Tummy tuck: recovery stages and planning

A tummy tuck, or abdominoplasty, is an operation to improve the shape of the abdomen. It is major surgery, and the recovery is something to plan as carefully as the operation itself: time away from work, help at home, travel and the weeks during which you will wear a support garment. This guide walks through the usual stages of recovery, from the hospital stay to the months when scars mature, and looks at planning surgery after pregnancy, including combined procedures sometimes called a "mommy makeover". Your own surgeon will give you the plan that applies to you.

What a tummy tuck does and who it is for

The NHS explains that a tummy tuck can remove excess loose skin, fat and stretch marks and tighten the abdominal muscles. It is aimed at skin that exercise cannot fix, such as loose skin left after pregnancy or major weight loss. It is not a quick route to weight loss; the NHS says the operation is generally advised only when body mass index (BMI) is in the healthy range, and BAPRAS, the UK plastic surgery association, describes the ideal patient as someone near their ideal weight.

There are different types of operation:

• a full abdominoplasty uses a cut from hip to hip above the pubic area and a second cut around the belly button; the abdominal muscles can be realigned and the belly button opening is re-created;
• a partial or mini abdominoplasty is for a smaller amount of excess skin in the lower abdomen; it leaves a horizontal scar above the pubic area and no scar around the belly button, with a smaller effect.

UK plastic surgeons note that liposuction alone may suit some younger people with good, elastic skin and localised fat, but it has less effect than abdominoplasty. The type of operation influences how long recovery takes, so ask which one is being proposed for you and why.

Planning after pregnancy: the "mommy makeover"

The American Society of Plastic Surgeons uses the term "mommy makeover" for surgery to restore the shape of the body after childbearing. It may combine a tummy tuck with procedures such as a breast lift or breast enlargement and liposuction, and it is typically done as a single operation. The society describes suitable candidates as being in good health, at or near their ideal body weight, having realistic expectations and having finished having children. BAPRAS takes a similar line on family planning: anyone hoping for another pregnancy is advised to postpone a full abdominoplasty until no more children are planned. Your surgeon will judge whether combining several operations is appropriate in your case.

Planning ahead of surgery

A little planning makes recovery easier. Points to think about include:

• Time off work. The NHS describes about 4 to 6 weeks off work and exercise, and UK plastic surgeons recommend at least four weeks off work.
• Getting home. Arrange for an adult to collect you by car and remain with you for the following 24 hours (NHS).
• Driving. You should not drive for a few weeks; your surgeon and your insurer can advise when it is safe.
• Follow-up. There is usually a check a few weeks after surgery to look at how the wound is healing. Know where it will take place.

Patients flying in for surgery need extra margin. NHS guidance on surgery abroad says to stay off planes for 7 to 10 days after a tummy tuck, since a flight soon after major surgery adds to the clot risk. The same guidance warns against booking a holiday for the days after the operation, suggests finding out in advance who handles complications and where follow-up happens, and points out that ordinary travel insurance usually excludes surgical complications.

Stage one: the operation and hospital stay

A tummy tuck is usually done under general anaesthetic and, according to the NHS, takes 2 to 5 hours. You may feel some pain on waking, and painkillers are given. The NHS expects a hospital stay of a few nights for most patients; for a full abdominoplasty, BAPRAS describes 2 or 3 days.

Small tubes called drains may be placed under the skin to remove blood or fluid. UK plastic surgeons explain that after a full abdominoplasty these are usually removed before you go home. They also note that patients are up and moving from the first day. You will leave hospital with dressings and a pressure garment, such as a corset or tummy-control pants.

Stage two: the first weeks at home

The first weeks are about protecting the wound and letting the swelling settle. Based on NHS information:

• the support garment is usually worn for 6 weeks;
• keeping your knees bent in bed helps protect the stitches;
• it can be hard to stand up straight at first, and the abdomen feels tight; this improves over time;
• pain and bruising are expected, and the abdomen can feel numb for a few months or longer;
• a temporary, fluid-filled swelling can appear above the scar.

The American Society of Plastic Surgeons notes that most people are standing fully upright within a week or two. It suggests asking your surgeon how to care for the wound and any drains, how and when to bathe, when stitches will be removed, how long to wear the pressure garment and which problems should prompt a call.

Stage three: return to activity and the longer term

The NHS describes full recovery taking around 6 weeks, and UK plastic surgeons say full exercise should usually be possible within six weeks. These timings are approximate and vary with the type of operation and the person, so check with your surgeon before returning to strenuous activity.

The final appearance takes longer. The American Society of Plastic Surgeons explains that swelling and ongoing internal healing can hide the final result at first. The scar will not disappear. BAPRAS explains that for roughly the first six weeks it tends to look red and raised, that it changes over about the next six months, and that it then fades towards white; the NHS says raised or red scars should fade over 12 to 18 months. Most scars settle well, but some stay red and lumpy.

A few other points are worth knowing. If you have had a caesarean section, the existing scar may be incorporated into the new one, but previous abdominal surgery can limit what can be achieved. No surgeon can promise a particular outcome, and some patients go on to have a further procedure.

Possible complications

As well as the expected effects of surgery, possible complications include:

• bleeding, sometimes pooling under the skin as a haematoma, which occasionally means going back to the operating theatre;
• fluid collecting under the skin (seroma), which may need draining with a needle;
• wound problems such as infection, delayed healing, the wound separating or, less often, loss of skin;
• thick or obvious scars, bulges, or extra skin at the ends of the scar ("dog ears");
• lasting numbness or changes in sensation of the lower abdomen;
• deep vein thrombosis (a clot in a leg vein) and, more seriously, pulmonary embolism (a clot that reaches the lungs);
• breathing problems and risks related to the anaesthetic.

Ask how each of these would be recognised and managed if it happened.

When to seek help

NHS guidance for UK patients is straightforward: if pain becomes severe or something unexpected happens, ring the clinic without delay. Two other groups of warning signs are worth knowing.

Wound infection. Guy's and St Thomas' NHS Foundation Trust lists signs such as skin around the wound that is red, sore, hot or swollen, pus or other fluid coming from the wound, the wound opening, and feeling generally unwell or having a fever. It explains that infection can develop from 2 to 3 days after surgery until the wound has healed. Contact your surgical team or doctor straight away if you notice any of these.

Blood clots. Having recent surgery increases the risk of deep vein thrombosis. Warning signs listed by the NHS include a throbbing ache in one calf or thigh, swelling of that leg, and reddened or darker skin over the sore area. Its advice in the UK is to call NHS 111 or request an urgent GP appointment when DVT is suspected, and to dial 999 or attend A&E at once if breathlessness or chest pain develops too, because the clot may have travelled to the lungs.

Next steps

Recovery from a tummy tuck goes more smoothly when the practical side is arranged early: time off, travel dates, help at home and follow-up visits. To discuss whether a full or mini operation, or a combined procedure, might suit you, visit our plastic and aesthetic surgery specialty page, or use Find my physician for guidance on whom to contact.