Surgeons often perform abdominoplasties on patients who have had multiple c-sections. The resulting scar tissue as well as weakened muscles, loss of skin elasticity, and a stubborn abdominal panniculus resistant to diet must all be addressed.

The specific type of abdominoplasty performed (i.e., complete abdominoplasty, “mini’ abdominoplasty, and/or abdominoplasty combined with suction-assisted–lipectomy) may be influenced by pre-existing abdominal scarring and post c-section anatomic variations. The abdominal scar resulting from a c-section can vary from almost unperceivable and asymptomatic, to a thickened unsightly tender keloid. Rarely, the scar may involve not only the skin, but adhesions may be present involving the underlying fat, fascia, and muscle. If the abdominal wall is weak your plastic surgeon will discuss options available to improve this.  A plastic surgeon’s judgment and expertise combined with a patient’s realistic expectations and compliance can result in an excellent outcome following abdominoplasty after multiple c-sections.

18 years is a long time.  Is this a very recent change?? ... a gradual change?? ... any pain??
Without the benefit of an exam, my guess is that the scars may be tethered to the deeper tissues and if you gained any weight in the last 18 years, like most people do, liposuction alone may reduce the protrusion.  The recovery from that would be substantially less than a tummy tuck.  The alternative would be to combine liposuction with a possible revision of the scars.  Discuss this with your surgeon at the time of your consultation.  Thank you for your question.

There is usually some degree of swelling after abdominoplasty but this should resolve in 4 - 6 weeks. If this "bulge" is new, it might be the underlying abdominal wall which is now visible as the swelling subsides.  It might be a fluid collection that may have to be drained by your surgeon.  Rarely the sutures used to tighten the abdominal wall may become disrupted recreating the weakness present before surgery.  I would suggest you visit with your surgeon to have an evaluation of this and receive an opinion on what it might be.

A tummy tuck (abdominoplasty) usually addresses the abdomen with attention directed to tightening a lax muscular abdominal wall and removing excess fat and skin to the extent that each exists.  A belt lift, or belt lipectomy, is more of a circumferential procedure - like a belt, it goes all the way around the trunk.  It involves the removal of excess skin and fat and is often employed in individuals who have undergone massive weight loss and have significant hanging excess skin.  With that said, most plastic surgeons performing tummy tucks understand that our patients are 3-dimensional - that the abdomen is connected to the hips and the hips connected to the flanks - and that aesthetically appropriate body contouring is usually a circumferential procedure.  When a tummy tuck is performed, liposuction is usually added to extend the procedure all the way around the trunk; if circumferential skin excision is necessary to deliver the best result, then it should be performed.  So, a belt lift does not necessarily include a tummy tuck, but the two procedures are intimately related.

I don't like my patients to diet down to an unmaintainable weight. Rather, I like them to make healthy changes to their diet and lifestyle and see where the weight "levels off." I feel large weight adjustments should be addressed prior to surgery.

However, the "finishing touches" (i.e.-10 pounds) are not a reason to not move forward with surgery. Losing that additional weight after surgery will only make you (and your surgeon) look better! And it may be easier to lose after the surgery takes care of the “big stuff.”

The description given by the consumer is one of the most common reasons for recommending a tummy tuck. However, there are many other factors that can determine if this is the best treatment for her at this time. Examples would be: how many more pregnancies she will have; what is her existing height and weight; the condition of her skin and muscle in this area; the condition of her general health; are there any conditions that may affect healing; and what are her expectations?


As you can see, the best recommendation is for her to seek a consultation with a qualified Board Certified plastic surgeon that will examine her, discuss her specific needs, and then together they can decide on her best options.

Abdominoplasty is the perfect solution for this patient’s problem. It is possible to remove all the lower midline scar at the same time; one will achieve all the benefits of abdominoplasty. One word of caution, if your belly button is too high, it may not be possible to remove the entire vertical scar. There may be a small residual vertical scar in the suprapubic region. In terms of risks, there are no more added risks but one should remember the common standard surgical risks of any surgical procedure, which includes bleeding, infection, wound breakdown, scarring, etc.

You may have a breast lift with implants and the abdominoplasty at the same time as the umbilical hernioraphy but the umbilicus may be put at risk. If they were performed separately I would wait approximately 6 months after the hernioraphy. The umbilicus is still put at risk.

With a loss of 107 pounds, the abdominoplasty is most likely the procedure of choice. It can be combined with liposuction of the hips and back. It is possible to combine a breast reduction or lift with this operation, however, we have to evaluate and balance the risk of a longer and more extensive operation with the benefit of a one stage procedure. The choice of mastopexy versus a breast reduction depends on the size of the breasts desired by the patient. A consultation with a board certified plastic surgeon will answer all of your questions in a specific way. Every patient is unique and requires a specific tailored operation.

Plastic surgeons most of the time repair the umbilical hernia during the abdominoplasty. I personally work with a general surgeon during my abdominoplasty procedures, and he repairs the umbilical hernia.

Most likely you do not need another full abdominoplasty. It could be that liposuction alone may be of benefit, or a mini-abdominoplasty may be useful. It depends if the problem is laxity of the abdominal wall from the pregnancies, or excess fat beneath the skin, or excess skin. A board certified plastic surgeon can readily advise you after a brief consultation and examination.

Weight loss can potentially affect the outcome of surgery. It is recommended that patients who plan on losing weight do so prior to surgery. Remember that weight loss should be done slowly and in a healthy manner. Otherwise you could have nutritional deficiency that may impact healing potential.



The other reason to drop weight prior to surgery is that you could develop additional skin laxity after the weight loss which could have a negative impact on your final result.

If you are now 30 pounds over your desired weight, I would suggest that you continue to lose what you can in the 6 weeks prior to your surgery. Of course, a starvation diet is not healthy, but you can probably lose at least 10 pounds in that time period. If you do lose 10 of the 30 pounds prior to the scheduled surgery, I would go ahead with the tummy tuck and plan to continue your weight loss after the surgery. Remember, if you lose the weight you will have a much "happier" result. If you do not lose most of the 30 pounds before or after surgery, you will very likely not be pleased with your final surgery result.

Actually, many of my tummy tuck patients are concerned about extra weight prior to surgery and few are at their “ideal” weight at the time of the actual surgery. Those who do lose the extra pounds before or even after surgery are generally thrilled with their result. I always caution my patients that surgery alone will not make anyone thin and that the final result is a team effort. Both the surgeon and patient must do their part to achieve the best final result.

A reverse abdominoplasty is a procedure designed to improve abdominal contour, especially in the upper portion of the abdomen. For patients that have skin excess or laxity above the belly button, this procedure may be an option. The procedure places an incision along the lower portion of the rib cage, just below the breasts. The final scar may be hidden by the breasts to some extent, except for in the midline. Patients in poor health or who have extensive abdominal scars may not be a candidate for this procedure.

I believe you are a good candidate for this surgery now. Body contouring surgery in someone that originally weighed 270 pounds will remove a significant amount of redundant skin and underlying fat. As a result of the surgery, you will lose additional weight but more importantly, will see yourself in a different light and more than likely this will stimulate you to continue on a healthy diet with increased physical activity and possibly more weight loss.



Needless to say, this is major surgery and a full medical evaluation would be necessary to determine your ability to undergo extensive surgery. Body contouring procedures can be staged with different procedures being performed at separate times after allowing for healing and recovery. A thorough consultation with a plastic surgeon would be in order to determine the exact surgical plan.

Yes, the surgery can be done with no increased risk to you than the average person without your history. Other medical conditions such as diabetes, etc. may interfere with healing.

Assuming that you are otherwise healthy and a candidate for surgery in general, you would be an excellent candidate for a tummy tuck (abdominoplasty). If your C-section scar is a low transverse incision, it could be used for your abdominoplasty incision. Additionally, most and possibly all of your exploratory surgery vertical scar would be removed with the tummy tuck. If you are planning future pregnancies, you should wait until you have completed your family planning since further pregnancies would alter the results of your tummy tuck.

Your situation is not uncommon after multiple C-sections, and actually is an excellent demonstration of why abdominoplasty, or tummy tuck, incisions are positioned low and horizontally, and not vertically. The low horizontal incisions generally heal much better than the vertical incisions below the belly button. Multiple pregnancies are usually associated with an excess of loose skin and some bulging of the abdominal wall muscles which could be improved with tummy tuck surgery. In fact, the "ugly" vertical scar could probably be completely removed and replaced by skin from the upper abdomen, which would be pulled down and tightened. Although plastic surgeons try to make the scar as small or as short as possible, the "bikini cut" scar that you have would need to be lengthened in order to prevent redundant skin from puckering on each side. The incision would probably extend from hip to hip, but again, it would only be as long as necessary to make everything smooth. This scar should be low and hidden by lingerie or even bikini type swimsuits. If your 4th C-section healed well, then a scar of the same type and location should heal just as well even if it is a little longer.

There are many types of abdominoplasty, or tummy tuck, operations that are performed, and it is impossible to know exactly which variation would be the best for you without an examination. It does seem by your description that you would be a good candidate for a full tummy tuck with an incision around the umbilicus (belly button), tightening the bulging abdominal wall, and removing the vertical scar and excess skin in the lower abdomen. The skin from the upper abdomen would be tightened by pulling it down to leave a low horizontal (bikini cut) scar.

The body stores fat in various areas. This fat is useful in times of starvation, but in this modern era, hopefully this excess fat will never be necessary. Fat can be stored subcutaneously (under the skin). Alternatively, fat can be stored inside the abdomen. This type of fat is often very dense and is associated with the various organs inside the abdomen. In particular, there is an organ known as the 'omentum' that can contain several pounds of fat. All of this fat can contribute to a protrusion of the abdominal wall, causing you to have the appearance that you complain about.



Whether or not body contouring surgery can help you depends on your particular situation. If you have been overweight, or if you have been pregnant, the muscles of the belly may have been overstretched. This would allow the contents inside the abdomen to protrude. If this is the case, then an abdominoplasty, also known as a 'tummy tuck,' might be the appropriate operation. A tummy tuck tightens the muscles of the belly, and the skin and fat may also be tightened. Sometimes this operation is performed through tiny incisions with the aid of a surgical instrument called an endoscope. If your muscles are not overstretched and you are a bit overweight, then you may benefit most from simple weight loss. Finally, liposuction might be useful if the fat is under the skin but not inside your belly. The proper procedure can only be determined from examination by a qualified surgeon.

Ideally, patients who wish to undergo body contouring procedures and are smokers should stop for several months prior to surgery to make sure they have truly kicked the habit. Smoking tends to be a stress reliever to many patients, and the stress associated with surgery can often trigger a relapse in smoking; so, ideally, I like to see my patients off cigarettes for 6 months to prove they can resist the urge. Unfortunately, the long term negative effects of smoking on tissues may not improve for years, but the immediate effects of nicotine (nicotine constricts small blood vessels in the healing tissues causing increased risks of wound breakdown and infection) are greatly reduced after 2 to 3 weeks. In general, patients are advised that they will be at greater risk for a number of complications if they have smoked in the past few years (regardless if they have quit), and those risks increase considerably if they smoke in the time period of 2 to 3 weeks before surgery and 2 weeks after surgery.

I would not recommend an abdominoplasty at the time of a spinal fusion for several reasons. Technically, the combined procedure would be compromised by the relative inability to flex the table which is necessary in order to remove the appropriate tissue and achieve the best possible result. Second, the braces often worn after spinal surgery can rub and cause difficulty for the patient. Pressure or friction on freshly operated skin should be avoided. I would recommend that you determine which issue is more significant and treat the problem initially.

I would not recommend an abdominoplasty at the time of a spinal fusion for several reasons. Technically, the combined procedure would be compromised by the relative inability to flex the table which is necessary in order to remove the appropriate tissue and achieve the best possible result. Second, the braces often worn after spinal surgery can rub and cause difficulty for the patient. Pressure or friction on freshly operated skin should be avoided. I would recommend that you determine which issue is more significant and treat the problem initially.

First, congratulations on your commitment and success in achieving your weight loss goal. A consultation and physical examination to permit evaluation of your muscle tone and integrity and skin tone, as well as the degree and location of skin and soft tissue excess, are really necessary to make a definitive recommendation. However, I can offer some general advice. Before any consideration of abdominoplasty or any other body contouring surgery, you should be at or very close to your desired weight, and stable at that level. While there are a number of abdominoplasty techniques that permit us to address the varied needs of individual patients, it may be that a “more limited” approach might not be the best option for you. The most desirable location for the abdominoplasty scar is ordinarily, at least in part, along the lower abdominal crease just above the pubic hairline. The direction and extent of the scar as it extends laterally can be varied according to the desires and physical characteristics of the patient, as well as according to the amount and location of the redundant abdominal skin. With a skin excess predominantly above your umbilicus (belly button) as you describe, it is likely that your abdominal skin would need to be mobilized over your lower ribs and to the bottom of your breast bone. That means a full and complete elevation of your abdominal skin - not a "limited" or "more minimal" approach. It is also quite possible that after such a major weight loss, even with your good muscle tone, your abdominal muscles may have been separated from each other in the midline or a horizontal spreading of the muscles may have occurred as well. In that case, further abdominal recontouring and support can be achieved with a surgical tightening of those muscles. Although it may be possible to limit the extent of your lower abdominal scar because of the location of the skin excess you describe, it may also be necessary to extend that scar more laterally to permit the best improvement of any significant upper abdominal horizontal skin laxity. While the conservative view that "less is more" may often be appropriate, it may not be able to provide the optimal result for you. An ASAPS-member plastic surgeon possesses the training and skills necessary to determine the best approach to help you achieve your goals, and I recommend that you find one of our members in your area and schedule a consultation.

It is certainly possible to have an abdominoplasty (tummy-tuck) at the same time as a hysterectomy. There is some increase in the risk of complications, but these are still relatively infrequent. The first few days after surgery are a little more difficult, but the overall recovery is not much different than if you had the hysterectomy alone.

How soon a woman can have an abdominoplasty following childbirth depends on individual factors including how quickly your tissues contract or shrink. Typically, I would recommend waiting at least 3, and possibly as long as 9, months after delivery. I would encourage you to resume a daily exercise regime including abdominal toning and strengthening exercises, starting 6 weeks after delivery. The advice of a board-certified ASAPS-member surgeon, following his or her examination of your abdominal area, is the best way to determine when you may be ready for surgery.

A hysterectomy and an abdominoplasty can be combined if you get a go-ahead from both your gynecologist and your plastic surgeon. There is some increased incidence in the complication rate, but in most cases the two procedures are successfully done together without undue complications. Abdominoplasty might have a positive effect on back problems that are postural in origin, but I am unaware of any documented improvement in incontinence, unless additional bladder surgery is done simultaneously.



There are many different insurance policies available and each has its own provisions. At any rate, make sure to obtain supportive documentation from your surgeon. Most insurance companies will cover functional/correctional surgery. However, most will not cover all the cost when functional and cosmetic surgeries are combined. For specifics, ask the consumer reps at your insurance company. Some insurance companies will not tell you what’s covered until after your claim is filed—and then they may deny the claim.

Most plastic surgeons would advocate combining a tummy tuck with a medial or upper thigh lift; however, also combining an upper arm lift with these procedures would not be advisable. In order to make a full recovery from abdominoplasty and thigh lift surgery, full strength and mobility of the upper arms would be necessary for something as basic as getting out of bed. It would be prudent to have arm lift surgery performed a minimum of 3-6 months after the abdominoplasty/medial thigh lift procedure. Many plastic surgeons will perform combined procedures on patients when they deem that the combined surgery is safe for the individual. Facelift surgery is often combined with cosmetic eyelid surgery and eyebrow/forehead surgery. Breast lift surgery is often combined with a tummy tuck. Tummy tuck surgery is frequently combined with liposuction of areas within the midriff, hips and thighs. Patients must realize beforehand that combined surgery increases the operative time and postoperative convalescence, thereby prolonging the time before one can return to a normal lifestyle. For example, a patient having only a facelift can generally return to a normal routine in about three weeks. However, when combined with cosmetic forehead, eyelid and laser resurfacing surgery, up to six weeks recovery should be expected.

It depends. If your hernia is very large and/or you have thinned out tissues (muscle/fascia), a tummy tuck may not be possible. Liposuction (lipoplasty) is contraindicated if you have a known hernia so that should be done after your hernia is repaired or after you've recovered from your hernia surgery.



If you have a small hernia that is easily fixable and good tissues, a concomitant tummy tuck is certainly a possibility if you're willing to accept the risks of surgery. Combining liposuction with a tummy tuck also increases risk for complications, and I would personally be hesitant to do both procedures at the same time as a hernia repair.

Thank you for your question regarding muscle repair during full abdominoplasty. In general, a full abdominoplasty would include removal of redundant skin on the abdomen, repositioning of the umbilicus (belly button) and tightening of weakened abdominal muscles. In very rare instances, the musculature is sufficiently tight and only the sagging skin needs to be repaired. In such a rare case, I subscribe to the adage, "if it ain't broke, don't fix it."

Absolutely, assuming you are an appropriate candidate. First, are you planning another pregnancy? This may be a consideration when deciding which procedure is right for you. Second, please seek consultation with a plastic surgeon certified by the American Board of Plastic Surgery. The ASAPS web site or patient referral line (1-888-ASAPS-11) is an excellent source for finding such a surgeon in your area. Some options that exist for the "pouch below your navel" include: 1) liposuction (lipoplasty) alone; 2) liposuction with a "mini" or modified tummy tuck; or 3) a full tummy tuck (abdominoplasty). Sometimes, with the latter two procedures, abdominal muscle tightening is also performed. The consultation, which includes a history and physical examination, will guide you and your surgeon through a discussion of the option or options best suited for you. Naturally, this discussion will include risks, benefits, and alternatives.

A tummy tuck should not be done at the time of a Caesarean section, or even in conjunction with a vaginal delivery. You should wait at least 6 months.

Congratulations on your weight loss and change in lifestyle. It is not unusual after a significant weight loss to have some residual fatty tissue of the abdomen and some loose skin. An abdominoplasty, or tummy tuck, can help remove the excess skin and fatty tissue that remains and, at the same time, the muscles can be tightened to firm up the abdomen further. Additional contouring with lipoplasty (liposuction) for the hips, waist, and upper abdomen can provide further improvement in contour. The tummy tuck operation is not designed for weight loss, although a few pounds will be shed, but it generally is designed for improvement in contour. You did not mention your current weight, but I think that probably you could proceed with abdominoplasty and achieve a very nice improvement, and likely any additional weight that you would be able to lose would complement the results of your surgery.

An abdominoplasty (tummy tuck) can be performed on a 33-year-old woman who is planning to have children. If you are considering this, however, you should be aware of the following:

1) Abdominoplasty involves not only removing loose skin, but also muscle plication (tightening), both of which will be exposed to the stretching/expanding forces of pregnancy. Therefore, there is no guarantee that you will be able to maintain the results of the abdominoplasty after your pregnancy. You might need to undergo additional procedures, including a revision of your muscle plication/abdominoplasty.

2) While the muscle plication will be stressed during pregnancy, labor may be easier because the abdominoplasty will have improved the function of the rectus muscles (the vertical muscles in the abdomen). The pregnancy should not be any more difficult: your skin will stretch regardless. The muscles also may also stretch, however, which might require the revision mentioned above.

A ptotic or “drooping” belly will not be helped by lipoplasty (liposuction) and, in fact, may "droop" more following lipoplasty. An abdominoplasty, or "tummy tuck," with tightening of the underlying muscles and removal of the excess skin would be a better choice for you. You already have the long scar at your pubic area secondary to the tubal pregnancy operation, and the incision for the abdominoplasty procedure would be located in the same place, so I say "go for it."

Without a complete examination, I can only advise based on the information presented. In general, it seems that an abdominoplasty (tummy tuck) would be appropriate. Depending on the amount of tissue to be removed, the surgical plan might include a combination of liposuction and a "mini" abdominoplasty. Having this covered by insurance would be extremely unlikely.