An expert guide: Tummy tuck procedures for post-weight loss patients

In this informative article, highly respected consultant plastic and reconstructive surgeon Mr Jonathan Duncan shares his expert insight on abdominoplasty procedures for patients who have undergone significant weight loss. The revered specialist details the key areas patients should reflect upon while considering tummy tuck surgery and how different surgical approaches may better suit different patient profiles.

What is an abdominoplasty?

An abdominoplasty, also known as a ‘tummy tuck’, is a procedure which re-contours and enhances the abdominal aesthetic. Abdominoplasty patients have a wide-ranging profiles, including all ages, women who are post-pregnancy and those who have gained or lost weight.

In today’s society, people are taking more focus on personal health and wellbeing and therefore those who may be struggling to lose weight with diets are looking to newer modalities for effective results. This may include gastric band, gastric sleeve and gastric bypass procedures or some of the more newly available drugs, such as weight loss injections or pills, which can help patients to lose significant amounts of weight. This is a great positive and I have seen many patients who have experienced significant health benefits as a result of their weight loss, including diabetes reversal.

Unfortunately, although people may feel very well following their weight loss, they can often end up in a complex psychological position as they are left with large amounts of excess skin and soft tissue on the abdomen. This can have various distributions across the lower abdomen, over the hips and the in upper central abdomen, which means that many people feel that they have to hide themselves away or dress the way they used to by wearing big, baggy clothes to hide the excess skin and tissue.

As a doctor, I’m privileged to be trusted by patients who allow me to see what they are dealing with and to invest in their story. In my position, I see patients of all shapes and sizes and some are unfortunately living with significant discomfort, almost tucking excess tissue on their abdomen into their trousers, for instance.

The patient profile for abdominoplasty surgery is a wide spectrum and those who are post-weight loss are still in the same category as any other patient. However, they may differ in that they likely have more expendable tissue that they wish to lose as opposed to other patients who have not gone through weight loss and are simply seeking a cosmetic abdominoplasty.

How does abdominoplasty for post-weight loss patients differ from traditional tummy tuck surgery?

Patients who are undergoing an abdominoplasty after losing a significant amount of weight will require a more extensive operation, although the recovery time does not differ from that of a traditional tummy tuck procedure.

As you can imagine, a patient who is generally slim but has lost a small amount of weight will typically have excess tissue that is fairly centrally located, meaning that the scar pattern will be much smaller. On the other hand, people who have lost a lot of weight will carry a much larger amount of excess skin and soft tissue. In many cases, this means that the excess won’t sit only centrally in the lower abdomen but will extend laterally out on to the hips.

In order for the surgeon to be able to get the best possible result, this means that post-weight loss patients should expect that their scar will generally be slightly longer and will extend round to over the hip, heading towards the posterior aspect of the hip.

Additionally, patients who have lost a lot of weight are more likely to be recommend for a fleur-de-lis abdominoplasty. A standard abdominoplasty will only deal with excess skin and tissue vertically, leaving the patient with a horizontal scar across the lower abdomen. In contrast, the fleur-de-lis procedure will also have a vertical extension, heading up the midline up around the belly button and towards the rib cage. This allows the surgeon to deal with the excess in a vertical direction as well as excess in the vertical plane. Due to the greater volume of skin and tissues to be removed in patients who have gone through significant weight loss, there is a higher chance that this will be recommended to achieve the best outcome.

It’s by no means necessary that post-weight loss patients undergo surgery with the fleur-de-lis approach and this decision comes to down to a personal choice that you can make in consultation with your specialist. It’s important to remember that the results of the fleur-de-lis technique do come at the expense of having a vertical scar, as well as the typical low horizontal scar. Despite this, many patients are very unhappy with the appearance of their abdomen and have put in so much work to lose the weight, that the most important factor for them is achieving the best possible outcome by removing the maximum amount of skin and soft tissue. Thorough counselling with a specialist is very important in helping patients to establish their goals from surgery and the approach that is best suited to them.

What should be considered before undergoing an abdominoplasty following weight-loss?

By the time patients come to see me, they have usually already made up their mind that they want to opt for an abdominoplasty. Therefore, in our initial consultation, I explain a few things that it is important for patients to consider before moving forward.

It’s important to be clear about what your expected outcomes are and what you really want to get out of this process. It’s key that you are really honest with your surgeon about your goals because if you’re not on the same page, ultimately, you may be left unsatisfied with your results.

It’s important to consider that the potential of post-weight loss abdominoplasty surgery is not just a big financial investment but also an investment in time and recovery. Therefore, to ensure we achieve the best results, I would always counsel patients that they should be as optimised as possible for the surgery. This may relate to giving up smoking or having any conditions such as diabetes well controlled before undergoing their operation.

In terms of weight loss, by the time patients come in to see me, their journey should be fairly well down the line. Some patients start to consider an abdominoplasty far too soon after they have had weight control surgery and in those cases, we need to put the brakes on a little. I would advise patients to aim for a weight and final results that are realistic for their body frame and size. Setting yourself unrealistic goals is the worst thing you can do as if you end up putting weight on following surgery, the goalposts for the surgeon change making it very difficult to achieve good results. While half a stone, for instance, may not pose too much of an issue, significant weight gain, such as upwards of a stone or two stone, can really affect the quality of your results. Many patients who have undergone weight loss surgery may have fluctuations in their weight while they are still establishing nutritional balance so this a key area to consider.

In order to get their desired results, I advise my patients to ensure they are in a happy and comfortable position with their overall health and weight. While patients may be keen to plan holidays or trips, it’s important not to put any pressure on yourself or plan to be doing anything for at least two months after abdominoplasty surgery. Not allowing yourself adequate recovery time can cause people to put subconscious pressure on themselves to be better too quickly, which can in fact delay overall recovery and slow down wound healing. Overall, it’s important to be healthy, happy and in a good place if you’re going to embark on surgery of this type.

You can read more of Mr Duncan’s expert insight on tummy tuck procedures for post-weight loss patients in his other detailed article on the topic. If you are considering an abdominoplasty and wish to schedule a consultation with Mr Duncan, you can do so by visiting his Top Doctors profile.