 

Only in extremely unusual cases would a tummy tuck be performed in a regular hospital, which may be used for rare patients with specific medical issues. Likewise, it is exceedingly rare for patients to be kept in a hospital overnight for observation.  This means patients generally go home the same day they have the procedure to begin recuperating. Due to the aftereffects of anesthesia and the surgery itself, patients will need someone to drive them home once they are cleared to depart the surgical center. 

II. Is tummy tuck surgery right for me?

Generally speaking, ideal candidates for tummy tuck surgery are those with a BMI at or below 38  who have moderate to severe loose or sagging skin in the abdominal region; who have reached a stable weight plateau and maintained it for at least six months to a year; have not previously had other surgeries in the abdominal area; and who are unlikely or unable to become pregnant in the future, either through choice, medical intervention, or a combination of the two. 

Note that these are only general guidelines, and each patient’s case must be evaluated on its own merits and risks. 

Specific medical history and overall health play a large role in determining whether the benefits of tummy tuck surgery outweigh the potential risks for a given patient, so it’s important not to discount your eligibility or suitability for a tummy tuck procedure based on this list without consulting a board-certified cosmetic surgeon. Likewise, you should avoid focusing solely on a tummy tuck, as it may not be the best option or even an option at all, depending on your situation. 

Why does my BMI matter for a tummy tuck?

BMI, or Body Mass Index, is one of the most widely used indicators of a healthy height-to-weight ratio. Although the use of the BMI has been intensively scrutinized and often criticized for having a series of glaring oversights in its development and ongoing implementation, it is still relied upon heavily by the medical community, largely for lack of any better, more comprehensive, or more specific tool.

In the state of Florida, where Dr. Pane practices, cosmetic surgery, including abdominoplasty procedures, is more rigorously controlled by state law and guidance from the American Society of Plastic Surgeons and the American Board of Cosmetic Surgery than elsewhere, largely because Florida is such a major destination for plastic surgery. 

State law is designed to maximize patient safety and reduce the likelihood of complications arising from cosmetic surgery, and the state legislature has capped the BMI for most cosmetic procedures at 40, or morbidly obese, due to the greater risks to the patient during anesthesia, the surgery itself, and the recovery period. 

Atlantic Coast Aesthetics generally does not perform tummy tucks in the office surgical setting on patients with a BMI over 38, largely due to legal constraints and comfort considerations for the anesthesiologists needed to safely perform these procedures.  High-BMI patients (above 40) are candidates for surgery at an ambulatory surgery center (ASC) or hospital setting, but cannot have surgery in the office-based setting, per Florida rules.

An anesthesiologist can and will cancel a patient’s procedure if they deem the patient’s risk profile to be too high, which can lead to undesirable outcomes for the patient, including unnecessary travel expenses and scheduled recovery time off work. To prevent this, Dr. Pane prefers to err on the side of caution and marks a BMI of 38 as the typical upper threshold.

Once again, it’s important to remember that the numbers don’t lie, but they also don’t tell the whole story. Every patient is different, with different needs and requirements, so BMI alone is not a reliable or accurate measure of a patient’s suitability for abdominoplasty surgery or lack thereof. You should always consult with a qualified cosmetic surgeon before determining whether a given cosmetic procedure is right for you.

III. Preparing for tummy tuck surgery

The first step in a tummy tuck procedure starts with a virtual consultation or, ideally, in-person consultation. During the initial consultation, you should expect to go over your complete medical history, including any surgeries, medical problems, illnesses, chronic conditions, current and previous medications, allergies, and other factors that may impact your procedure. A face-to-face consultation is preferable because the surgeon can see and manipulate the target area to determine how best to proceed. This means you may need to disrobe partially or completely during the consultation to allow for a proper evaluation of your current situation.

During the consultation, your surgeon will present various options for how to proceed. They will explain the potential benefits and risks and help set realistic expectations for the outcome of each option so you can prepare. They will also go over aftercare protocols and what you should expect in the days, weeks, and months following your procedure so you have the most complete picture possible of what your postoperative life will look like and can plan accordingly.

Once the consultation is complete and you and the surgeon agree on the best course of action for your body, needs, and desired outcomes, your tummy tuck surgery date will be scheduled. 

It is critical that you follow all preoperative instructions, including restrictions on eating and drinking, and continue to take any medications you may be on. In some cases, your cosmetic surgeon may work with your medical team or primary healthcare provider to determine which medications you can safely discontinue during the preop phase, as some medications can interfere with anesthesia or healing and cause unwanted and unnecessary problems during or after the surgery and in the recovery period. It is strongly recommended that patients abstain from activities and behaviors such as drinking alcohol, smoking, or consuming marijuana during the preop stage and after the procedure, as these can extend patient recovery times and lead to complications such as infection, excessive bleeding, and other issues.

You should expect to have a final consultation either the day before or on the day of your tummy tuck procedure. 

During this consultation, you’ll likely be evaluated again and asked about any changes in the situation. You will also be asked about how you’ve followed preoperative instructions and what effects if any, this has had on you. Although it is unlikely, your surgery can be canceled if red flags of undue risk appear during the final consultation, so it’s very important to comply with preop instructions and be completely honest for your own safety and to obtain the best possible results.

Once the final consultation is complete, you’ll be prepped for surgery, and the anesthesiologist will place you under sedation. At this point, the procedure will begin. 

IV. During and after your tummy tuck surgery procedure

In a standard tummy tuck, as we mentioned previously, an incision is made across the lower abdomen below the bikini line to allow the removal of the excess skin. An incision is also made just below the belly button to allow for access to the abdominal muscles to facilitate tightening. During the surgery, your vital signs will be monitored by the surgical team to ensure you stay sedated and safe.

Once the surgery is done, wound drains will be placed. These plastic ports allow excess blood and other fluids to flush away from the incision site rather than pooling under the skin, which can lead to infection, swelling, and other complications. After this, the incision will be sutured closed, and the area will be cleaned one final time. At this point, you should be ready to enter recovery.

You may feel groggy, disoriented, sore, or numb immediately upon awakening. These are common side effects of surgery and anesthesia and are not a cause for alarm. When you awaken, the surgical or recovery staff will check in with you to determine how you’re feeling and make sure your vital signs are stable and within normal parameters. After you’re fully awake and “with the program,” they will go over your discharge, follow-up, and aftercare instructions. You will need a ride from the surgical center, as you will not be able to safely operate a motor vehicle for several hours after the anesthesia fully wears off due to lingering aftereffects of the sedation.

Once you’ve got your discharge paperwork and necessary prescriptions, you’ll be cleared to go home and begin the recovery process.

Light activity can begin on the very day of surgery and consists of walking to move blood in the legs. This can be done every hour, while awake, and is preferable to resting completely.  It is important to move around frequently but keeping the activity light for the first few weeks. No lifting more than a few pound for the first three weeks. Full activity and unrestricted lifting can generally occur by six weeks. as full recovery from the healing process is about 6-12 weeks. 

V. Aftercare for a tummy tuck and preventing postoperative complications

As stated previously, most postoperative complaints are generally mild and well tolerated. Soreness, tightness, temporary numbness, seepage from the incision area, swelling, bruising, redness, and tenderness are all perfectly normal. However, if you notice the area around the wound is bright red, hot to the touch, or feels unusually firm or protrudes noticeably to the eye or touch, these could be signs of an incipient infection or other complication that needs to be addressed as quickly as possible, such as a seroma or hematoma. 

During the early stages of your recovery, you may be advised to wear a compression garment such as a faja to help protect the incision from injury and contamination and to support the healing skin as it knits back together. You should only use compression garments as directed by your surgeon or care team, as improperly fitted or used garments can do more harm than good. You will likely be advised to stick to painkillers like acetaminophen or such medications as you’ve been prescribed. Medications containing ibuprofen or aspirin are to be avoided, as they  can cause blood thinning and prolong the healing process.

You may notice that the postoperative discomfort you experience is less than you expected, and this is a good thing! However, you need to be mindful of the fact that you’ve had a major procedure in terms of both invasiveness to your body and the surface area involved. Do not try to push yourself by doing too much or too fast after your surgery. This can lead to suture breakage, excess fluid drainage from your wound drains, or even reopening the incision, which is an emergency situation that must be addressed immediately if it happens. Be sure to keep in contact with your medical team and keep track of the days since your procedure, as well as how the wound is healing.

Normally, you can resume full activity once the wound drains are removed at your appropriate follow-up appointment, as long as everything else looks good, and there are no signs of infection, stitch breakage, fluid buildup under the skin, or other points of concern. 

At this point, the surface sutures will be in the process of dissolving as the wound continues to heal and form scar tissue. Any sutures placed under the skin’s surface will remain for a longer period to facilitate healing, but they should eventually dissolve on their own as well. 

In your discharge paperwork, you’ll find a list of common postoperative complications to look out for and their signs and symptoms. 

However, we want to stress that you know your body, pain tolerance, healing capabilities, and yourself far better than we do, so if you notice anything that seems unusual, abnormal, or “not quite right,” it’s better to contact your surgeon immediately than to ignore it or dismiss it as just a normal part of the healing process. 

While your symptoms may very well be typical, ignoring potential warning signs of a complication could jeopardize the final outcome of the procedure or even endanger your health and life. Listen to your body and bring any concerns to your surgical staff immediately!

In addition to using any prophylactic antibiotics and painkillers as directed by your surgeon, and managing your activity to accommodate wound healing and recovery, how you care for your body after surgery and having realistic expectations about the outcome can make a big difference in the results you see and reduce the likelihood of complications or the need for tummy tuck revision later. 

Eating a healthy diet, getting a reasonable amount of exercise for your healing progression and postoperative progress, proper hygiene and wound care, and avoiding behavioral factors like smoking, drinking, or recreational drug use can all help accelerate healing and reduce the risk of complications. In addition, you should try to avoid areas of high indoor or outdoor air pollution as much as possible and avoid exposing your wound or scar to direct sunlight until the area is fully healed.

VI. Conclusion

We hope you’ve found this guide to tummy tuck surgery to be informative and helpful in determining whether a tummy tuck is right for you. If you are interested in undergoing tummy tuck surgery or want to explore other options to help you achieve the body you’ve always wanted, Dr. Pane and the staff of Atlantic Coast Aesthetics invite you to follow us on Facebook, Instagram, Twitter, and LinkedIn, and of course to contact our office by clicking here or calling (561) 295-1871 to schedule a consultation today!