For thousands of people, a flat tummy is the Holy Grail of fitness: legendary, sought-after and elusive. Especially after pregnancy, regaining the abs of our youth can seem like a fruitless pursuit. Yet we crunch, roll, flex and squeeze our mid-sections, believing that if we just work a bit harder or exercise differently, we can achieve our goal.

Exercise is beneficial to our overall health, yet no workout or diet can eliminate the loose skin and telltale post-pregnancy pooch that many women have, says Michele Koo, M.D., of the Aesthetic Surgery Institute. For people with significant amounts of loose, sagging abdominal skin resulting from pregnancy or significant weight loss, abdominoplasty, better known as a ‘tummy tuck,’ may be the only way to obtain a sleek, smooth midriff.

Statistics indicate that an increasing number of people are coming to this conclusion. According to the American Society of Plastic Surgeons, 146,240 tummy tucks were performed in 2006, a 133 percent increase since 2000.

“Abdominoplasty is effective for removing fat and excess skin from the abdomen while also repairing musculature,” Koo says. Following multiple pregnancies, some women are left with a diastasis recti, a separation between the left and right side of the rectus abdominis muscle. Abdominoplasty allows the diastatis to be repaired, improving both the integrity of the abdominal wall and its appearance.

If the surgeon repairs the abdominal muscles in addition to tightening skin and removing fat, abdominoplasty is considered a major surgical procedure that requires general anesthesia, sutures and surgical drains. Most patients stay overnight to benefit from nursing care and pain medications, says Judith Gurley, M.D., a plastic surgeon in private practice. “There is a scar across the lower abdomen, but it fades and the incision usually heals very well,” she says.

Following surgery, Gurley offers patients a pain pump that delivers an anesthetic directly to the internal surgical site, and she instructs them to wear a surgical support garment. She advises patients to plan for at least two weeks of recovery at home. Complete activity, including sports and exercise, can usually be resumed after six weeks.

Not all patients require a complete abdominoplasty to achieve the desired results. “Some people just have a little skin wrinkling, and some need a big, tight tuck along with liposuction,” says Alan Londe, M.D., of Tempo Surgical Inc. Patients who do not require muscle repair may be able to have the procedure at an outpatient surgical center.

Londe says an increasing number of men are expressing interest in abdominoplasty, especially after dramatic weight loss, although he estimates that 90 percent of the tummy tucks he performs are on women. Costs vary depending on the complexity of the procedure and the length of stay at a hospital or surgical center, but most patients can expect to pay between $5,000 and $15,000 out of pocket.

“It takes good judgment to determine exactly how to approach abdominoplasty,” Londe says. “Each procedure is tailored to the patient’s individual skin texture and abdominal structure.” For that reason, he advises anyone considering the procedure to seek an experienced surgeon who can provide before and after photos of actual patients.