Female Voice: This is, as I said before, a term pregnancy with a lot of stretched out skin and stretched out muscles to accommodate the growth of this baby. This is what she looks like five years after delivering. You can see stretched out skin hanging over her panty line, as well as over here, the outline of her muscles, called the rectus abdominis muscles, which are sitting out here to the side because they've also been stretched out.

So, when patients come to see me, they're not happy with the way their abdominal wall looks. There's often a range of procedures that we discuss during a tummy tuck consultation, so that patients can know why I'm recommending what I'm recommending and what is available out there. These are the four procedures that we generally use to address changes in the abdominal wall.

So, a tummy tuck is actually a repair in two layers. There is removal of extra skin and fat that has accumulated mostly in the lower portion of the abdomen, which is a superficial repair. But there's also a repair of the deeper muscles, which have been separated by all that stretching during pregnancy.

Liposuction is a procedure where we just remove fat through very small incisions, but we're not doing anything to the overlying skin. So, if you have stretched out skin, liposuction can make you smaller in size, but it's not going to reduce that extra skin.

A mini tummy tuck is a smaller procedure than a full tummy tuck, with smaller incisions, but we're really only working on muscle separation below the belly button, and also there's less skin removed. So, this is a procedure for a certain group of patients.

I just want to show you a little bit about what we're talking about when we say muscle separation or rectus diastasis. This picture is a CAT scan of an abdomen at the mid portion of the abdomen. Number five, where the two arrows are pointing, are the rectus abdominis muscles. Number six over here is that connective tissue layer between the two muscles, which prior to pregnancy is very tight and brings the two muscles right next to each other in the anterior abdominal wall.

This is a CAT scan of an abdomen after a full-term pregnancy. What you can see here is that these two muscles are still here, but now this connective tissue layer between them is very stretched out. The muscles themselves are separated from each other, and this is what we refer to as rectus diastasis.

And again, the picture on the left shows the pre-pregnancy tight fascia with good approximation of the muscles. The picture on the right shows this stretched out muscle layer. When that muscle layer is stretched out like that, there is really no exercise in the world that is going to bring those muscles back together in a way in which they're anchored.

So, when we do a tummy tuck, and this is the deep layer repair that I was talking about earlier, what we're actually doing is sewing this connective tissue from all the way up here to all the way down to your pubic bone, tightening it up so that the rectus abdominis muscles come back into a more appropriate position in the midline. That reestablishes the core muscle integrity of your abdominal wall, and all exercise that you do after that will actually be much more efficient.

So, here are four very different bellies, and the procedures that we would recommend for each of these patients is different. In the top left, what you see is a belly with a lot of abdominal wall fat. This young woman brought in pictures of herself when she was about two years old, and she had a big fat belly, and the rest of her is in really good shape. Whereas, the patient on the upper right has an abdomen that's stretched out really below the belly button. So, she has some loose skin, but a lot of muscle wall laxity, which you can see by this bulge over here. But it's pretty much all confined to below the belly button.

The patient in the lower left has a hugely stretched out abdominal wall that's very thin, and you can see that she looks like she's probably about five months pregnant still, although she's not. You see all that extra skin hanging down below her underwear. The patient on the bottom right finally is a patient who has muscle separation, which you can see, with the shadows of the muscle over here. But she also has a relatively thick abdominal wall.

These are the exact same patients in the same orientation, but now with a side view. So again, isolated . . . pretty much isolated fat to here, good abdominal wall contour, not a whole lot of skin above the belly button, but a big bulge below, a totally shot abdominal wall, and a pretty loose abdominal wall with a fair amount of fat on the abdominal wall.


Moms Who Want Their Bodies Back (Part 1)

Bay Area Plastic Surgeon Elizabeth Lee, MD, explains what a tummy tuck is and compares it to other body contouring procedures.