NYC Tummy Tuck

The New York City guide to tummy tuck surgery

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What is a tummy tuck?

A tummy tuck, also known as an abdominoplasty, is a popular option for individuals with excess skin and soft tissue of their abdomens. This is especially true after changes associated with pregnancy and significant weight loss. Many of these changes cannot be reversed by losing weight. Specifically, skin redundancy requires surgery to improve contour as does the repair of separated abdominal muscles (diastasis recti or a rectus diastasis).

What is a diastasis recti or rectus diastasis?

A diastasis recti and a rectus diastasis are two terms to describe the process in which the paired abdominal muscles in your midline (rectus abdominus muscles) are stretched and separate from each other. This can happen after pregnancy of a single child but more commonly happens after several pregnancies, pregnancies with large babies, or multiple gestation pregnancies. It is important to note that exercise can strengthen the abdominal muscles but will not bring the abdominal muscles closer together. Thus, the only current option to repair a diastasis recti is through surgery. While an abdominoplasty surgery is sometimes synonymous with a diastasis recti repair, it does not always need to be performed during an abdominoplasty. Some individuals have excess skin and soft tissue but their abdominal muscles are already approximated in the midline. For these individuals, a tummy tuck without a muscle repair would be appropriate.

What is the difference between and mini abdominoplasty, an abdominoplasty, and a fleur-de-lis abdominoplasty?

A mini tummy tuck describes a procedure where excess abdominal tissue below the umbilicus (belly button) is removed. The belly button can either be left in place or in some cases can be “floated” which means that the stalk is transected and the belly button is moved closer to the underwear line as a tradeoff for additional skin resection and redraping. A traditional abdominoplasty denotes a similar incision in the underwear line but instead of stopping at the belly button, the skin is undermined to the level of the xiphoid and ribs. The belly button is separated from the abdominal skin, the skin is pulled over and redraped and a new hole is cut out to recreate a new belly button. This is the most common type of abdominoplasty performed. In cases of severe skin excess, a fleur-de-lis abdominoplasty can be performed. The lower incision is again in the underwear line but in this variation, additional skin is removed from the midline leaving a vertical scar in the middle of the abdomen. The patient needs to understand that the larger scar burden is a tradeoff to excess skin. This operation is generally reserved for massive weight loss patients.

Can I have liposuction at the time of my tummy tuck?

The short answer is yes. Many patients can benefit greatly from liposuction at the time of tummy tuck. That being said, there are considerations and limitations to how aggressive your surgeon can be with fat removal in order to attempt to avoid wound healing problems.

Will I have drains after my tummy tuck?

Potentially. This is a decision that is discussed in your preoperative visit with your surgeon. Drains are small soft tubes that help avoid excess fluid from accumulating in your body. While drains are a small inconvenience for a few days, drains help the recovery process. Some surgeons do not use drains. Instead, these surgeons tend to use a series of sutures to quilt down the potential large spaces that fluid wants to accumulate. This is sometimes advertised as a drainless tummy tuck. The sutures are sometimes called quilting sutures or progressive tension sutures. In my practice, I tend to perform liposuction extensively before performing a tummy tuck. In these cases, I would be hesitant not to use drains as liposuction generates a fair amount of excess fluid.

What is a drainless tummy tuck?

A drainless tummy tuck is an abdominoplasty without the use of drains. As mentioned before, quilting sutures or progressive tension sutures are generally used to help fluid from accumulating and causing problems. A patient who does not require liposuction may be a good candidate for a drainless tummy tuck. In my opinion, a patient should not choose a surgeon based on his or her use of drains. Drains are removed after a few days but your results are yours to enjoy for many years.

What is a mommy makeover?

A mommy makeover is a term used to describe a tummy tuck performed in conjunction with an aesthetic breast surgery. The aesthetic breast surgery could be a breast reduction, a breast lift (mastopexy), a breast augmentation (breast implants), or an augmentation/mastopexy (lift plus implants). A tummy tuck performed with a breast procedure is safe to have as long as your surgeon can do both cases in an expeditious manner.

Am I a candidate for a tummy tuck?

Individuals who are interested in a tummy tuck should be in good health and be fit for elective surgery. Patients should avoid smoking and nicotine-containing products that can affect blood flow and, ultimately, healing. In addition to the general health risks of smoking, there is an increased risk of complications, poor healing, and tissue loss. In addition, surgeons should be aware if you have a personal or family history of blood clots of other medical problems that make you a higher than average risk for blood clots of the leg and embolism to the lungs.

Can I have a tummy tuck before having children?

Yes, you can have a tummy tuck before having children. That being said, I counsel my patient’s extensively and encourage them to wait until they are done having children to improve the final result. Even the best results can be compromised with weight loss, weight gain, or additional pregnancies.

How long is tummy tuck surgery?

A tummy tuck, depending on the complexity, takes around 2-3 hours. Additional operative time may be needed if another procedure is performed at the same visit. The total operative time may be longer when accounting for anesthesia time at the beginning and the end of the procedure.

What should I expect the first week after a tummy tuck?

A tummy tuck is a major surgery and can have some discomfort in the early postoperative period. This is especially true if a diastasis recti repair is performed. There are ways to help keep you comfortable in the early postoperative period including local anesthesia, TAP blocks, and Exparel (liposomal bupivacaine – a longer acting numbing medicine). You will be walking in the recovery room and should walk in the early postoperative period to prevent blood clots. Some surgeons like to give additional support of your abdomen with an abdominal binder. The most common complaint during the first week of recovery is that the patient feels very sore from the diastasis recti repair. After the first few days this sensation improves. Longer term, patients can sometimes complain of prolonged numbness of the skin below the belly button. This innervation takes the longest to recovery after abdominoplasty.

What are my limitations after a tummy tuck?

All surgeons have slightly different protocols so each patient should follow their surgeon’s protocols. In general, tummy tuck patients should be treated similar to other major surgeries with the avoidance of strenuous activity and exercise for the first 4-6 weeks after surgery. As mentioned before, patients should walk frequently to attempt to avoid blood clots.

How much does a tummy tuck in NYC cost?

There are 3 main costs of a tummy tuck surgery: the facility fee, the anesthesia fee, and the surgeon's fee. Many surgeons also require one night in a hotel with a visiting nurse which adds an extra cost. For the patient, the average total cost in NYC for a tummy tuck will likely be $12,000-$25,000+ depending on the surgeon you choose.

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