Last updated: 11/24/2009

The patient is usually placed under general anesthesia for the duration of surgery. The advantages to general anesthesia are that the patient remains unconscious during the procedure, which may take from two to five hours to complete; no pain will be experienced nor will the patient have any memory of the procedure; and the patient's muscles remain completely relaxed, lending to safer surgery.

Once an adequate level of anesthesia has been reached, an incision is made across the lower abdomen. For a complete abdominoplasty, the incision will stretch from hipbone to hipbone. The skin will be lifted off the abdominal muscles from the incision up to the ribs, with a separate incision being made to free the umbilicus (belly button). The vertical abdominal muscles may be tightened by stitching them closer together. The skin is then stretched back over the abdomen and excess skin and fat are cut away. Another incision will be made across the stretched skin through which the umbilicus will be located and stitched into position. A temporary drain may be placed to remove excess fluid from beneath the incision. All incisions are then stitched closed and covered with dressings.

Individuals who have excess skin and fat limited to the lower abdomen (i.e., below the navel) may be candidates for partial abdominoplasty. During this procedure, the muscle wall is not tightened. Rather, the skin is stretched over a smaller incision made just above the pubic hairline and excess skin is cut away. The incision is then closed with stitches. The umbilicus is not repositioned during a partial abdominoplasty; its shape, therefore, may change as the skin is stretched downward.

Additional procedures

In some cases, additional procedures may be performed during or directly following abdominoplasty. Liposuction, also called suction lipectomy or lipoplasty, is a technique that removes fat that cannot be removed by diet or exercise. During the procedure, which is generally performed in an outpatient surgical facility, the patient is anesthetized and a hollow tube called a cannula is inserted under the skin into a fat deposit. By physical manipulation, the fat deposit is loosened and sucked out of the body. Liposuction may be used during abdominoplasty to remove fat deposits from the torso, hips, or other areas. This may create a more desired body contour.

Some patients may choose to undergo breast augmentation, reduction, or lift during abdominoplasty. Breast augmentation involves the insertion of a silicone- or saline-filled implant into the breast, most often behind the breast tissue or chest muscle wall. A breast reduction may be performed on patients who have large breasts that cause an array of symptoms such as back and neck pain. Breast reduction removes excess breast skin and fat and moves the nipple and area around the nipple (called the areola) to a higher position. A breast lift, also called a mastopexy, is performed on women who have low, sagging breasts, often due to pregnancy, nursing, or aging. The surgical procedure is similar to a breast reduction, but only excess skin is removed; breast implants may also be inserted.

Breast reconstruction

A modified version of abdominoplasty may be used to reconstruct a breast in a patient who has undergone mastectomy (surgical removal of the breast, usually as a treatment for cancer). Transverse rectus abdominis myocutaneous (TRAM) flap reconstruction may be performed at the time of mastectomy or as a later, separate procedure. Good candidates for the surgery include women who have had or will have a large portion of breast tissue removed and also have excess skin and fat in the lower abdominal region. Women who are not in good health, are obese, have had a previous abdominoplasty, or wish to have additional children are not considered good candidates for TRAM flap reconstruction.

The procedure is usually performed in three separate steps. The first step is the TRAM flap surgery. In a procedure similar to traditional abdominoplasty, excess skin and fat is removed from the lower abdomen, then stitched into place to create a breast. The construction of a nipple takes place several months later to enable to the tissue to heal adequately. Finally, once the new breast has healed and softened, tattooing may be performed to add color to the constructed nipple.

Costs

Because abdominoplasty is considered to be an elective cosmetic procedure, most insurance policies will not cover the procedure, unless it is being performed for medical reasons (for example, if an abdominal hernia is the cause of the protruding abdomen).

A number of fees must be taken into consideration when calculating the total cost of the procedure. Typically, fees include those paid to the surgeon, the anesthesiologist, and the facility where the surgery is performed. If liposuction or breast surgery is to be performed, additional costs may be incurred. The average cost of abdominoplasty is $6,500, but may range from $5,000–9,000, depending on the surgeon and the complexity of the procedure.