NEW YORK, NY, UNITED STATES, July 12, 2023/ — Carrying extra fat and skin around the lower abdomen isn’t a rare phenomenon, but it’s a rare person who isn’t bothered by it. That dissatisfaction is the main reason driving the popularity of a “tummy tuck,” known medically as abdominoplasty, according to Dr. Constance M. Chen, a renowned plastic and reconstructive surgeon.

Tummy tuck surgery is among the top cosmetic surgical procedures performed in the United States, according to the American Society of Plastic Surgeons (ASPS). And its appeal has only been growing: More than 100,000 abdominoplasties took place in 2020, a 56% increase from the 62,000 done in 2000, according to the ASPS.The procedure involves removing loose, excess skin and fat from the lower abdomen and stretching out the remaining skin to create a flat contour. The procedure is akin to resecting the “spare tire” around the trunk. Usually, loose abdominal muscles are tightened as well to strengthen the core.

“Body-contouring procedures are one of the ways people who are unhappy with their body shape, despite being near their ideal body weight, can take charge of how they look and feel,” says Dr. Chen, a board-certified plastic surgeon with special expertise in the use of innovative techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. “Undergoing abdominoplasty can make it easier to find clothes that fit and boost self-esteem.”

What a tummy tuck can fix

There are many reasons a person’s abdominal tissue can sag or contain excess fat, the most common being pregnancy and significant changes in weight over time.

When a woman’s body undergoes the natural changes of pregnancy, the belly skin stretches and it doesn’t always snap back. The same thing happens when someone gain a significant amount of weight and then loses the extra fat. Pregnancy and extreme weight loss can leave extra skin that exercise alone can’t fix. “Depending on the elasticity of someone’s skin, the skin doesn’t always contract completely when someone’s body size does,” Dr. Chen says. “Sometimes the only way to remove excess overhanging skin is by resecting it surgically through a tummy tuck.”

In addition, the stretch from pregnancy or weight gain can cause the abdominal muscles to separate, a phenomenon known medically as “rectus diastasis.” When this happens, a bulge to form in the middle where the muscle separates that can be unsightly and it can also cause back pain. Since the outer covering of the muscles, known as the fascia, have been stretched out and damaged, the only way to correct a rectus diastasis is by surgically repairing the fascia to reform the body’s normal internal corset. Repair of the rectus diastasis is part of a standard tummy tuck.

One indication that exercise alone won’t restore a person’s body contour is if there are stretch marks on the abdominal skin. Stretch marks occur when the middle dermal layer of the skin is damaged, and indicate that the skin will not be able to snap back completely. Similarly, the bulge from a rectus diastasis indicates that the fascia has been damaged and requires surgical repair. Since a tummy tuck excises the skin of the lower abdomen, it also removes the stretch marks on that skin.

“The goals of a tummy tuck are two-fold: it flattens the abdominal contour and reinforces the abdominal muscles,” Dr. Chen explains. “Not only does this help a person’s body appear younger and slimmer, but it usually helps them feel better with less back strain as well.”

What to expect after a tummy tuck

After a tummy tuck, you will have drains that drain out excess red-tinged fluid from the area under the abdominal skin. Usually the drains are in place for a week or two until the fluid stops draining because the tissues have healed. There is also a long scar from hip to hip that can be designed to be hidden under a bathing suit bottom. The abdomen may feel tight and even numb for weeks or even months, but this sensation or lack thereof will improve over time. You should plan to take a couple of weeks off of work, and avoid lifting anything over 5 pounds for 2 months.

It is also important to remember that while an abdominoplasty can successfully remove extra fat and skin that was there before the procedure, it cannot prevent future contour changes from pregnancy or weight gain. Thus, it is best to undergo a tummy tuck after a person has completed childbearing with no future pregnancies planned and when a person is at a stable weight, Dr. Chen says. “Excess fat is removed from the abdomen during a tummy tuck, but that doesn’t mean more fat can’t be added there later,” she says. “To reap the most rewards from abdominoplasty, people should be engaged in an active, healthy lifestyle.”

“Abdominoplasty is an effective way to restore one’s body after pregnancy or extreme weight gain,” says Dr. Chen. “Anyone considering a tummy tuck should consult with an experienced board-certified plastic surgeon to understand what to expect from this potentially life-changing procedure.”

Constance M. Chen, MD, is a board-certified plastic surgeon with a special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast and body surgery. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.