The answer is complicated. From a medical standpoint, tummy tuck surgery does not affect your ability to get pregnant or have a baby. On the other hand, pregnancy may have a significant effect on your tummy tuck results. Keep reading to find out why.
Before we delve into detail regarding having a baby after tummy tuck surgery, it’s important for you to understand why your stomach may not be flat. Once we understand that, I’ll explain what actually happens during tummy tuck surgery. Then I’ll explain how getting pregnant may affect your tummy tuck results and how long you should wait after pregnancy to have a tummy tuck,
How to Get a Flat Stomach
There are four separate causes of a stomach that isn’t flat:
- Loose skin. Both pregnancy and significant weight loss may result in loose skin, but this loose skin will shrink up some over time. If you just had a baby or hit your goal weight, give your skin a full six months to shrink up. Any loose skin left after that time frame will likely require surgery to improve.
- Rectus diastasis. The rectus abdominis muscles are the two strips of muscle on the front of your abdomen which create the “six-pack”. They are connected in the midline by a sheet of tough connective tissue called fascia. When you gain weight or get pregnant, this fascia stretches out to allow the baby to grow (or to allow the fat to accumulate, which is decidedly less fun than having a baby).
After the baby is born, or you lose the weight, the fascia will shrink up some. As with loose skin, this process takes at least six months, but often there is still some stretch left, creating a widened space between the muscles. (The word “diastasis” means widening.) So a rectus diastasis is literally a widening between the rectus abdominis muscles. And this is what causes your belly to look six months pregnant right after you had a baby.
- Subcutaneous fat. Subcutaneous means under the skin. So subcutaneous fat is the fat that you can pinch between your finger and thumb. Compare this to intra-abdominal (see below).
- Intra-abdominal fat. This is the fat inside your abdominal cavity, packed around your internal organs. Also known as visceral fat, intra-abdominal fat causes a hard, round belly (think beer gut). The fat feels hard because you’re actually feeling the abdominal muscles, which are pushed outward by the fat behind them.
Your flat stomach solution depends on the cause.
Let’s talk fat first. Liposuction can remove subcutaneous fat. So if subcutaneous fat is the only thing keeping your stomach from being flat, liposuction is a great option. But it’s not unusual to have more than one factor keeping your stomach from being flat. If that is the case, you’ll only see a partial improvement from liposuction.
An important point in this discussion is that liposuction cannot remove intra-abdominal fat. This fact often confuses people, so it may be helpful to think of it this way:
To remove fat that is behind your abdominal muscles — packed in and around your internal organs — would require us to literally open up your abdominal cavity and move all your organs around. Not safe, and not even really possible. The only way to safely remove intra-abdominal fat, in fact, is good old weight loss. On a side-note, losing weight reduces subcutaneous fat as well. But if you have that stubborn fat around the midsection that doesn’t respond to weight loss, liposuction may be a great option for you.
How do you know if you need a tummy tuck?
If your problem is loose skin and/or a rectus diastasis, and you don’t have a lot of excess fat, then a tummy tuck will get you that flat stomach you’ve been wanting.
Tummy tuck surgery (aka abdominoplasty) has two major components:
- Removal of loose skin
- Repair of rectus muscles to correct rectus diastasis
I find that very few people need only skin removal without a diastasis repair, and vice versa. And this makes sense — excess fat or pregnancy tend to stretch out skin and the abdominal muscles at the same time.
Tummy tuck surgery leaves a scar from hip-to-hip low on the abdomen and another scar around the belly button. The belly button (umbilicus) actually stays where it is, attached to the underlying abdominal muscles. Most or all of the skin below the belly button is removed. So if you have stretch marks over your lower abdomen, many of them come off with the excess skin. You can read more about the procedure on the American Society of Plastic Surgeons website.
A brief side note here: if you have extra subcutaneous fat as well as loose skin, your surgeon may recommend a two-stage approach. Liposuction first removes the fat, then six months down the road after everything is healed, a tummy tuck removes the loose skin and tightens the abdominal muscles.
Why not do liposuction and a tummy tuck at the same time? Aggressive liposuction compromises the blood supply to the skin. If you have a tummy tuck at the same time this can cause major healing problems (think death of the skin). It is safe, however, to liposuction the hips or waist at the same time as a tummy tuck.
Can You Still Get Pregnant After a Tummy Tuck?
Now that you understand what a tummy tuck involves and what it treats, we can talk about how tummy tuck surgery affects pregnancy and vice versa.
First, let me reassure you that abdominoplasty surgery does not affect your actual ability to get pregnant or carry a baby. Skin removal and muscle repair have no effect on your fertility. And there is no health risk to mom or baby.
But if you get pregnant after tummy tuck surgery you can expect some changes during and after pregnancy. You may find that the pregnancy doesn’t show as early. After all, those tightened abdominal muscles take time to stretch back out.
What about after pregnancy? Having a baby grow will stretch your muscles and skin back out. It’s impossible to predict how much they will stretch, and to what degree the skin and fascia will retract (shrink up) after pregnancy. But, pregnancy will essential undo much of what a tummy tuck accomplishes. If you get pregnant after having a tummy tuck, you may end up with new stretch marks, loose skin, or stretched muscles. For this reason, I advise patients to wait to have tummy tuck surgery until after they are done having children.
What if you gain weight after a tummy tuck?
Pregnancy has a pretty dramatic effect on the abdomen because babies simply take up a lot of space. In contrast, gaining weight doesn’t usually result in the same amount of stretch. But it can still affect your results, especially if you tend to gain weight in your midsection.
Removing excess skin does not prevent fat from accumulating in the skin that remains, and if you accumulate intra-abdominal fat, it will stretch out the rectus muscles, creating a new diastasis. Even if you lose all the weight you gained, your skin and abdominal muscles may not completely recover.
How long after having a baby can you have a tummy tuck?
As I mentioned above, you should wait to have tummy tuck surgery until after you are done having kids. But how long do you have to wait after your last pregnancy? It takes your body about six months to recover after pregnancy. (Are you noticing a theme here with the six month timeline?) Although you will likely feel fully recovered long before this, your skin and abdominal muscles are still shrinking up.
Six months is actually the minimum timeline, assuming you quickly lose all the pregnancy weight. In reality it may take a year or more to lose all the weight you gained during pregnancy. I recommend being at a stable weight for a full six months before having surgery — that loose skin will still be shrinking up if you are in the process of losing weight. The ultimate result, (how much your skin shrinks up) depends on your age, skin quality, and how much weight you gained in the first place.
What if you never lose the excess weight?
Simply being overweight doesn’t mean you can’t have a tummy tuck. But for the best results, I do recommend you be at a weight you plan to maintain. If you have a tummy tuck and then lose a lot of weight, you’re going to have loose skin afterward. You should also be within range of your ideal body weight, with a BMI of around 30 or less. This is because if you are significantly overweight, you likely have excess intra-abdominal fat, which means you won’t get a great result after tummy tuck surgery.
If you’ve made it this far, you’ve learned quite a bit about tummy tuck surgery. You’ve learned that tummy tuck surgery (aka abdominoplasty) is great for removing loose skin and correcting a rectus diastasis (stretched abdominal muscles). If you have excess fat, however, you may need to lose weight naturally or have liposuction first to get an optimal result.
Tummy tuck surgery is cosmetic, and does not affect fertility. So it’s absolutely possible to get pregnant after a tummy tuck. But pregnancy will stretch the abdominal muscles and skin, affecting your results. For this reason, I recommend waiting until after you are done having children to have tummy tuck surgery done.
If you just had a baby, I recommend losing the baby weight and then waiting another six months prior to having surgery. If you’ve just lost a lot of weight that same six-month rule still applies. This is because your skin and abdominal muscles take time to shrink up after pregnancy and weight loss, and your result will be better if you let that process happen prior to surgery.
If you would like to see what results you can expect from a tummy tuck, check out these before and after photos. And if you’re in the Cleveland area and ready to take the next step, you can reach us at (440) 974-8577 to schedule a consultation.