There's more than one type of tummy tuck

Are you considering a tummy tuck? You're not alone. Tummy tucks were among the top five plastic surgery procedures performed in 2022. Women and men are getting this popular procedure to tighten their abdominal muscles and remove stretch marks, extra skin and fat, plus reshape their waistlines.

There are many types of tummy tucks or abdominoplasty, and the one you'll need depends on how much loose skin you have and, therefore, what kind of incisions are appropriate to remove it.

Mini tummy tuck

A mini tummy tuck is for patients with a "pooch" or loose skin and fat only below the belly button and does not address issues with the upper abdomen. The incision for a mini tummy tuck is smaller than that for a full tummy tuck and is typically located just above the pubic area.

During a mini tummy tuck, the surgeon removes excess skin and fat from the lower abdomen and may tighten the underlying muscles. The belly button is usually not repositioned, unlike in full and fleur-de-lis tummy tucks.

This procedure is best suited for those close to their ideal body weight but have loose skin or a small amount of excess fat in the lower abdomen that doesn't respond to diet and exercise.

Full tummy tuck

According to ASPS Member Surgeon Michelle Roughton, MD, most people need a full tummy tuck.

"What that means is you get a scar from hip to hip, a scar around your belly button," said Roughton.

For a full tummy tuck, surgeons typically make a hip-to-hip incision as low as possible on the abdomen. They also make another incision around the belly button. The center portion of the abdominal skin and the underlying fat are then removed.

Before the incision is closed, the surgeon lifts the upper abdominal skin and fat layer off the body to access the abdominal wall muscles, or rectus abdominis, which have often separated vertically, a condition called diastasis recti. A surgeon repairs this condition by sewing the muscles, which strengthens and flattens the abdominal wall.

"We pull the six-pack muscles or the rectus abdominis back together. They're usually stretched out from pregnancy from having been significantly overweight," said Roughton.

The incision is then closed low on the abdomen so bikinis and underwear can hide the scar that will eventually form. The surgeon also repositions the belly button. A full tummy tuck often includes liposuction of the hips and flanks so the patient comes out of surgery with a flatter stomach and a better silhouette.

Fleur-de-lis tummy tuck

Some patients need a more extensive surgery than a full tummy tuck to achieve their goals. These patients have often undergone massive weight loss. The sagging skin left behind makes them good candidates for a fleur-de-lis tummy tuck, which also involves repositioning the belly button.

"Some people have so much skin laxity both kind of up and down and side to side, that what is best for them, to remove as much of the loose skin as possible, is a fleur-de-lis tummy tuck," said Roughton. "So, an incision that looks like an anchor with an up and down component through which the belly button comes out the center and then a hip-to-hip component as well."

A bikini can't entirely hide a fleur-de-lis scar, but the tightened abdominal wall muscles, flatter stomach, and improved silhouette make it a worthwhile surgery for many patients despite the extensive scarring involved.

Recovering from a tummy tuck

ASPS Member Surgeon Nneamaka Nwubah, MD, offers a candid perspective on recovery after a tummy tuck.

"It's important to be aware of the prolonged swelling," said Nwubah. "It can be frustrating and annoying for patients. The nervous sensation changes are another thing to be aware of."

She said patience is needed as the swelling can take up to a year to resolve fully. Also, patients can lose abdominal sensation because nerves are severed during a tummy tuck, and it takes up to a year for them to regrow to the point that patients can again feel abdominal skin sensation.

Despite these challenges, Nwubah emphasizes the positive aspects of a tummy tuck.

"It's definitely a rewarding procedure in terms of the outcome," said Nwubah. "It's the most transformative procedure we do, but you have to put a lot in to get that. The recovery is very difficult."

Recovery time from a tummy tuck can vary depending on several factors, including your overall health, the extent of the surgery and how your body heals. Generally, here's a rough timeline:

• First Two Weeks: This is usually the most challenging phase. You'll likely experience pain, swelling and some bruising. Most people need help with daily activities and are advised to take time off work. Mobility is limited, and you should avoid any strenuous activity.
• Weeks Three and Four: You'll start feeling more like yourself. Swelling and bruising continue to decrease, and you might be able to return to work, provided it's not physically demanding. Light walking is encouraged, but still no heavy lifting or vigorous exercise.
• Weeks Five and Six: By now, you will likely see significant improvements. You might be able to start incorporating more activities and light exercises, as advised by your surgeon.
• Weeks Seven and Eight: Most people are cleared to resume most normal activities, including some forms of exercise. However, complete healing will take longer.
• Several Months to a Year: Full recovery, including the fading of scars, can take up to a year. Your final results will become more apparent during this time.

It's important to follow your surgeon's instructions throughout your recovery and attend all follow-up appointments to ensure you're healing properly. Remember, these timelines are general and can vary based on individual circumstances.

Making your decision

A tummy tuck is a major surgery, and choosing to undergo one should be made with careful consideration. The decision should include being able to take enough time off afterward to recover. Each type of tummy tuck has its unique benefits and challenges. It's essential to consult with a qualified board-certified plastic surgeon who is an ASPS Member Surgeon to determine the best approach for your body and goals.

Remember to enlist as much help as possible at home after a tummy tuck and to be patient with the process. The road to recovery might be challenging, but the results can be incredibly rewarding.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.