Is a Tummy Tuck Safe?

Published by David Berman on Oct 10, 2019

Who is the Patient?

If you are over 50 years old and in good health, I would insist you get a medical clearance from your family doctor. This will include standard blood work and an EKG. Of course, if there are other issues, then these will need to be cleared by other specialists. It should be obvious that this is an elective surgery and you should be in good health before considering this procedure. This minimizes any risk to you. My oldest tummy tuck patient was 71 years old and she sailed through both the operation and the recovery! She needed almost nothing for pain.

Your plastic surgeon and your anesthesiologist or nurse anesthesiologist, should be comfortable doing tummy tucks. I strongly believe the surgeon should not be administering the medication to put you asleep.

What is the Procedure?

A general description of a tummy tuck as is follows:

You will be marked in the pre op area in the standing position.

The incision is often at a previous C-section scar or the top of the pubic hair area. However if someone has a lot of droopiness in the pubic area, I will shift the incision inferiorly (down) to tighten up the pubic area.

Also if the patient prefers a lower incision, this is also possible. The incision can also be moved more superiorly (up), allowing more abdominal skin to be removed. Liposuction, especially to the love-handles is frequently done at the same time but strictly speaking is not part of a traditional tummy tuck. However, I liposuction at least the love-handles (flanks) in about 90% of my tummy tuck patients.

You will then get an IV and for many patients, this is the last thing they remember. Once in the operating room, I like to inject the incisions with local anesthetic (this decreases discomfort in the incision after surgery and also decreases any bleeding during the procedure from the incision).

Pneumatic stockings are applied (these pump the calves to circulate blood to prevent blood clots). We also put a warming blanket on the lower half of your body to prevent hypothermia.

After the incision is made, the skin and fat are elevated off of the muscle layer almost up to the rib cage. The umbilicus (belly button) is circumscribed and it stays were it is (however, the skin will move down so that a new opening will need to be made for the umbilicus but you do not get a “new” umbilicus.)

I will then tighten the fascia which is the layer over the muscle in the midline (and sometimes besides the midline). This will flatten the abdomen for those patients, whose abdomens have been stretched due to either child bearing or weight gain. After this, the head of the bed will be elevated approximately 45 degrees (you can grab more loose skin if you are half sitting up then if you are lying flat) and the redundant skin will resected, weighed (women always want to know how much fat and skin was removed) and discarded.

I then will apply internal and subcutaneous sutures to close the wound. I rarely use drains – a fact my patients love! The incisions will be covered with mastisol (glue for surgeons) and steristrips. Of course, there are many variations of this, but this is a basic tummy tuck.

In my experience, your entire time in the operating room will be 2.5-3.0 hours. No foley catheter will be placed. Of course, if I perform additional procedures, such as a breast augmentation or breast reduction, and these will require additional time, a catheter will be placed but just for the duration of the surgery.

You need someone to drive you home from surgery. You cannot take a taxi or Uber.

How to Minimize the Risks After Surgery?

I strongly encourage all of my patients to walk immediately after surgery. Some patients start walking sooner than others. You can definitely do stairs immediately so no need to relocate your bed to the main floor of your house.

In addition, I stress to walk in an upright position and bent over. This early walking strongly reduces your risk of blood clots. In addition, I firmly believe it helps my patients recover faster by being up and reasonably active sooner.

If the procedure lasts longer than 3 hours of general anesthetic, I will have my patients take Lovenox (a blood thinning agent like heparin but safer. It is an injection) which they will start about 12 hours after surgery and use once every 24 hours for 7-8 days.

I give all of my patients my personal cell phone number so they can text me if they have any concerns.

Is a tummy tuck safe after pregnancy?

Most tummy tucks are done after a woman has finished having children. However, I have done several tummy tucks on women who did not have any children but hoped to have them one day. In these cases, I will do a slightly different procedure, as I will not tighten the muscles. The recovery is even quicker in this case.

What if a woman who says she does not plan on having more children, and then finds herself pregnant after a tummy tuck? I have had this happen to me on several occasions. It is nothing to worry about. The baby always wins. I had 2 patients of mine, who had tummy tuck and less than a year later, found themselves pregnant. Both had uneventful pregnancies and deliveries.

How do you prepare to manage the risks?

Most of this would apply to any general anesthesia case

Be in good health. This is elective surgery and if you are not in good health, you should not be doing this.
If you are over 50 years old, I have you cleared by your family doctor, as well as have a panel of blood work done (if you had this blood work done recently it should be fine), as well as an EKG. Of course, particularly situations may require different blood work and clearances (eg. if you have lung or kidney problems).
It is very important to be up and mobile/walking as soon as possible. It is good to walk around your house or apartment, every few hours that you are awake. When you are resting in bed, it is good to bend your ankles up and down. This works the calf muscles and decreases the risk of blood clots.
You must be off all nicotine products for at least 4 weeks before and after surgery.
Stay in touch. I give all of my patients my cell phone, so if you have a concern, please share it with me.

Is a Tummy Tuck Safe for Diabetics?

A tummy tuck is safe for diabetics, provided your blood sugars are controlled by your medication. Of course, you should let your doctor who helps manage your diabetes know about your upcoming tummy tuck.

It is prudent to check your blood sugars more frequently after surgery. Please be advised, my days of advising about blood sugars are long passed. If you have concerns about your blood sugar, you need to see your family doctor or the emergency room doctor. It is always best, if you are a diabetic on medicine, especially if it is a type of insulin, that you be the first case of the day.

Stretch Marks and Your Tummy Tuck

Most of the time, I am able to remove most, or all of the skin between the pubic region and at least the lower part of the umbilicus (belly button). This means I remove any stretch marks in this area. Those stretch marks that are higher up, will now be moved much lower in the abdomen.