At the Body Contouring Surgery Clinic (BCSC), our Specialist General Surgeons (FRACS) work with many patients who have completed a major weight loss journey. Some achieve this through bariatric surgery, such as gastric bypass surgery or sleeve gastrectomy, while others do so through lifestyle changes. Whatever the method, significant weight loss has a positive impact on your health but often leaves behind challenges such as excess skin and weakened abdominal muscles (diastasis recti). These changes can cause discomfort, difficulty with clothing, skin irritation, and limitations in movement [1,2].
Tummy tuck (abdominoplasty) surgery is one of the most common body contouring procedures performed after weight loss. This article explains why excess skin develops, what abdominoplasty involves, who may be suitable, the different types of procedures available, and what to expect from preparation, recovery, and risks [3,4].
When the body carries excess weight over many years, skin stretches beyond its ability to recoil. After significant weight loss, particularly following weight loss surgery, the skin may not shrink back. This leads to loose, redundant skin and folds, with some patients also experiencing excess skin and fat in the lower abdomen [2,3].
These changes are not only cosmetic. Many post bariatric patients report persistent skin irritation, rashes, and skin infections in the folds. Clothing fit may be difficult, and mobility can be affected [1]. Such issues often lead patients to consider body contouring surgery.
Body contouring refers to a group of plastic and reconstructive surgery procedures that target excess tissue after massive weight loss [3]. They can focus on different areas depending on where skin laxity is most problematic. Common procedures include:
Among these, abdominoplasty is often most requested because the abdomen is commonly affected after major weight loss [4].
Several factors are assessed when determining suitability for abdominoplasty:
Medicare may provide partial rebates under item 30177 for abdominoplasty after bariatric surgery or weight loss. To qualify, patients generally must:
Eligibility is confirmed during consultation, and rebates only apply when surgery is considered reconstructive rather than purely cosmetic surgery.
From 2016 to 2025, Medicare data shows fluctuating use of item 30177. The highest number of abdominoplasties was recorded in 2020–21 (2,902 cases), with numbers decreasing to 2,106 in 2024–25. On average, 2,296 procedures were performed annually [2].
Around 94% of patients were women, most aged between 35 and 54. The highest numbers occurred in New South Wales, Victoria, and Queensland [2]. These demographics align with what we see in practice: many post bariatric patients are women who have completed their families and achieved a stable weight.
Abdominoplasty procedures primarily focus on vertical excess in the abdomen. The choice of operation depends on the extent of redundant tissue [3,4].
This is considered when only a small amount of excess skin lies below the navel. It involves a shorter incision and modest tissue removal. Rarely performed in post bariatric patients, as they usually present with more extensive skin laxity [3].
When skin and fat extend from hip to hip, often combined with diastasis recti, a standard abdominoplasty may be appropriate. It involves a hip-to-hip incision, tightening of the underlying abdominal muscles, removal of redundant skin, and repositioning of the belly button [4].
For those with vertical excess that extends around the flanks and lower back, an extended abdominoplasty may be required. This provides more extensive tissue removal to address circumferential laxity [3].
In selected cases, liposuction (suction-assisted lipectomy) is performed alongside abdominoplasty to remove residual fat deposits. This is considered for patients who, despite weight loss, still have stubborn areas of adipose tissue [6]. Combining procedures can increase operative time and recovery demands, so careful patient assessment is essential.
Some patients also present with hernias, such as umbilical, ventral, or incisional hernias. These can sometimes be repaired at the same time as abdominoplasty. This approach may treat abdominal wall integrity while also removing redundant skin [7].
Abdominal redundancy after weight loss can be vertical, horizontal, or both [3].
Vertical excess is most common and is treated with standard abdominoplasty procedures, which remove skin by pulling downward [4].
Horizontal excess occurs when skin laxity stretches across the width of the abdomen. This requires procedures with vertical excisions, such as the Fleur-de-Lis abdominoplasty [5].
Other procedures, including upper abdominal lipectomy, may be considered when tissue excess is primarily in the upper abdomen [6].
Preparation involves detailed consultation and planning. Nutritional assessment is particularly important in bariatric surgery patients, as vitamin or protein deficiencies increase risks of infection or delayed healing [2]. Smoking should be stopped at least four weeks before surgery [3]. Patients are advised to arrange home support for the recovery period and to attend at least two consultations before surgery [1].
Abdominoplasty surgery is carried out under general anaesthetic in an accredited hospital. The procedure takes three to five hours. Patients usually stay in hospital for one to three days [4].
The surgeon makes a low abdominal incision, lifts skin and fat, repairs or tightens abdominal muscles (diastasis recti), and removes excess tissue. In most cases, the belly button is repositioned. Compression garments and drains may be used. Some patients undergo combined procedures such as suction assisted lipectomy [6].
Recovery after tummy tuck (abdominoplasty) surgery is gradual. Early walking is encouraged to reduce the risk of blood clots such as deep vein thrombosis [5]. Compression garments help support healing [6].
Most patients can return to light work after two to three weeks. Gentle exercise may begin after six weeks, while strenuous activity is avoided for at least eight weeks. Scars usually mature over 12 to 18 months [3].
Every surgical procedure has risks. Possible complications of abdominoplasty include bleeding, infection, seroma, haematoma, poor wound healing, pulmonary embolism, skin sensation changes, and scarring [4,5]. Published studies report rates of infection at 4%, wound separation at 8.6%, seroma at 8.4%, and haematoma at 2.6% [1].
Most surgeons recommend waiting at least 12–18 months after bariatric surgery before undergoing abdominoplasty. This allows time for weight to stabilise and for nutritional recovery [2,6]. In cases of severe pannus-related infections, early panniculectomy may be considered [1].
These procedures serve different purposes. Gastric bypass is a form of weight loss surgery to help patients lose weight and treat obesity-related conditions [2]. A tummy tuck (abdominoplasty) surgery is a type of post-bariatric plastic surgery performed after weight loss to remove redundant skin and repair the underlying abdominal muscles [3].
Abdominoplasty should be performed after weight loss has been achieved and stabilised. Surgery performed before weight reduction may lead to unsatisfactory outcomes if further weight gain or loss occurs [5].
Yes. Many post bariatric surgery patients undergo abdominoplasty as part of post bariatric body contouring. Timing depends on stability of weight and nutritional health [2,4].
Abdominoplasty is not designed for weight reduction. While patients may experience small reductions in body weight due to excess skin removal and reduced adipose tissue, the operation is reconstructive and not a substitute for bariatric or lifestyle-driven weight management [6,8].
Abdominoplasty after bariatric surgery or weight loss is one option to treat excess abdominal skin and weakened muscles (diastasis recti) following major weight loss. At BCSC, our Specialist General Surgeons (FRACS) assess each patient individually, considering stability of weight, functional problems, and overall health.
The aim is to treat functional concerns, while ensuring patients understand the recovery process and risks involved. Outcomes differ between individuals, and decisions about surgery should always be made in consultation with a qualified surgeon.
