Can Tummy Tuck Change or Distort the Pelvic Area?

Question

Is it possible for the pelvic anatomy to be distorted during Tummy Tuck, through the imbrication of the muscle and fascia?

Brent Moelleken, MD · Answer

As with all surgeries, there is a golden amount of tissue to remove that maximizes the results and minimizes potential complications. Too little yields unsatisfactory results. Too much yields aesthetic and biologic problems. If aggressively performed, the pubic structures can indeed be elevated in a strange fashion with a tummy tuck. 
Plication sutures tighten the fascia (not the muscle, as is commonly thought).  The plication sutures rarely cause deformation of the pubic area.  In fact, they usually greatly improve this region.
However the entire balance and harmony of the abdomen and pubic area should be considered when performing a tummy tuck.  A board certified plastic surgeon with great experience in tummy tuck surgery can address the fine points of balancing results with avoiding distortion. Every doctor has his or her own style, so patients should watch carefully the before and after pictures for an artistic style that suits them.

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question about whether the pelvic anatomy can change after a tummy tuck.

It’s a very insightful question — and the short answer is yes, the appearance of the pubic region (mons pubis) and lower pelvic area often changes after a tummy tuck, but this is usually intentional and part of the surgical design. During a tummy tuck (abdominoplasty), the skin and tissues of the lower abdomen are tightened, and the mons pubis — the area right above the genitals — is lifted along with the rest of the abdominal wall.

In many patients, especially after pregnancy, weight loss, or aging, the mons pubis can become full, saggy, or descend lower. A tummy tuck naturally elevates and tightens this region, often making it flatter, firmer, and more youthful in appearance. So while the look of the pelvic area may change, it’s typically considered an improvement, not a distortion.

Now, regarding your concern about muscle and fascia imbrication (tightening), it’s important to understand that when the rectus abdominis muscles are brought back together during a tummy tuck (muscle plication), this mainly affects the strength and flatness of the abdominal wall, not the deep structures of the pelvic anatomy like the uterus, bladder, or deeper pelvic organs. However, tightening the abdominal muscles and skin can create some initial tension and pull upward on the pubic region, making it feel tight or different early in the healing process. This tension usually relaxes over time as swelling subsides and tissues soften.

It’s also worth noting that during tummy tuck surgery, drains are typically placed, and these often exit through small incisions made low on the pubic area or above the groin. Early swelling or pressure around the drain sites can also temporarily make the pubic region feel or look distorted, but this usually resolves as you heal.

In rare cases, if too much skin is removed or if the skin is anchored too tightly, patients can feel excessive tension or distortion in the lower abdomen or pubic region. This is why it’s so important to work with an experienced, board-certified plastic surgeon who understands the balance between achieving a tight abdomen without overcorrecting the pubic area.

Thank you again for your thoughtful question. You’re asking the right things — and with the right surgeon and proper technique, a tummy tuck should enhance your overall contour, not distort it.

Wishing you the best on your surgical journey.

Sincerely,
Dr. J. Timothy Katzen, MD, MBA, FASMBS, FICS
(Certified by the American Board of Plastic Surgery and President of the American Society of Bariatric Plastic Surgeons; Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery; Member of the American Society of Plastic Surgeons, American Academy of Cosmetic Surgery, and RealSelf Hall of Fame)

Before moving forward, be sure to review your plastic surgeon’s qualifications, examine before-and-after photos carefully — especially the pubic region and incision lines — and make sure they have significant experience with both tummy tuck and massive weight loss body contouring surgeries.

Emmanuel Mallol Cotes, MD · Answer

Thank you for your question. It is hard to provided with a valid medical opinion without photos.  I would suggest to be treated by board certificated plastic surgeon with experience in this procedure, to get the best desired results.
Kind Regards,Dr. Emmanuel Mallol Cotes.-

Armando Soto, MD, FACS · Answer

Hi there-
The short answer to your question is that yes, it is possible that your pubic area could be altered by tummy tuck surgery.  The longer answer is that your individual anatomy and the precise technique used will affect the risk significantly, and even in patients with severe ptosis (sagging and distortion) of the area, the appropriate tummy tuck technique will actually aesthetically IMPROVE the area.
Poor attention to this point of anatomy and technique can result in a poor aesthetic outcome and even functional change.  The best advice I can give you is the same advice I give everyone: find a Board Certified Plastic Surgeon you like and feel you can trust (there is no substitute for our years of training doing tummy tucks under supervision). Talk to them about your concerns and get all your questions answered. If you aren't comfortable, move on until you find someone you are comfortable with.  I hope that helps.

Farbod Esmailian, MD · Answer

By imbricating the muscle, you are in a way decreasing the volume intra-abdominal to an extent. But will the plication affect your pelvic anatomy in a way to prevent perhaps pregnancy or other issues? Unlikely.
During a tummy tuck, the work that is done is all extra pelvic or outside the pelvic and abdomen so there should not be any issues.
Hope that helps.

Robert M. Freund, MD · Answer

While abdomenoplasty does not seem to affect pelvic anatomy, pregnancy does. At the time of pregnancy, your body releases an enzyme that loosens the attachments between the two sides of the pelvic bones. This enzyme allows the pelvis to widen for birth. The only problem is that the bones may not return to their position after birth. Thus, pelvic anatomy is changed.

Sutton Graham II, MD · Answer

Dear JS:  I'm not sure I understand your concerns, but I will try to answer.
Tummy tuck, with its imbrication of the lax anterior abdominal wall tissues by midline abdominal imbrication, would not directly affect the internal pelvic organs, which are positioned lower within the pelvic space.  The tightening of the lax skin and subcutaneous tissues may provide desirable support to (or re-suspension of) the mons pubis externally.
Patients could have pre-existing laxity of the pelvic floor support in addition to laxity of the anterior abdominal wall.  This should be assessed by a patient's Gynecologist.  It is not unusual to have both areas addressed during a combined set of operations by both surgeons.

William B. Rosenblatt, MD · Answer

A tummy tuck should not change the pelvic region. It might pull the pubic mound (mons) up but the labia and other vaginal structures should not be affected. A thigh lift may deform the labial region.

Peter E. Johnson, MD · Answer

Muscle and facial plication used during the tummy tuck procedure to tighten the abdominal wall does not affect the pelvic anatomy. Your body will feel and function the same way after. Imagine gently pushing in on the area with a girdle, or a binder. The effect is the same, though the muscle plication will hold with the girdle or binder off.The outside you is the new and improved; while on the inside, it's the same old you.Best of luck.

Hisham Seify, MD, PhD, FACS · Answer

During the tummy tuck procedure the fascia of the abdominal muscle is usually tightened in one or two layers. There is a great tendency nowadays not to produce too much tightening as this could have more postoperative complications. The pelvic anatomy should not be affected by this plication as the degree of tissue mobilization is limited. Some discomfort could be left early but things will get better after sometime.

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