Who is a candidate?
The abdomen goes through changes with pregnancy, weight gain, weight loss, and aging. Common reasons for having a tummy tuck (abdominoplasty) or mini-tummy tuck include:
- Loose skin on upper and/or lower abdomen
- Laxity of abdominal wall (abdomen pooches out with or without excess fat)
- Rectus diastasis (separation of the paired rectus abdominus muscles)
- Stretch marks on lower abdomen
- Rashes or open wounds below skin folds
Will insurance cover tummy tucks?
Insurance does not typically pay for a tummy tuck, though it may pay for a panniculectomy (removing an overhanging “apron” of lower abdominal skin) if you meet specific criteria laid out by your specific insurance plan. Please see the panniculectomy to read more about insurance coverage for this procedure.
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Tummy tuck versus Mini-tummy tuck
The main difference between a tummy tuck and mini-tummy tuck is the length of the incision.
During a tummy tuck, a horizontal incision is made more or less hip to hip, the skin and underlying tissue is raised to the level of the border of the ribs and the xiphoid (lowest part of sternum), the rectus muscles are brought back together in the middle, the belly button is brought out through the skin at it’s new location, and the extra lower abdominal skin is removed.
In a mini-tummy tuck, the incision is smaller (more like a long C section incision), the rectus muscles may or may not be tightened, the belly button is not moved, and the skin above the belly button is not moved or tightened at all.
Also, if the upper abdominal muscles need to be tightened, this would require an incision around the belly button and endoscopic repair (endoscopic mini-tummy tuck).
Therefore to be a good candidate for the mini-tummy tuck means you have no extra skin above the belly button, no laxity or pooching out above the belly button, and a limited area of excess skin below the belly button. To be a good candidate for the endoscopic mini-tummy tuck, you have no extra skin above the belly button and a limited area of excess skin below the belly button.
Risks of tummy tuck surgery
The standard surgical risks include pain; bleeding; infection; scarring; painful or hypertrophic scarring; hematoma; seroma; injury to vessels, nerves, bowel, surrounding structures; asymmetry; poor cosmetic result; prolonged edema, numbness, parasthesias; fat necrosis; loss of all or part of umbilicus; deep venous thromboembolism; pulmonary embolism; death; need for further procedure and out of pocket costs; and risks of anesthesia.
Tummy Tucks after Massive Weight Loss
Patients who have tummy tucks following massive weight loss tend to have a greater risk of the problems above, specifically with wound healing, possibility of an open wound, stretching of the skin after surgery, risk of infection if lengthy operating room time, and possibly more complications related to anesthesia in patients with a high BMI (body mass index).
Massive weight loss and nutritional deficiencies really take a toll on the skin and tissues. Dr. Patel has had excellent experience taking care of patients who have undergone all types of weight loss surgeries.
Depending on the bariatric surgeon, patients with lap bands may wish to have the port revised to lay behind the muscle fascia, making it out of the way for surgery and also making it less visible or noticeable after the tummy tuck smooths and tightens the skin. Recommendations will vary patient to patient, and can be clarified at the consultation.
Postoperative follow-up visits
Visits following surgery typically occur the day after surgery (for dressing change and making sure there was no bleeding, fluid collection, or blood supply issues overnight), the week after surgery (for removal of drains if present), 2 weeks after that, and then spread out less frequently thereafter. The schedule is adjusted based on doctor/patient preferences and needs.
Walking the day of surgery, with assistance as needed, is required.
One night stay in an aftercare facility, or private duty nursing at your home or hotel, is also required for the night of surgery.
Nurses will assist you in getting up and walking, teach you how to take care of your drains and dressings, and give you injectable pain and/or nausea medication if you are not eating enough to take oral medications, or if oral medications are not enough to keep you comfortable. Often patients with young children or a hectic home schedule find it easier to recover at the aftercare facility, and stay for additional nights to recover and heal in a peaceful environment.
You may shower 24 hours after the drains have been removed. No baths, soaking in tubs, hot tubs, or swimming pools until incisions are fully healed. Gentle soap (non-perfumed, non-irritating soap preferred) and water over the incision is okay. Scar gel may be used starting 2 weeks after surgery or once incisions have no open areas, crusting, or scabs.
An abdominal binder is placed at the end of surgery, and wearing it 24 hours a day is recommended for the first 2 weeks following surgery, and then it should be used as needed during periods of activity or as needed to help minimize swelling. In general, Dr. Patel recommends avoiding exercise and heavy lifting (>15 pounds) for 6 weeks following surgery, at which time you can ease back into your workouts.
Light activity that does not involve working your core is okay (such as normal walking, but not speed-walking). Activity should be limited to small periods with adequate rest in between.
You may return to work 2 weeks after surgery, depending on your pain level, stamina, and activities required in your occupation. Often patients like to take more time off due to lifting restrictions, length of work-day, or comfort level with returning to work.
You may drive once you are no longer taking pain medications or muscle relaxers, and allow a 24 hour minimum window between your last pain medication or muscle relaxant dose and driving.
If you notice any pain and or swelling in the legs (especially if only on one side), you should notify Dr. Patel and report immediately to the emergency room to make sure you do not have a blood clot, which can be life-threatening. All recovery processes and recommendations vary patient to patient, so these general guidelines may not apply to every patient.