From fat and skin removal to repairing stretched out muscles after pregnancy - the tummy tuck continues to be one of the most sought-after procedures for women of all ages. We asked our go-to expert Dr Tristan de Chalain, to explain what to expect from abdominal contouring, known as abdominoplasty.

“It’s essential to realise that the term abdominoplasty or tummy tuck covers a family of similar but not identical procedures, from a minimalist skin only mini-abdominoplasty to a significant, circumferential lower body lift.”

— Dr Tristan de Chalain

Here’s what you need to know about abdominal surgery

Who is the best candidate for a tummy tuck?

It ranges from younger women seeking a mummy-makeover, aged between 20 and 40, when pregnancy has stretched and separated the abdominal muscles, causing the tummy to stick out. This so-called 'mummy makeover' usually involves a breast augmentation lift and some form of mini or full abdominoplasty. The next category is where the abdomen is fuller and more protuberant; it may form an apron. Most commonly seen in women who have gained weight in middle-age. These patients are candidates for a full abdominoplasty which involves removing all the skin and fat between the pubis and the navel and top to bottom repair of the separated abdominal muscles. Finally, there is the patient who has had bariatric or weight-loss surgery. They may have lost between 20, 30 or even up to 100 kg. However, these patients are often left with a swag of soft tissue: skin, residual fat and supporting connective tissue, which needs to be removed in a variant of the abdominoplasty, which involves taking tissue away from right around the body, a procedure known as a lower body lift. In most cases, I will also use liposuction to help tailor the final result. In any of these categories, the ideal patient is a reasonably fit, non-smoker with few or no medical problems.

Do you need to change your lifestyle or exercise routine before surgery?

It's not a trivial operation; it has significant risks and mitigation. These risks call for appropriate patient buy-in. For example, this is not an operation I will do on a smoker. I insist on no smoking six weeks before and after surgery to minimize the risks of lung and breathing problems in the early post-operative phase and poor wound healing and unfavourable scar formation. Likewise, there is no doubt that the fitter the patient's is, the easier they will cope with surgery demands. I recommend preparing for the surgery by walking 30 minutes every day for six weeks.

Janie’s surgery story

For 53-year-old Auckland-based Janie, her tummy tuck was always on her to-do list. "I have always wanted one since I had my children. I also had a nasty appendix scar from the age of eight, so I was never confident enough to wear a bikini. So, in March, I could afford one at the grand old age of 52, so I had the mini tuck.“ Janie’s tummy button was not moved, just the lower part of the tummy lifted, contouring, and flattening. Janie says she would do it again in a heartbeat; she adds that preparing for her surgery started with weight loss. "I had lost nearly 30 kgs over two years by stopping drinking alcohol for five months, which was bloody hard. But once I started, it became easier. Not drinking meant I didn't snack. My life became about eating the right portion sizes and exercise - all the stuff we all know but don’t follow." The next step in her journey was finding the right surgeon. "A good surgeon is worth their weight in gold. Remember, cheaper is not better when it comes to scars on your body. I picked Tristan de Chalain. He's one of the best when it comes to stitches and leaving the minor scars possible." As far as the procedure and the downtime goes, Janie says it was relatively short and pain-free. "I remember being wheeled into the operating theatre, chatting and laughing with the anaesthetist, and then waking up to the nurses back in my room. I quite happily ate some food and then slept all through the night. I was a little apprehensive at first, getting out of bed and moving to the sitting position, but surprisingly I felt fine. I did get plenty of rest at home, so I hardly needed painkillers at all." Janie was able to work from home for two weeks after the surgery and then returned to the office. For her, the results far outweigh any inconvenience or downtime. "My tummy is fabulously flat, and my clothes fit me much better. I don't have that little pouch of flab that can sometimes hang over the jeans or your top (aka the muffin) that has gone. I love my new look. I'm not perfect, at 53 years of age, but it's made me more confident and much happier."

How long does the procedure take, and what's the downtime?

Each patient is different. Surgery is tailored to their particular needs and expectations. A typical abdominoplasty, in my hands, takes about four and half hours. A mini-abdominoplasty may take about two hours, and a lower body lifts to seven hours. I usually recommend two-to-three nights in the hospital, and the downtime is similar to a C-section (cesarian). I tell my patients to take it very easy for two-to-three weeks, and to do no fitness training, sport or gym work for six weeks. Most people return to work between two or three weeks.

What are the complications, if any?

No surgery is without the risk of complications. The risks include bleeding, scarring and infection, and loss of tissue due to poor blood supply. As well as asymmetry, blood clots and pulmonary emboli (when blood clots in the legs break free and travel to the lungs), fluid accumulates in the lung base. In performing abdominoplasties, great care is taken to manage and lessen these risks. Very few of these risks ever eventuate as real complications, which is why part of your pre-op consultation focuses on risks and how we would manage them before surgery.

What about scars. Will they be visible?

Again, this depends on several factors. The first is how the individual's physiology makes scars. As a surgeon, I do my best to make scars fine, with the skin edges closed under minimal tension and provision of prolonged tape support or applications of scar gel or massage oil are recommended. Still, the final quality of the scar is largely beyond my control. Hence the saying, "The surgeon makes the cut, but the patient makes the scar". The second part of scar quality and visibility is partly dependent on good surgical planning, the nature of the problem, and anatomical quirks. For example, we are removing the tissue between the pubis and the navel. Some people have a short distance between these two points, whereas others have a very long waist. These and similar factors will influence where the final scar will be located and its visibility in revealing clothing or togs.

What stands in the way of anyone interested in having a tummy tuck?

Each individual's situation is different, but usually, there are three factors. The first is fear. Fear of pain, discomfort, a bad result, possible complications, or others will say or think. Also, inconvenience. We all lead busy lives, and few have the luxury of disposable time. Surgery like this demands downtime and, in effect, putting your life on hold while you recover. Finally, there is cost. The financial outlay is not insignificant, and for most people, who have multiple calls on their disposable income, it isn't easy to justify.

What does a tummy tuck cost?

In New Zealand, elective plastic surgery costs are related to the time spent in the operating theatre and the extent and complexity of the surgery and anaesthesia required. All in, it costs between $5000- $6000 per hour of surgery. Of course, this may vary from region to region, different hospitals, surgeons and anaesthetists vary in their charges, but this figure is a valid estimate. For the average abdominoplasty, most surgeons would need between three and five hours to complete the procedure. This is a rough estimate and the reason the surgeon will need to thoroughly assess your medical history, your body and your expectations before surgery.

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