Background: The tummy tuck (abdominoplasty) is one of the most popular of all the body contouring procedures. Whether helping to reverse the effects of pregnancy or that of weight loss, it achieves what no amount of diet and exercising can do…the removal of loose/stretched out abdominal skin. But it does so with the aesthetic trade-off of a lengthy scar and a significant recovery.
For some patients the amount of abdominal overhang or fullness makes the decision to buy a scar to get rid of it fairly easy. For others that decision is more difficult as their abdominal problems vs the scar may not justify that substitution. In this situation they may opt for a smaller scar with a mini-tummy tuck, or even liposuction, even though the result will not compare to what a full tummy tuck can achieve.
Recovery from a tummy tuck is often stated to be 2 to 3 weeks. It would be kind to say that prediction is a woeful underestimation for the vast majority of patients. The definition of recovery highly depends on what one interprets as recovery. Is it being able to return to work? It is comfortable enough to resume working out? Is it feeling absolutely perfectly normal? Estimates for those criteria of recovery would 2, 4 and 6 weeks respectively.
Case Study: This 38 year-old female wanted to get rid of her ‘full belly’. She was not overweight, although 15 to 20lbs more than what she was in high school. Despite her best efforts at diet and exercise (everyone has their own limit of what they can do) she could not budge the way her abdomen and waistline looked. She felt if she had a tummy tuck she would be able to get ‘over the hump’ of getting a better abdominal shape and lose some weight.
Under general anesthesia, a lower horizontally oriented elliptical excision of abdominal skin and fat was excised. The upper part of the excision went above the bellybutton while the lower edge was just above the pubis. The stalk of the belly button was preserved. The tails of the excision stopped at the hip points. Once this was removed, a midline tunnel under the upper abdominal skin flap was done up to the xiphoid process of the sternum. Midline rectus muscle fascial plication was done from the xiphoid process down to the pubic with a large permanent suture. The upper abdominal skin flap was brought down over the excised defect and closed in multiple layers over a drain to the pubic incision line skin edges. Lastly, liposuction was done beyond the tummy tuck zone around the waistline and into the back for final waistline reshaping.
Her drain was removed one week after surgery. She returned to her desk job 11 days after surgery…with some difficulty. She reported being very tired the first week she went back to work and could really only work a half day during her first week back. She resumed some light walking a month after surgery. Any form of more strenuous working out did not start until six weeks after surgery. She stated she felt 99% herself by two months after undergoing a tummy tuck.
Case Highlights:
1) A tummy tuck does a good job of removing extra skin and fat from the lower abdomen but does so at the ‘price’ of a long scar.
2) The greatest flattening effect of a tummy tuck is in the lower half where the tissue excision takes place. In some patients some upper abdominal fullness will persist as tissue is stretched out in this area but not removed.
3) Most patients underestimate a tummy tuck recovery. Do not expect to return to work for 2 to 3 weeks or resume working out for 4 to 6 weeks.
Dr. Barry Eppley
Indianapolis, Indiana