Jason R. Hess MD FACS
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San Diego, Ca 92103

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Tummy Tuck (Abdominoplasty) and Mommy Makeover

The toned abdomen is a youthful symbol of health, fitness, and beauty.  A finely contoured abdominal physique is often difficult to achieve with exercise alone. Factors in our lives such as heredity, child bearing, and physical deconditioning may contribute to a protuberant abdomen.  Workplace stresses and the "American Diet" are also partly to blame for unsightly belly bulges.


Abdominal aesthetics are defined by a number of factors. The skin of a fit abdomen is tight, muscles are toned, and there is minimal excess fat. Child bearing and weight fluctuations are common challenges to the ideal abdominal physique leading to stretch marks, excess fat, and muscle laxity.  The solution to these symptoms depends on their severity. 


A modest amount of excess fat should respond favorably to a healthy diet and vigorous exercise.   Areas of excess fat that fail to respond to these measures may be effectively treated with liposuction. When excess skin or stretch marks are apparent, exercise alone may prove ineffective.  An abdominoplasty, when well executed, is capable to producing dramatic improvement in the contour and aesthetics of the abdomen when applied to the appropriate candidate.  


Am I a Candidate for Abdominoplasty?


The ideal candidates for abdominoplasty are men or women who are otherwise in good health and have skin laxity of the abdomen, women who have finished child bearing, or men or women who have undergone dramatic fluctuations in their weight, but are weight stable at the time of surgery. After bariatric surgery, many men and women have plateaued in their weight loss and choose to undergo an abdominoplasty to address the unfavorable excess skin.


Who Should Not Consider a Tummy Tuck?


Smoking is a relative contraindication to abdominoplasty. This means that an abdominoplasty can still be performed in an otherwise healthy individual, but resection of excess skin and fat must be more conservative due to the high risk of wound healing complications in smokers. Women who are considering future children should generally wait until they have finished child bearing.


Abdominoplasty tightens the rectus fascia, a layer enveloping the abdominal muscles.  This muscle is stretched by massive weight gain or future pregnancy. Abdominoplasty is not a weight loss procedure.  Most patients lose between four and  ten pounds with abdomnioplasty depending on preoperative body habitus.  Clothing size may decrease, but abdominoplasty is not a cure for obesity. Bariatric surgery is often preceded by abdominoplasty.


Patients should consider abdominoplasty only when they are weight stable. This means that if an individual is losing weight from diet, exercise, or bariatric surgery, this weight loss should reach its plateau prior to surgery. 


Diabetes, peripheral vascular disease, nutritional deficiencies, and prior abdominal surgeries may adversely affect wound healing. These issues must be carefully evaluated at the time of surgical consultation. 


How is a Tummy Tuck Surgery Performed?


Abdominoplasty, also known as tummy tuck surgery, is a procedure designed to remove excess skin and fat from the abdomen and flanks. Abdominoplasty is one of the highest satisfaction of plastic surgical procedures.  This surgery is often confused with liposuction, but there are dramatic differences between tummy tuck surgery and liposuction alone.


Difference Between Liposuction and a Tummy Tuck


Liposuction simply removes excess fat. Abominoplasty removes excess skin, excess abdomimal fat, and tightens abdominal muscles.


Abdominoplasty Surgery


Depending on the patient, abdominoplasty may require two to five hours of surgery. General anesthesia is almost always necessary. A low transverse incision is created below the bikini line.  This incision should be hidden by most undergarments following surgery. The skin and fat of the abdomen are elevated. The navel is retained in its anatomically correct position. 


The fascia (a layer covering the abdominal muscles) is tightened with sutures in the midline.  Liposuction is performed on many patients as needed. The abdomen is then flexed and excess skin and fat are excised. The navel is then reset into the abdominal skin.  


Complete Abdominoplasty


The lower transverse abdominal incision is generally created from hip to hip. The length of the incision is tailored to the amount of correction required. Abdominoplasty is a cosmetic procedure, so incision length and quality of scarring are of utmost importance to your surgeon.  Surgery is performed with meticulous attention to detail. The skin, subcutaneous fat, and muscle are surgically repaired as needed.   


The navel will be reset into the tightened abdominal skin. Drainage tubes may be placed beneath your skin and these will be removed in a few days. Partial or mini abdominoplasty. Mini-abdominoplasties are often performed on patients whose fat deposits and stretch marks are isolated to the region below the navel. 


The advantage of this procedure is a narrower incision, however, the abdominal muscles are not tightened above the navel. There are many variations to abominoplasty procedures, and the optimum results are achieved by tailoring the procedure to each individual.  


What to Expect Postoperative


Depending on the procedure, 5-14 days away from work may be required. While abdominoplasty is one of the highest satisfaction of plastic surgical procedures, it is not a minor surgery. 


Prescription pain medication is required for pain control for the first week following surgery.  The majority of discomfort originates from tightening of the abdominal muscles. Patients may find it necessary to walk in a flex posture to relieve tension from the incision for the first few days following the surgery. The results are immediate and long lasting, but minor swelling may last for several months following surgery.


An abdominal binder is an elastic garment that is necessary following surgery.  This garment will be provided at the time of surgery and should be worn for four weeks following surgery.  

Surgical incisions will be red and visible for up to six months. Scars gradually fade thereafter. The final results are apparent several months following surgery. 


A consultation is the best means of gathering more information regarding abdominoplasty surgery.  



Mommy Makeover



A mommy makeover is a combination of procedures designed to help mothers return to their pre-maternal figures.  Most often, these procedures are performed following child bearing years and include surgery to enhance the breast and abdomen.  Breast enhancement may include a breast augmentation, mastopexy (breast lift), or a combined augmentation mastopexy.  An abdominoplasty is also performed to re-establish the feminine contour of the waist and abdomen. 


Breast Changes:


Many women find that childbearing may create irreversible changes to breast tissue. Whether or not women choose to breastfeed, breast tissue proliferates during pregnancy in preparation for lactation. This may create a significant increase in breast volume that may persist in the early postpartum period. Unfortunately, this tissue will often involute resulting in breasts that have lost their youthful lifted contour. Stretch marks may occur, and volume that existed in the superior pole of the breast may now be found in the lower pole.  


Abdominal Changes:


Postpartum abdominal changes may be dramatic. Volume and hormonal changes during pregnancy combine to relax the skin, fascia, and muscle of the abdominal wall. The expanding uterus sometimes contributes to the separation of abdominal muscles (rectus diastasis). The relatively rapid expansion of abdominal skin may lead to unsightly stretch marks and wrinkles. Hips and flanks may loose their feminine contour due to hormonally regulated fat deposition occurring during pregnancy. While child-bearing is a beautiful and natural phenomenon, it’s effects may wreak havoc on the female figure. Fitness regimens are helpful and recommended; these efforts fail to tighten loose skin and fascia.  


What Can Be done?


In general, aerobic exercise and a balanced diet will help many to achieve their goal of maintaining an attractive figure. Despite a disciplined regimen, however, many find their desired figure to be unattainable. When this is the case, contouring of the breast and abdomen can be safely achieved on an outpatient basis. These procedures are tailored to each woman’s frame and personal goals.  




The length of recovery depends on the extent of the procedure and often differs with each individual. When an abdominoplasty and breast augmentation are performed in combination most women require 10-14 days away from work or other responsibilities.


Abdominoplasty requires the insertion of drains beneath the abdominal skin that are removed as their output declines.  Patients are asked to wear an abdominal binder that is similar to a girdle for four weeks after surgery.


Breast augmentation involves less discomfort than abdominoplasty. When performed alone, approximately 3 days recovery are required. Patients are discharges with pain medications and antibiotics.  Most often, they return to the office the day after surgery.