As wonderful as children are, pregnancy can play havoc with abdominal muscles and skin. When her family is complete, one of the most powerful rejuvenation procedures a woman can have is an abdominoplasty, or tummy tuck. “During pregnancy, there are many changes to the abdominal wall,” says plastic surgeon Dr. Judith Gurley. “The muscles can separate and may not come back together after pregnancy. When that is combined with stretch marks and stretched skin, a tummy tuck is a good option.” Not all women need the surgery. For women who have good elasticity and maintain muscle integrity, a little leftover baby fat can be contoured away with liposuction, but a good number of women will not be happy with the results of only doing liposuction.

    “Stretch marks are determined genetically more than by the size of the baby or weight gain. They are rips in the underneath surface of the skin,” Gurley says. “There isn’t much you can do about it but to remove that skin with a tummy tuck.” Gurley suggests her patients look at the midsection as a whole, not just the shape and silhouette, but also the condition of the skin. If there are stretch marks and the muscles have been separated, a tummy tuck will tighten the skin, repair the abdominal wall and rebuild core muscle strength. Patients should understand what to expect of the different procedures. 

    “I draw them pictures and help them understand visually what they will look like with different options,” she says. “A tummy tuck is major surgery and patients won’t be able to use their abdominal muscles for up to six weeks, so they need to be realistic about that.” Gurley cautions that a tummy tuck, with its expense and down time, is not a good idea if subsequent pregnancies are planned. It would undo everything she had accomplished.

    Dr. Michele Koo generally advises her patients to wait a minimum of six months after their last pregnancy to allow the body to return to its pre-pregnant state. Rigorous exercise will help with muscle tone, weight loss and cardiovascular conditioning, but it will have no impact on the shape of stretched-out skin or the split in the rectus abdominus (six-pack) muscles. “The amount of excess skin, the laxity of the skin, the shape of the muscles, and the amount of fat to be removed determine the extent of the surgery,” Koo says. “Often, my patients take this opportunity to have liposuction on their thighs and hips, which completes the package of a smooth, flat, shapely trunk. I always repair the split muscles of the abdomen and make the belly flat with a cute ‘inny’ belly button, removing all the excess skin and fat that used to hang over it. An umbilical hernia can also be repaired at the same time.”

    Koo says the post-pregnancy tummy tuck is one of the most worthwhile procedures her patients have. The results are extremely long-lasting and achieve what can’t be accomplished by diet and exercise alone. “Many women feel discouraged and depressed about their post-pregnancy bellies and don’t feel any motivation to continue to exercise and diet,” Koo says. “After an abdominoplasty, when they see how good they look, patients really want to continue a healthier lifestyle and maintain their new bodies.”

    Plastic surgeon Dr. Paul Rottler agrees that abdominoplasty is a powerful solution to tighten the abdomen and restore core strength and stability. But, he says, not all women are good candidates for the procedure. “Tummy tucks are not a weight loss solution, so very obese women won’t benefit as much, and wound healing is an issue. I won’t perform this surgery on smokers because nicotine constricts blood flow and causes delayed healing. Diabetics also have some delayed healing issues. We are also seeing more reports in the literature of tummy tucks being associated with deep vein thrombosis (DVT), because we are tightening the abdominal wall and increasing intra-abdominal pressure, which puts pressure on those deep leg veins.” 

    In DVT, blood clots develop in deep veins and can travel to the heart and lungs. Because 30 percent of patients who develop deep vein clots during surgery have no symptoms, Rottler   uses preventive care with all surgeries involving general anesthesia. “We use compression stockings to keep blood flowing to the legs, and give blood thinners for up to 10 days to prevent this complication,” he says.

    On the comfort side, Rottler says the surgery has greatly improved. “I use a special suturing technique when reconnecting the abdominal muscles at the midline so that I don’t have to use drains. Patients are more comfortable and can bathe sooner. We also put in a pain pump at the time of surgery which dispenses measured pain medication to the incision area for 100 hours. Patients return to the office on the fourth day to have it easily removed. The pain is more tolerable and patients are able to move around more easily,” he says. “It’s a good surgery to restore that pre-pregnancy firm trunk.”