What do I need? 133lbs, 5’4” 39yr old mom of 5 ten pound babies. Tummy tuck? (photo)

It looks like a tummy tuck may help you get the better body contour you want. This surgery would tighten up the loose skin, remove any excess fat and repair the abdominal muscle separation that is contributing to your protruding belly (common after multiple pregnancies).

In your side view, you can see bulging from the pregnancies.  If you are not planning future pregnancies, I recommend abdominoplasty with mesh reinforcement.  The mesh will resolve the hernia, will reinforce the mechanical strength of the abdominal wall, create a more hourglass figure resulting in early satiety and helps maintain a reduced weight.
 Best Wishes,Gary Horndeski, M.D.