Tummy Tuck or Abdominoplasty, is an operation designed to re-contour the abdominal and trunk regions after pregnancy or significant weight loss. According to The American Society of Aesthetic Plastic Surgery (ASAPS), it was the third most popular cosmetic surgery procedure performed in 2016, and over 180,000 tummy tucks were performed by its members last year. I have listed 5 important facts about this operation.

1. BMI matters

Body Mass Index is a value derived from the weight and height of an individual, and is used to determine degree of obesity. A BMI of 30 or higher indicates obesity, 25 to 29.9 indicates that someone is overweight. Most surgeons require prospective tummy tuck patients to have a BMI below 35, but many prefer that number to be much closer to 30. The reason being safety issues and much better results with a lower BMI. Diet and exercise prior to surgery is recommended to optimize the outcome.

2. Ideal candidates for surgery

Healthy individuals who are non-smokers with realistic expectations do best after this operation. Weight loss patients should be stabilized at their present weight, and weight plateaued. In other words, maximum weight loss should be achieved and that weight maintained and steady for 1 to 3 months prior to surgery. This allows the plastic surgeon to remove as much redundant skin and fat from the abdomen and trunk as possible. Mothers seeking to retrieve their pre-pregnancy bodies should complete their family and not plan further pregnancy. After surgery, if a patient does become pregnant, it could greatly affect the results from tummy tuck surgery, but will not affect the pregnancy.

3. Tummy Tuck surgery involves 3 primary maneuvers

Ideally, this operation should be tailored to the needs of each individual. Specific anatomical issues need to be addressed, and these can vary from person to person. The procedure involves removal of redundant skin and fat from the lower abdomen, liposuction of the flanks and sometimes upper abdomen and plication or repair of abdominal wall muscles that became stretched out from weight gain or pregnancy. Usually all 3 of these maneuvers is performed, but not always. For example, sometimes liposuction is not needed in very fit individuals with just redundant skin and no fat. Sometimes other areas are targeted also, like liposuction of the back or thighs to complement the results attained from the tummy tuck. Many women opt for a "Mommy Makeover," which includes breast lift, with or without implants, returning their bodies to pre-pregnancy form.

4. Smoking affects healing and scarring

Aside from being poisonous to the heart and lungs, smoking causes serious detrimental issues to our largest organ, skin! It chokes blood vessels which bring vital oxygen and nourishment to the skin, altering wound healing and scar formation. Smokers likely have such serious issues with wound healing that most plastic surgeons will not perform tummy tucks on them unless they stop smoking for a minimum of 2 weeks before and after the operation. The risk of blood clots breaking off and going to the lungs (pulmonary embolism), is also higher in smokers undergoing this operation.

5. Final results attained 4 to 6 months after surgery

While results can be dramatic, it may take as long as 4 to 6 months for all swelling to resolve and as long as 12 months for final scar maturation. It is for this reason that I counsel my patients before surgery to understand this healing process and the need for patience and diligent scar care. Patients are usually placed in an elastic surgical girdle or abdominal binder after surgery to protect the abdominal muscle repair and speed swelling reduction. Patients may return to vigorous activities like exercise and heavier lifting 4 to 6 weeks post op.

Tummy Tuck surgery has enjoyed wide popularity largely because of dramatic results attained by board certified plastic surgeons. Unfortunately, physicians from other specialities are performing tummy tucks with limited results. Board certified plastic surgeons undergo a vigorous training residency and rigid oral and written exams to insure superior competence with regards to cosmetic operations like abdominoplasty. If considering tummy tuck surgery, seek consultation with a board certified plastic surgeon.

Robert Tornambe, MD is a New York City Plastic Surgeon and Medical Advisor for Trueself. Certified by the American Board of Plastic Surgery, Dr. Tornambe has been practicing plastic surgery for more than 25 years. He is a fellow of the American College of Surgeons, was featured in NYMAG's "Best Doctors" issue, and was the Chief of Plastic Surgery at NYC's Cabrini Medical Center for 20 years.