Tummy Tuck

Tummy Tuck

A “tummy tuck” is a more casual name for abdominoplasty, the medical term for a procedure that is performed to make the tummy flatter, tighter, and more youthful in appearance. This is accomplished by surgically addressing the three common problem areas of the abdomen: excess skin, excess fat, and muscle laxity or separation. Dr. Charles Slack, a board-certified plastic surgeon, offers the tummy tuck as one of many body-contouring surgeries for patients in Plano, McKinney, and the surrounding communities at his practice in Allen, Texas.

Tummy Tuck Procedure

A number of different tummy tuck procedures are available, such as mini, modified, or full tummy tucks. Although each of these procedures involves the surgical removal of skin and fat from the abdomen and in some cases the tightening of abdominal muscles, they differ in the manner and the extent to which they address each of these areas.

For instance, with a full abdominoplasty all of the skin and underlying fat from just above the navel down to the pubic area is removed. A mini or modified abdominoplasty removes a smaller amount of skin and fat from the lower abdomen well below the navel. If one of your goals is to remove stretch marks on your lower abdomen that extend all the way to your navel, a mini or modified abdominoplasty won’t accomplish this goal. Loose skin in the mid and upper abdomen requires a full abdominoplasty to get meaningful tightening, but a small amount of skin overhanging a caesarean section scar can be improved with a mini or modified abdominoplasty.

Similarly, there are differences in the extent of muscle tightening and length and location of incisions, as well as the areas and amount of liposuction that can be safely performed with each procedure. In general, the more tissue that is removed the tighter the abdomen becomes and the better the overall result. With more extensive surgery, the incisions are longer, and the recovery is typically more difficult.

Choosing the appropriate procedure depends on your goals, your unique anatomic issues, and the specific trade-offs, risks, and recovery associated with each procedure that you are willing to accept. Dr. Slack’s role involves more than just performing the surgical procedure. It involves taking the time to listen to you and to understand your goals, as well as spending the necessary time to educate you before any incisions are made.

Recovery after a Tummy Tuck

A full tummy tuck has a significant recovery period. For the first 3-5 days, most of your time will be spent in bed or a recliner. Physical activity will be limited, but Dr. Slack encourages patients to get up and move around a little during the early post-operative period. This includes getting up and down to go to the bathroom, moving from the bed to a recliner, and as you are able, moving around the house. Early mobilization is important in preventing the formation of blood clots and in speeding up the recovery process.

Dr. Slack offers a “drainless” tummy tuck for his patients. This procedures uses specialized progressive tension sutures remove the need for drains to remain in the surgical incision during the recovery period. This is one less obstacle to getting back to your normal routine.

Due to a combination of lower abdominal tightness from the surgery and post-operative swelling, most patients will walk a little bent over for the first 7-10 days. By two weeks, almost all patients are walking upright and are driving themselves. Dr. Slack suggests planning on taking 2 weeks off from work if you have a desk job; longer (4-6 weeks) if your job requires more strenuous activity. Exercise is limited to walking the first 2-3 weeks; this is gradually increased depending on how you are doing. Dr. Slack asks his patients to avoid any heavy weight lifting and abdominal exercises for 6 weeks.

Abdominal swelling is significant after surgery. This is particularly true in the lower abdomen. Some patients can’t fit into the pants or shorts they were wearing before surgery due to swelling even though a large amount of skin and fat was removed. At about 2 weeks, the swelling will start to improve, but it takes about 6-8 weeks for the majority of the swelling to resolve. Patients usually come back at this point saying their clothes are fitting much more loosely, or they have gone down in waist or dress size. Some of the improvements from a tummy tuck will be obvious right away, but because of the swelling the final result will take some time to become apparent.


Long Term Results 

Many people hesitate to pursue a tummy tuck because they have seen a lot of before and after pictures and they worry about the scarring. However, these images generally show the scar immediately after surgery. But scars take about 18 months to fully mature. The images below give you an idea of how a scar usually fades over that 18-month time frame. The scar becomes much less obvious over time.

Tummy Tuck

Tummy Tuck

Exercise and proper diet are still the best way to improve the appearance of your abdomen, but some problems such as loose overhanging skin, stretch marks, or rectus muscle separation will not improve with any amount of exercise. If these are issues that are of concern to you, and you are considering a tummy tuck, Dr. Slack would love the opportunity to discuss this option with you.

Tummy Tuck FAQ’s

1. What is the recovery like?
What I have learned over the years is that everyone’s recovery is different and that I can’t predict exactly what a particular patient’s recovery will be like. For instance, I did a full tummy tuck on a patient who I was sure was going to have a difficult recovery due to how tight she was after surgery. To my surprise she walked up to my office 3 days after her surgery barley bent over, complaining of minimal pain, looking as if hadn’t had surgery and wondering why I had spent so much time preparing her for a difficult recovery. She subsequently sent two friends to see me for my “pain free, easy recovery” tummy tuck; needless to say, the did not experience the same “pain free, easy recovery” tummy tuck that she did. Though I can’t tell anyone exactly what they will experience, I can tell them, in general, what recovery will be like for most patients. I believe in preparing my patients for the worst, so I don’t sugar coat the recovery process. That way they are not caught off guard if they have a more difficult recovery. The first 5-7 days are generally pretty tough. You will be confined mainly to a recliner or be in bed with your back propped up and pillows under your knees so as to be bent at the waist. Getting in and out of bed or a recliner will be the most painful part because you are using your abdominal muscles to do this. Once up, you will have to walk a little bent over due to the tightness in your tummy. Although it is difficult to get up, actually walking is generally not too painful for most patients. Walking around inside your house is very important for preventing blood clot formation and I ask all my patients to walk two or three times a day starting the day after surgery. Because you will be walking bent over and have to lay in the same flexed position, lower back pain and stiffness becomes an issue. Muscle relaxers, back massages and heating pads can help with this, but it won’t get completely better until you are walking upright and can lay in different positions.

Most patients are able to walk upright by two weeks, although they generally still feel tight. At two weeks they have survived the worst part of their recovery and can start seeing the light at the end of the tunnel, but they’re still not out of the tunnel. Driving, for most, is fine after two weeks and many can go back to work as long as they don’t have jobs that require a lot of standing or heavy manual labor. Even though they feel better they are still in the very early stages of healing. Healing requires a lot of energy expenditure, energy expenditure that can’t be seen. Because of this, most patients tell me they wake up feeling good but by the afternoon they feel really wiped out. So, if it is possible, arranging to work half days that first week back it isn’t a bad idea. By a month after surgery most patients feel they are back to normal, but they still are not cleared for full physical activity. I’m a little more liberal than some of my colleagues when it comes to exercise. I limit exercise to only walking for the first 2-3 weeks and encourage patients to do as much as they can. After three weeks, depending on how they are doing, I will let them use some machines at the gym but nothing high impact and nothing that uses core abdominal muscles. At eight weeks they can resume all activities without restrictions.

2. How much pain will I have?
If you have done any research, you know that patients will tell you the pain after a tummy tuck varies from the “worst ever” to “all I needed was Tylenol.” I would tell you that for most, the truth lies somewhere in between. You can expect to have pain. Having no pain after a tummy tuck is simply not realistic as is the expectation that a pill will somehow take away all the pain. Post-surgical pain is normal but should be tolerable when managed appropriately.How that pain is managed depends on the individual patient because each patients’ response to pain is unique. Some patients can recover without any narcotics (as you can see in some of their video testimonials, click through would be nice here) while other will need some form of narcotic pain medication. If you need a narcotic to manage your pain, you need a narcotic. There is no shame in that and It is not a sign of weakness if you do. When I prescribe narcotic medications, it is my goal to try to have my patients start tapering off them after 3 days and be off them completely by the end of a week. This isn’t always possible but more often than not works out. Narcotic medications have side effects that can make recovery more difficult. These include constipation, itchiness, altered sensorium and of course the potential for addiction. So, there are good reasons to avoid or minimize their use if you can. One medication that helps with this is Exparel. Exparel is a numbing agent given during surgery that lasts 2-3 days. It does not take away all the pain but does, in my opinion, lessen the pain during the first 2-3 days (which are generally the worst). It is a fairly expensive drug and is not always included in the cost of surgery. Ask your surgeon if he or she uses it and there is any extra cost. When used with a non-narcotic recovery regimen, I have found the combination of the two to be a very effective way of avoiding narcotics altogether.

3. When can I go back to work?
I think for most people that have desk jobs, jobs that don’t require a lot of standing or that aren’t physically demanding, two weeks is a reasonable timeframe. You should be getting around pretty well by then and be able to drive. If you have a physically demanding job, then you will need 6 weeks off. I have had patients go back to work after a week to jobs that were more demanding than I thought they could tolerate and I have patients who have taken 6 weeks to go back to less demanding jobs. I think It all depends on how you are doing in your recovery and how important it is for you to get back to work. Two weeks is a reasonable estimate but everyone is different.

4. Do I have to have a drain?
No, you do not have to have a drain. That leads to the question of why use a drain at all then. One of the most common complications after a tummy tuck and many other plastic surgery procedures is the development of a seroma. A seroma is a collection of fluid in the space created by the surgery. In the case of a tummy tuck, it is the space between the skin and fatty tissue below it and the abdominal wall. When separating these tissues from each other, large raw surfaces are created. These injured raw surfaces will ooze fluid similar to a large scrape or burn until they heal. If the fluid is not removed, it will simply fill up the space created by the surgery. Drains are replaced to prevent this by evacuating this fluid. Another option is to obliterate the space so that there is very little room for fluid to accumulate. This accomplished by placing sutures between the skin/fatty tissue layer and the abdominal wall. These sutures, known as progressive tension sutures, ultimately dissolve but are present long enough to prevent a seroma from forming thus precluding the need for a drain.

5. Where and how long will my scars be?
There will be scar along your lower abdomen/upper pubic area and possibly around your belly button. The length of the scar depends on how much skin needs to be removed as does whether or not you will have a scar around your belly button. With a modified or mini tummy tuck only skin below the belly button is removed. No incision is made around the belly button and the length of the scar is similar in length to or slightly longer than a c-section scar. A full tummy tuck removes all the skin from just above the belly button to the pubic area. This results in a hip to hip scar and a scar around the belly button. Longer abdominal scars are required with extended tummy tucks or full body lifts. So the length and location of the scar all depends on how much skin needs to be removed in order to achieve the result you are looking for.

6. Will my scars go away?
Unfortunately, no. The scars are permanent. They will fade over time but that does not mean the will fade away. During the early phases of the healing process the scars will become red and slightly raised after initially being thin and flat. This starts about the third week after surgery and continues for the duration of the healing process which lasts 6 months. After 6 months scars go through a process known as remodeling in which they fade and flatten. Remodeling takes around a year to complete so it is a year and half after surgery before you really know what your scar will look like. Some will continue to lighten over an even longer period of time.

7. Do you have to cut the muscle?
Actually, it is a common misconception that the rectus abdominis muscle is cut. It is not cut. The tissue on top of the rectus muscle, known as fascia, is sewn together to repair a rectus diastasis. A rectus diastasis is a widening of the distance and a thinning of the tissue between the rectus muscles along the mid-line. Repairing this problem is known as rectus plication and involves tightening of the fascia only not cutting the muslce.

8. Am I a candidate for a mini tummy tuck?
It depends on what you are trying to accomplish. A mini or modified tummy tuck only removes a small amount of skin in the lower abdomen. Repair of muscle separation and liposuction of the abdomen can be done as part of this procedure if needed. If you have a large amount of excess skin, skin that folds over all the way across your waist, skin that hangs down significantly when you bend over, loose skin above your belly button or a lot of stretch marks throughout your lower abdomen, you probably aren’t a good candidate for and won’t be happy with a mini or modified tummy tuck.

9. Things that might help with recovery.
By far the most difficult things to deal with after a tummy tuck are getting up to walk, walking and lower back pain. Several of my patients have used a maternity pillow to wrap around their lower back when they are in a recliner. This supports the lower back helping with some of the stiffness and tightness that develops from being in one position. Devices that can be used to massage the lower back and heating pads can also be helpful. A word of caution however when using a heating pad. Don’t use it on your tummy, only on your lower back unless you have had lower back (flank) liposuction. If you have had surgery in one of these areas, they won’t have normal feeling after surgery. As a consequence, you may not be able to feel how hot the heating pad is getting and you can easily burn yourself without realizing it. To assist with getting up and down renting a medical lift chair is a great idea. These chairs recline and are able to stand you up from a seated position. They can be rented from medical supply companies. In my area a two-week rental is just under $200 (this includes delivery, set-up and pick up). For assistance with walking or while standing to take a shower, a walker is very helpful. I am amazed out how many people either have a walker or know someone who has a walker they can borrow. If you can’t borrow one there are fairly inexpensive options available for purchase.