Different Types of Abdominoplasty Surgery for Your Unique Body Concern Post Weight Loss

Abdominoplasty is a surgical procedure (commonly known as a tummy tuck) designed to address multiple concerns resulting from significant weight loss after bariatric surgery or pregnancy.  Because each patient is unique, abdominoplasty can be tailored to suit the concerns, needs, and goals, as well as the medical history of each patient.

Examples

• If, for example, a post-pregnancy patient presents with muscle separation and excess fat but minimal loose skin laterally, a full abdominoplasty with diastasis recti repair and VASER Liposuction would be the likely course of treatment.
• On the other hand, if a post bariatric surgery weight loss patient presents with extensive loose skin around the midsection, including the upper and lower abdomen, but no muscle separation or excess fat deposits,  fleur-de-lis abdominoplasty would be the most appropriate choice. There would be no need for diastasis recti repair or liposuction in this situation. 

Each of these issues can be addressed with abdominoplasty surgery (tummy tuck), resulting in a more toned appearance and a restoration of strength and function.

Disclaimer: Operation performed by Dr Bernard Beldholm. Adult content, surgery has risks; individual results vary, seek 2nd opinion. Please see the full disclaimer.

Concerns and Solutions

1. Loose Skin: After weight loss or pregnancy, the skin may lose its elasticity, leading to sagging. Abdominoplasty removes the excess skin and tightens the remaining skin.
2. Diastasis Recti: A condition involving the separation of the abdominal muscles, common after pregnancy, diastasis recti can be treated with abdominoplasty.
3. Excess Subcutaneous Fat: After massive weight loss, stubborn fat deposits in the abdominal area may remain. When diet and exercise are not effective, abdominoplasty with liposuction helps create a more defined shape.
4. Hernias of the Abdominal Wall: A hernia in the abdominal wall, often related to weakened muscles, can be treated during abdominoplasty with umbilicoplasty, improving a patient’s appearance and functionality. 

Types of Abdominoplasty  Surgeries

There are several types of abdominoplasty surgeries effective for post weight loss patients.

• Mini Abdominoplasty
• Lipo-Abdominoplasty
• Full Abdominoplasty
• Extended Abdominoplasty
• Fleur-de-Lis Abdominoplasty
• Abdominoplasty with Umbilicoplasty
• Lower Body Lift (Belt Lipectomy)

READ MORE: Abdominoplasty After Bariatric Surgery

Mini Abdominoplasty (Tummy Tuck)

For patients with minimal excess skin and fat, a Mini Tummy Tuck is the most suitable option. A procedure that focuses solely on the lower abdomen, making it less invasive than a full tummy tuck, a Mini Abdominoplasty is an ideal solution for individuals who are in good physical health but have a small amount of loose skin and fat below the belly button. The procedure may also address minor cases of abdominal muscle separation.

Because it involves a smaller incision, a Mini Tummy Tuck typically results in less visible scarring, lessened discomfort, and a quicker return to one’s everyday routine.

In addition, because the recovery time for this procedure is typically shorter compared to other types of abdominoplasty, it is a popular choice for those seeking a minimally invasive solution with maximum satisfaction.

Disclaimer: Operation performed by Dr Bernard Beldholm. Adult content, surgery has risks; individual results vary, seek 2nd opinion. Please see the full disclaimer.

Mini Abdominoplasty with Lower Abdominal Muscle Repair

Mini abdominoplasty with lower abdominal muscle repair is a procedure that not only removes extra skin from the lower abdomen but also addresses loose abdominal muscles (Diastasis Recti).

This technique, which is particularly beneficial for individuals who have experienced muscle separation during or after pregnancy, involves making a small, horizontal incision just above the pubic area, through which the surgeon can access and tighten the abdominal muscles and remove the excess skin.

READ MORE: How to Tell if Your Abdominal Muscles Were Torn (Diastasis Recti) During Pregnancy

Mini Abdominoplasty with VASER Liposuction

Mini Abdominoplasty with VASER Liposuction combines the benefits of both a mini abdominoplasty and VASER liposuction to achieve optimal body contouring results. This procedure is ideal for individuals who not only have loose skin in the lower abdomen but also stubborn fat deposits that are resistant to diet and exercise.

Many post-pregnancy patients find it challenging to address the excess abdominal skin tissue and stubborn fat pockets by practicing a healthy lifestyle or turning to non-surgical solutions, requiring a more effective surgical approach.

Combining a Mini Abdominoplasty with VASER Liposuction with a Mini Abdominoplasty can enhance the surgical outcome by providing a smooth, contoured, and refined appearance. Often performed simultaneously with an Abdominoplasty, VASER Liposuction removes stubborn excess fat pockets and improves aesthetic results.

VASER Liposuction (Vibration Amplification of Sound Energy at Resonance) is a specialized technique that uses ultrasound technology to break down fat cells, making them easier to remove. This method is particularly beneficial for targeting stubborn fat deposits that do not respond to diet and exercise.

Mini VASER Lipo-Abdominoplasty Candidate Checklist

Candidates for a mini tummy take should meet the following requirements.

• Minimal redundant skin on the lower abdominal region
• Minimal or no muscle separation on the lower abdominal region
• No redundant skin or muscle separation on the upper abdominal wall 
• Reached goal weight 
• Maintained a stable weight for a minimum of 6 months
• Made concerted attempts at eating a healthy diet and exercising regularly have failed. 
• Understanding of the potential risks involved
• Realistic expectations
• Non-smoker or willing to refrain from tobacco use for 6 weeks before and after the procedure

*NOTE: These are general qualifications and don’t guarantee suitability for your surgical journey. I invite you to schedule a consultation with me to confirm suitability.

READ MORE: Two at Once: Undergoing Liposuction and Abdominoplasty (Tummy Tuck) Surgery at the Same Time (Lipo-Abdominoplasty)

Full Abdominoplasty Surgery

Disclaimer: Operation performed by Dr Bernard Beldholm. Adult content, surgery has risks; individual results vary, seek 2nd opinion. Please see the full disclaimer.

A full abdominoplasty is a more extensive form of the procedure than a mini, with the incision typically extending from hip to hip. Focusing on the entire abdominal area by removing excess skin and tightening the muscles, this type of surgery is commonly performed to address issues related to extensive weight loss.

Due to the extent of the surgery, the recovery process for a full tummy tuck can be more intense than for that of a Mini Abdominoplasty, involving longer downtime and more visible scars, though not as extreme as Fleur-de-Lis or an Extended Tummy Tuck. 

Extended Abdominoplasty Surgery

Designed for individuals with significant excess skin and fat following significant weight loss due to bariatric surgery or post-pregnancy weight loss, an extended abdominoplasty requires a longer incision, which allows extensive areas of sagging skin to be addressed.

During an extended abdominoplasty, excess skin and fat is removed from the lower back and flanks, and buttocks in addition to the abdomen. This results in a more comprehensive contouring effect.

READ MORE: Understanding the Difference Between Abdominoplasty and Lipectomy for Body Contouring

Fleur-de-Lis Abdominoplasty

Disclaimer: Operation performed by Dr Bernard Beldholm. Adult content, surgery has risks; individual results vary, seek 2nd opinion. Please see the full disclaimer.

Fleur-de-Lis Abdominoplasty is a procedure involving both vertical (from the groyne area along the midline) and horizontal incisions (from hip-to-hip)  intersecting at the groyne region, forming an inverted “T”. 

Removing significant excess skin and fat following substantial weight loss due to bariatric surgery or post-pregnancy weight loss, FDL delivers dramatic results that would be challenging with a standard abdominoplasty procedure.

Disclaimer: Operation performed by Dr Bernard Beldholm. Adult content, surgery has risks; individual results vary, seek 2nd opinion. Please see the full disclaimer.

Umbilicoplasty

Pregnant women might see their belly button shift position or change shape as their pregnancy progresses. Even childbirth can affect the belly button’s appearance. Difficult births can result in the tearing of the abdominal muscles, a condition known as diastasis recti. This condition changes the stomach’s appearance, often displacing the belly button.

There are three types of techniques of surgery through which surgeons can carry out a belly button reshaping operation:

• Umbilicoplasty
• Umbilical hernia repair
• Abdominoplasty (Tummy Tuck)

READ MORE: Dr. BB’s Guide to Belly Button (Umbilicus) Beautification And Abdominoplasty

Lower Body Lift (Belt Lipectomy)

Substantial weight loss (more than 30 kilos) after bariatric surgery could leave excess skin and fat 360 degrees around the patient’s waist, affecting the abdomen, flanks, upper pubic zone, buttocks, and thighs. Belt lipectomy surgery, also known as a circumferential abdominoplasty, removes excess skin from these areas with an incision around the beltline. 

A surgical procedure often performed in one or two stages, Belt Lipectomy is one of the most comprehensive options for post-weight-loss patients with sagginess after losing massive amounts of weight. 

READ MORE: Lower Body Lift (Belt Lipectomy) After Bariatric Surgery: A Full Guide

Types of Abdominoplasty Based on Conditions

Abdominoplasty (tummy tuck) is designed to address multiple concerns after significant weight loss following bariatric surgery or pregnancy.  As each patient is unique, abdominoplasty can be tailored to suit the needs, medical history, goals, and concerns of each patient.       

• If a post-pregnancy patient presents with muscle separation and excess fat in the mid abdomen and flanks but minimal loose skin laterally, for example, a full abdominoplasty with diastasis recti repair and VASER Liposuction would be an appropriate course of treatment. 
• On the other hand,  if a post weight loss patient presents with extensive loose skin on the upper and lower abdomen but no muscle separation, Fleur-de-Lis abdominoplasty without muscle repair wou;d be an effective treatment.

Each of these issues can be addressed with abdominoplasty surgery, resulting in a more toned appearance and a restoration of strength and function.

1. Loose Skin: After weight loss or pregnancy, the skin may lose its elasticity, leading to sagging. Abdominoplasty removes the excess skin and tightens the remaining skin.
2. Diastasis Recti: A condition involving the separation of the abdominal muscles, common after pregnancy, diastasis recti can be treated with abdominoplasty to tighten muscles.
3. Excess Subcutaneous Fat: After massive weight loss, stubborn fat deposits in the abdominal area may remain. When diet and exercise are not effective, abdominoplasty with liposuction helps create a more defined shape.
4. Hernias of the Abdominal Wall: A hernia in the abdominal wall, often related to weakened muscles, can be treated during abdominoplasty with umbilicoplasty, improving a patient’s appearance and functionality. 

Types of Abdominoplasty Based on Conditions

1. Loose Skin

After significant weight loss, the best type of tummy tuck to treat loose skin depends on the amount and location of the excess skin. For patients who have undergone massive weight loss, there are several types of tummy tucks to consider:

• Mini Abdominoplasty: Best for mild skin sagging below the belly button, with a smaller incision and less invasive procedure.
• Full Tummy Tuck: Best for moderate to severe loose skin and muscle separation (diastasis recti), with skin removal and muscle tightening.
• Extended Tummy Tuck: Ideal for patients with loose skin extending into the flanks and upper abdomen, with a longer incision for more extensive skin removal.
• Fleur-de-Lis Tummy Tuck: Best for severe skin laxity affecting both the upper and lower abdomen, involving both vertical and horizontal incisions.
• Body Lift: A comprehensive option for patients with loose skin around the abdomen, flanks, thighs, and back, typically after massive weight loss.
• Liposuction (VASER Liposuction): Best for fat removal when skin elasticity is good, but it’s not a substitute for addressing loose skin.

2. Diastasis Recti

A condition involving the separation of the abdominal muscles, common after pregnancy, diastasis recti can be treated with one of the following abdominoplasty procedures.

• Full Tummy Tuck (Traditional Abdominoplasty): Ideal for significant muscle separation and skin laxity, includes extensive diastasis recti repair.
• Mini Tummy Tuck: Good for mild diastasis recti with less skin laxity; limited muscle repair to the lower abdomen.
• Fleur-de-Lis Tummy Tuck: Best for severe muscle separation and excess skin, with muscle tightening both above and below the belly button.
• Extended Tummy Tuck: Ideal for patients with muscle separation and skin laxity extending beyond the abdomen.
• Body Lift: Addresses muscle repair in conjunction with skin tightening for patients with extensive abdominal and torso skin sagging post-weight loss.

3. Excess Subcutaneous Fat

After massive weight loss, patients often experience excess subcutaneous fat and skin laxity. While abdominoplasty (tummy tuck) procedures primarily target skin removal and muscle tightening, some procedures also address fat by including liposuction or other techniques for more comprehensive contouring. 

Here are the best tummy tuck procedures to treat excess subcutaneous fat after significant weight loss:

• Full Tummy Tuck with Liposuction: Best for moderate to severe skin laxity and localized fat deposits.
• Extended Tummy Tuck with Liposuction: Ideal for patients with excess fat around the abdomen, flanks, and lower back.
• Body Lift (Belt Lipectomy) with Liposuction: Comprehensive fat and skin removal for patients with excess fat around the abdomen, thighs, and lower body.
• Fleur-de-Lis Tummy Tuck with Liposuction: Best for severe skin laxity and fat in both the upper and lower abdomen.
• VASER Liposuction with Mini Abdominoplasty: Suitable for patients with limited fat and skin issues in the lower abdomen.

• Liposuction Alone (VASER Liposuction): Ideal for those with mild skin laxity and fat deposits without needing extensive skin removal.

Important Considerations:

• Skin Laxity vs. Fat Removal: If there is significant skin laxity, procedures like the full tummy tuck, extended tummy tuck, or body lift may be necessary. Liposuction is effective for removing fat, but it won’t tighten the skin significantly. In such cases, skin removal is essential.
• Stability in Weight: For optimal results, it’s important that patients have reached and maintained a stable weight before undergoing these procedures. Further weight fluctuations after surgery can affect the final results.

4. Hernias of the Abdominal Wall

A hernia in the abdominal wall, often related to weakened muscles, can be treated during abdominoplasty with umbilicoplasty, improving a patient’s appearance and functionality.

Here are the best tummy tuck procedures to treat hernias of the abdominal wall:

• Full Tummy Tuck with Hernia Repair: Best for moderate to severe hernias with skin laxity and muscle separation, especially in the lower abdomen.
• Mini Tummy Tuck with Hernia Repair: Suitable for small hernias and mild skin laxity below the belly button.
• Extended Tummy Tuck with Hernia Repair: Ideal for larger hernias with excess skin extending across the abdomen and flanks.
• Fleur-de-Lis Tummy Tuck with Hernia Repair: Best for severe hernias and extensive skin laxity.
• Body Lift with Hernia Repair: Comprehensive treatment for hernia and skin laxity, often after massive weight loss.
• Liposuction with Hernia Repair: Used for small hernias when liposuction is needed to remove fat around the hernia site.

General Practitioner Referral

In Australia, patients cannot undergo an abdominoplasty without getting a referral from a General Practitioner (GP).  In addition, the GP’s referral, which is valid for 12 months, is essential in claiming Medicare rebates.  

After obtaining a GP’s referral, the next step is to book a consultation with a qualified and experienced specialist surgeon. The specialist surgeon uses the GP’s information to determine if the condition is medically necessary. In addition, the specialist surgeon conducts a battery of tests to assess the patient’s eligibility to undergo abdominoplasty surgery.

The patient must also demonstrate that they have tried non-surgical treatment remedies like a healthy diet and exercise for at least three months without success.

The surgeon then determines which MBS Item Number the patient qualifies for and gives the patient a quote of the procedure’s cost. This is why you should prepare for a consultation before planning the surgery to know what to expect, financially.

Selecting a Specialist Surgeon

Selecting the right surgeon is a pivotal step in a patient’s tummy tuck journey. Certified specialist surgeons FRACS (Such as Dr Bernard Beldholm) who focus on abdominoplasty procedures, should have the expertise and experience that are crucial for a successful surgery. Initial consultations are an excellent opportunity to discuss the surgeon’s approach, review before-and-after photos, and review complication rates.

Obtaining Medicare Coverage for Abdominoplasty Surgery

Patients who find it challenging to cover the cost of their abdominoplasty surgery can seek rebates through Medicare, though there is strict eligibility criteria. 

Medicare will only cover abdominoplasty if it is deemed medically necessary. There are two qualifying groups for MBS numbers; post-pregnancy cases involving muscle separation and related symptoms and post-weight loss cases where the patient records a weight loss exceeding 5 BMI levels and maintained stable weight for at least 6 months. In addition, the procedure must be listed under the MBS Item Numbers. 

Qualifying for an MBS Item Number

Abdominoplasty procedures for cosmetic purposes are considered elective and, therefore, not covered under Medicare.  When abdominoplasty is performed for medical reasons, however, such as to restore or improve bodily functions, reduce pain, or eliminate skin infections, Medicare may offer a rebate to help cover the cost of the procedure. Medicare classifies eligible abdominoplasty procedures into two categories: post-pregnancy and post-weight loss.

Post-pregnancy

Medicare offers rebates to post-partum patients undergoing abdominoplasty to cover separated abdominal muscles (diastasis recti) and redundant skin that causes medical conditions such as difficulty walking or performing tasks, discomfort, rashes, and infections.

Post-weight Loss

Medicare covers patients undergoing abdominoplasty (tummy tuck) to remove excess sagging skin resulting from significant weight loss. Medicare describes significant weight loss as at least 5 BMIs. In addition, the patient must have maintained a stable weight for a minimum of six months before surgery. 

Understanding the MBS (Medicare Benefits Schedule)

Medicare is Australia’s universal health care medical insurance program, publicly funded and operated by Social Security. Medicare covers Australia’s citizens and permanent residents undergoing essential standard procedures but has limited coverage for specialised surgical procedures, including abdominoplasty. MBS (Medicare Benefits Schedule) is a list of medical services that Medicare covers, including eligibility criteria and fees for each procedure. 

Despite having coverage, however, patients must lay out the surgeon’s fee prior to undergoing the procedure, after which they can then claim the fees from the health fund and request a rebate. Medicare only covers a part of the total cost, leaving the patient to cover additional costs, such as the anaesthesia fee and hospital fees.

Patients with insurance can only claim rebates from their private health fund, not Medicare. After claiming from the private health fund, the fund will then claim the funds from Medicare. That is 75% of the scheduled fee. The hospital will bill the private health fund directly to cover any expenses incurred by the private health coverage.

What Medicare Will Cover in Australia

Below are the costs that Medicare covers for patients qualifying for rebates

• 100% of the costs to consult a GP (General Practitioner). 
• 85% of the MBS scheduled out-of-hospital fees (follow-up appointments, consultation with specialists, pre-operative assessments, and post-operative care)
•  75% of the MBS scheduled in-hospital fees

What Medicare Will Not Cover in Australia

Medicare covers a portion of doctor’s fees but does not cover hospital fees, such as theatre and accommodation fees.  

What Private Health Insurance Covers in Australia

Private health insurance offers higher coverage compared to Medicare. The costs covered by private health insurance include:

• A minimum of the full amount of the MBS scheduled fee for the surgeon
• A minimum of the total amount of the MBS scheduled fee for the anaesthetist
• A minimum of the total amount of the MBS scheduled fee for the surgeon’s assistant
• The total amount of the in-hospital fees

MBS Item Numbers for Abdominoplasty Surgery

MBS Item Number 30166

MBS Item Number 30166 covers the excision of excess redundant abdominal skin and lipectomy, as a wedge excision, for functional problems following massive weight loss of at least 5 BMI (body mass index) points. The patient must have maintained a stable weight for a minimum period of 6 months before surgery.

Eligibility Requirements

• Must have undergone significant weight loss (at least 5 body mass index (BMI) units) before the procedure.  
• Must have maintained a stable weight for at least six months
• For pre-pregnancy significant weight loss that occurred before pregnancy, the weight directly associated with conception is not included in the baseline weight calculation.

MBS Item Number 30175

MBS Item Number 30175 covers radical abdominoplasty procedures to repair rectus diastasis (separated abdominal muscles), skin and fatty tissue excision, and umbilicus (belly button) repositioning. The surgery should not be laparoscopic.

Eligibility Requirements

•  Abdominal wall defect as a result of pregnancy
• Diastasis of the abdominal muscles of a minimum of 3 cm 
• Moderate to severe discomfort or pain at the region of the diastasis during functional use 
• Urinary symptoms or low back pain likely resulting from diastasis rectus.
• Patient has failed to react to non-surgical treatments 
• Patient has not been pregnant in the last twelve months

MBS Item Number 30177

MBS Items Number 30177 covers lipectomy, skin, and fatty tissue excision due to redundant excess abdominal skin and fat that directly results from significant weight loss. The procedure includes a radical abdominoplasty, which may involve musculoaponeurotic layer repair and repositioning of the umbilicus (belly button).

Eligibility Requirements

• Intertrigo or another skin condition that poses the risk of loss of skin integrity.
• Treatment of the redundant excess abdominal skin using non-surgical (or conventional) treatments has failed for at least 3 months.
• Redundant excess skin and fatty tissue affects the patient’s daily functions. 
• Maintained a stable weight for at least six months before the procedure, following significant weight loss.