Tummy Tuck

A tummy tuck, or abdominoplasty, is an operation that flattens and firms the abdomen by removing excess skin and fat and tightening the abdominal muscles. It is most often chosen after pregnancy or significant weight loss, when the skin of the lower abdomen has stretched and the muscles have separated. It can also relocate the belly button to a natural position on the new, flatter abdomen. The scar lies low across the abdomen and is designed to be hidden under underwear or swimwear.

Many people who ask about a tummy tuck have already done everything right: they eat well, exercise and have reached a healthy weight. Yet a pouch of loose skin and a rounded lower abdomen remain. This is because neither exercise nor diet can remove stretched skin or bring separated muscles back together. A tummy tuck corrects both.

What a tummy tuck treats

• loose, overhanging skin on the lower abdomen
• stretch marks below the belly button
• a bulge caused by separated abdominal muscles (diastasis recti)
• a stretched or distorted belly button
• stubborn fat on the abdomen and waist, with the help of liposuction

Types of abdominoplasty

The type is chosen by examining where the excess skin is, how much there is and whether the muscles have separated.

Liposuction or tummy tuck?

This is one of the most common questions at consultation. Liposuction removes fat, and it works well when the skin is firm and elastic and the muscles are intact. It cannot remove loose skin and it cannot repair separated muscles. When liposuction is used on an abdomen with loose skin, the result is often a deflated, wrinkled lower abdomen that looks worse than before.

A tummy tuck is the better choice when there is loose or overhanging skin, stretch marks below the navel, or a bulge from separated muscles that persists when you tense your abdomen. A quick test is to lie on your back and lift your head slightly while feeling the centre of your abdomen above the navel. A gap or ridge between the two vertical muscles suggests diastasis, which liposuction will not fix.

Tummy tuck after weight loss

After major weight loss, whether through diet or bariatric surgery, the excess skin often extends around the waist and back and sometimes horizontally across the abdomen. A standard tummy tuck may not be enough. An extended tummy tuck, a fleur-de-lis tummy tuck or a circumferential body lift may be discussed. Your weight should be stable for at least six months, and ideally around twelve to eighteen months after bariatric surgery, with nutrition checked by blood tests before surgery.

Who is a good candidate?

A good candidate:

• has loose skin and/or muscle separation that does not improve with exercise
• is at or close to a stable, healthy weight
• is in good general health
• does not smoke, or is willing to stop well before and after surgery
• has finished having children, or is prepared for the effect a later pregnancy may have

A body mass index that is still high, active medical conditions, a history of blood clots, or plans to lose a lot more weight are reasons to wait or to modify the plan.

How a full tummy tuck is performed

The operation takes two to four hours under general anaesthesia.

1. Incision. A low incision is made across the lower abdomen, within the underwear line. A second incision frees the belly button, which stays attached to its stalk.
2. Lifting the skin. The skin and fat are lifted up to the ribs, exposing the abdominal muscles.
3. Muscle repair. Separated rectus muscles are brought together with strong stitches, from the breastbone down to the pubic bone. This narrows the waist and flattens the abdominal wall.
4. Liposuction. Fat on the flanks and waist is often refined with liposuction for a smoother contour.
5. Skin removal. The skin is pulled down, and the excess, usually including the skin between the belly button and the pubic area, is removed.
6. New belly button. The belly button is brought out through a new opening in the right position and shaped to look natural.
7. Closure. The incisions are closed in layers. Drains may be placed for a few days, although techniques such as progressive tension sutures can reduce or remove the need for them.

Preparing for surgery

Stop smoking and all nicotine products at least four to six weeks before and after surgery, as nicotine greatly increases the risk of wound healing problems. Hormonal contraception or hormone replacement may need to be paused because it increases the risk of blood clots; this is discussed at consultation. Stop blood-thinning medicines and supplements two weeks beforehand after checking with your doctor. Arrange help at home for at least two weeks and prepare a recliner or plenty of pillows so you can rest with your knees and upper body slightly bent.

Recovery

1. Days 1–2: hospital stay; walking in a slightly bent posture starts on the first day; compression garment on
2. Days 3–7: rest in a flexed position, short walks several times a day; drains may be removed
3. Days 7–14: posture gradually straightens; follow-up checks and dressing changes
4. Weeks 2–4: return to desk work for many patients; driving once you can brake firmly and move freely
5. Weeks 6–8: return to lifting and exercise, including abdominal training
6. Months 6–12: swelling fully resolves and the scar fades

A compression garment is worn for about six weeks. Numbness of the lower abdominal skin is expected and slowly improves over months, but some permanent reduction in sensation below the navel is common.

Risks

A tummy tuck is major surgery. Possible risks include:

• seroma, a collection of fluid under the skin, which may need draining
• delayed wound healing, especially in the centre of the scar and in smokers
• visible or widened scars
• haematoma (bleeding)
• infection
• numbness of the abdominal skin
• blood clots in the legs or lungs, the most serious risk after abdominal surgery

Prevention of blood clots includes early walking, compression stockings, calf compression during surgery and, when appropriate, blood-thinning injections. Your individual risk is assessed before surgery.

How long the result lasts

The removed skin does not come back, and the muscle repair holds well if your weight stays stable. Weight gain, pregnancy and ageing can affect the result, but most patients keep a much flatter, firmer abdomen for many years.

Tummy tuck in Istanbul

International patients should plan ten to twelve days in Istanbul. This allows for the operation, the hospital stay, drain removal if drains are used and a final check before flying. Long flights increase the risk of blood clots after abdominal surgery. Wear compression stockings, move your legs regularly and drink plenty of water. If you are flying for more than four hours, we may advise additional precautions.

Dr. Mehmet Özdemir is a plastic, reconstructive and aesthetic surgeon holding the EBOPRAS qualification, with body contouring among his main areas of focus. He trained in Germany, Poland and Brazil, consults in Turkish, Kurdish, English and German, and practises in Bakırköy, Istanbul.