Many tummy tuck patients come to my office with a mental image of a magazine model they have seen or the memory of what they looked like in their late teens and before children: a flat tummy, tight skin, slim waistline, and possibly even a six-pack. The majority claim to have realistic expectations, “I know I won’t look like that again,” but in the back of their minds they really do want to look like that again. My most important job is to educate them about realistic expectations. The best way, in my experience, is by showing before and after tummy tuck pictures of other patients and pointing out features that my patient shares with the before pictures they are looking at.
The most common misconception is that liposuction will achieve the shape patients desire and the tummy tuck will get rid of the extra skin left behind in the process. Fat or volume that is located behind the muscles, both in and around the intestines, cannot be reduced. After asking my patient to tense the stomach muscles, I pinch the overlying skin to show them the layer that will be thinned. Often it is just an inch or two in thickness. Although this top layer can be reduced, the overall shape and bulge will change very little because the majority of the bulk cannot be accessed. The only way to reduce intra-abdominal fat is to change eating and exercise habits under the supervision of a knowledgeable professional (physician, dietician, trainer), or to undergo weight reduction surgery (banding of the stomach or some intestinal bypass). The weight will drop slowly at a rate of about one to two pounds a week. After the weight goal is achieved, the patient may find that a large amount of extra skin is left. Since there is no reliable way of “shrinking” skin (despite numerous claims advertised everywhere), the patient may be a candidate for body contouring surgery, including abdominoplasty.
A patient seeking an abdominoplasty after massive weight reduction is usually very depressed about how he or she looks: “I lost the 150 pounds in order to be healthier and look better. Instead, the skin all over my body is hanging and flapping like a wet flag on a flagpole. I looked better when I was fat.” In fact, the patient is metabolically better. Blood sugars are usually under control and may not have been before the weight loss. Blood pressure is also down. The heart is pumping blood through one mile less of capillaries for every pound lost. However, the skin now looks as if it were made of wax and melted in an oven. The usual tummy tuck won’t work for this patient. He or she may think that a simple excision of skin at the beltline, leaving a scar that can be hidden by a bathing suit, will suffice. Unfortunately, there is also excess skin that runs from side to side, and this can only be tightened by removing skin through an incision that runs up and down, often leaving a scar in the midline that runs from the bottom of the breast bone to the pubic bone. This scar cannot be hidden if the abdomen is exposed. Ignoring this excess skin results in pooches at the sides above the hips.
The other major misconception that some patients have about the tummy tuck procedure is that they can have their surgery and go back to work after a couple of days. The minimum downtime after most tummy tuck surgeries is two weeks. This may be a problem for many patients that have a limited time available to be off work. If the patient’s job requires substantial physical activity, time off may be as long as six weeks, especially if heavy lifting is involved.
As long as patients are educated and have realistic expectations, most will be very happy with their results.