There are many reasons women come to me for a tummy tuck. Often they just don’t like the look and feel of their abdomen after pregnancy, or they’ve lost weight and are concerned by excess skin. Others are confused by bulges that have no apparent cause.
It’s a bit of a lottery how abdomens fare after pregnancy. Some women have stretchmarks while others can get through the process without a single one. There are also women for whom pregnancy can result in hernias.
For whatever reason a patient is seeking a tummy tuck (abdominoplasty), I first assess risk-versus-outcome and ensure she can undergo the procedure safely and achieve her desired goals.
A large majority of my abdominoplasty patients are fit, well-toned women who are regular gym-goers. Often they’ve spent hours working on their abs to improve muscle tone and strength (and various core strengthening exercises) to no avail.
Unfortunately, exercise won’t help a sagging or bulging tummy, as exercise will only tone muscle. Exercise can’t tighten skin or fascia [a structure of connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding some structures together], nor can it repair the torn or separated muscle wall that can occur during pregnancy.
Pregnancy stretches the midline of the abdomen. If this doesn’t shrink back after birth it may leave a permanent weak area. This alters the way the abdomen works – it bulges when a woman is standing and the weakness also spreads to the back and pelvis, leading to back pain and a weak pelvic floor with stress incontinence.
The skin of the abdomen stretches in pregnancy and this may not shrink either, especially after the second, third or further child. It can cause stretchmarks, localised fat collection and sagging.
Many women put up with this as they relegate their needs to the background while raising their families. There is a tendency to accept that their bodies have “changed for the worse”; the “price of pregnancy”.
But it doesn’t have to be that way. It amazes me the things women put up with. If your knee was injured, you’d get it fixed.
The post-pregnancy abdomen has the same impact on daily life. It can affect your ability to get out of bed in the morning, get up off the floor, lift children or heavy shopping bags into cars, jump on the trampoline – even laugh or cough without bladder leakage.
An abdominoplasty operation will restore everyday life function – core strength, continence and, as a side benefit, the wrinkly lower abdominal skin will be removed. The waist is lowered and narrowed, producing a more desirable hourglass shape.
In the same way pregnancy alters both the form and the function of the abdomen, so too does the development of umbilical or abdominal hernias [unusual protrusions of abdominal contents through a hole in the abdominal wall].
Unlike pregnancy weakness, the weakness associated with abdominal hernias is much more significant and clinically more concerning.