For most Toronto plastic surgeons, a good portion of the new patients coming in the door are either thinking about a tummy tuck or a mommy makeover. Naturally, they come with a lot of questions about the procedures. Let’s take a moment to talk through some of the most common ones.
What is the mommy makeover?
It is always a combination of procedures involving the abdomen and breast rejuvenation, designed to help a woman restore her body after pregnancy and childbirth; commonly, it includes a tummy tuck (abdominoplasty) and either a breast augmentation, breast lift, or a combination augmentation and lift. That being said, at my plastic surgery practice in Toronto, it is not rare to add a pubic lift (monsplasty) and labiaplasty as part of the mommy makeover.
What is meant by a tummy tuck? Mini tummy tuck? Full tummy tuck? Extended tummy tuck?
A tummy tuck — aka abdominoplasty — is a powerful and gratifying procedure. It removes excess fat and soft tissue in the lower abdomen area, often after pregnancies or serious weight loss. Most types aim at repairing (plicating) the stretched inner muscles (rectus muscles, or the so-called “6-pack abs” muscles) and restoring the woman’s hourglass silhouette. The belly button is often resized and rejuvenated as part of the procedure (umbilicoplasty). The mons pubis is also often liposuctioned and lifted, rejuvenating the genital area (monsplasty).
The classic or full version is an incision from one side to the other — usually at the beginning of each “love handle.” Basically, the incision should run where the skin is overhanging (called the pannus), and this will vary from patient to patient. The classic tummy tuck addresses both the belly button and the stretched muscles, along with the overhanging skin. It usually includes liposuction to the flanks and upper abdomen, as well.
The extended version is necessary when the patient has side rolls extending into the lower back area. The incision is much longer, and it is often reserved for overweight patients or after serious weight loss. This technique will literally excise the love handles (side rolls).
An even longer version is done when someone has lost a very large amount of weight, such as 100 to 200 pounds. In such a case, a circumferential excision is done – the so-called body lift or belt lipectomy – which is a combination of the extended tummy tuck with a buttock lift, often with buttock augmentation using the (normally discarded) fat.
The mini tummy tuck uses a smaller incision, slightly longer than a C-section scar. It is reserved for small ladies with an excess of skin that’s mostly under the belly button.
When can a mini tummy tuck be used effectively?
The mini tummy tuck addresses very well the area below the belly-button, i.e. the loose muscle and excess of skin, but this technique is much more limited in its ability to address the upper abdomen, should it require extensive tightening. In most mini tummy tucks, the belly button is untouched, but it could be “floated” if the surgeon wants to better address the upper abdomen. For aesthetic reasons, care must be given to not lower the belly button too far down.
Which tummy tuck is best for you: full tummy tuck, mini tummy tuck, of extended tummy tuck?
The variations in a tummy tuck procedure allow me to recommend the best option, depending on a number of factors:
- The patient’s anatomy
- The quality of the patient’s abdominal muscles
- The quality of the patient’s skin
- The patient’s history of weight loss or gain
- The patient’s obstetric history (as applicable)
- The duration of recovery a patient can afford
- Whether a patient smokes, has diabetes, or other conditions affecting blood flow
Is liposuction always necessary?
No, liposuction is not always necessary, but I must say most of my patients will benefit from it. Most of my plastic surgery procedures – neck lift, arm lift, breast lift, body lift, etc. – have a component of liposuction for shaping and contouring. Liposuction will help achieve the hourglass shape in women – or the masculine triangle of the male’s torso – by reaching the upper abdomen, the love handles, flanks, and the lower back rolls. Liposuction should be done carefully and safely by qualified plastic surgeons, as liposuction its own comes with the same risks associated with any other surgery. Liposuction should be performed by a certified plastic surgeon in an accredited surgical facility, with board-certified anesthesiologists and no more than 5000 mL of aspirate in one setting. Safety is very important.
Many patients will also add liposuction to the bra rolls, inner knees, or outer thighs. For larger volumes of liposuction combined with tummy tucks, I like to keep my patients overnight (we offer accommodation in an overnight facility) for observation and fluid and pain management.
What are the limitations of a tummy tuck?
A tummy tuck will not address the fat that is inside the abdomen and around the internal organs — something many males do have as we get older; this is best addressed with diet and exercises. A tummy tuck can help with very small ventral or umbilical hernias, but larger hernias need to be addressed by a general surgeon.
What situations would enable a person to avoid a tummy tuck and get good results with a simpler, noninvasive procedure? What types of noninvasive procedures are possible?
Simply put, the best noninvasive option is always diet and exercise.
The so-called “noninvasive” procedures have very limited success, often with significant pain. They require multiple sessions and have very small results, if any. You’ll see many new nonsurgical technologies coming on the market regularly — because not one has yet proven to be very successful. Remember: Marketing pictures can be misleading.
What specific risks are involved in a tummy tuck?
The common risks and complications are wide and thick scarring, bruising, and swelling. Rarer issues are hematomas (accumulation of blood) and seroma (accumulation of clear fluids), infection, wound re-opening, and skin healing issues (skin and fat necrosis).
Notably, these risks increase for smokers and patients with diabetes. Smokers have to stop smoking 3 to 4 weeks before the procedure, and refrain from smoker for at least 3 to 4 weeks after the tummy tuck.
Lastly (and much rarer), clots in the legs and embolism of clot or fat to the lungs are some possible complications.
What can I expect after tummy tuck? What is the cost?
Recovery is usually 2 to 3 weeks, depending on the type of tummy tuck performed. Cost also varies depending on the procedure(s) chosen. All tummy tucks should be done by certified plastic surgeons with certified anesthesiologists in an accredited surgical center. Care should be given for proper intraoperative volume management and DVT (deep venous thrombosis, i.e. clot) prevention. Overnight stay should be an option for larger procedures.
Dr. Marc DuPéré, Aesthetic Plastic Surgeon