Abdominoplasty: 5 facts about the procedure

Although abdominoplasty is often associated solely with removing excess skin from the abdomen, the procedure has a broader purpose. As techniques have advanced, surgery has become an important tool for restoring body contours, particularly after pregnancy, major weight fluctuations or significant weight loss.

According to Dr Flávia Bonato, a plastic surgeon and member of the Brazilian Society of Plastic Surgery (SBCP), the International Society of Aesthetic Plastic Surgery (ISAPS) and the Brazilian Association of Aesthetic Plastic Surgery (BAPS), modern abdominoplasty assesses the entire abdominal region and can address concerns beyond surplus skin.

“Many patients come to the clinic believing that excess skin is the only issue. In reality, there is often a combination of factors, such as separation of the abdominal muscles, changes to the waistline, laxity in the deeper tissues and excess localised fat. Treatment must take all these structures into account for the result to look harmonious,” she explains.

Here are five facts that can help you understand the procedure more clearly.

1. Abdominoplasty can correct separation of the abdominal muscles

One of the most common changes after pregnancy or substantial weight variation is abdominal diastasis, a condition in which the rectus abdominis muscles separate. This can leave the stomach protruding even in people with a low body-fat percentage or those who exercise regularly.

“During abdominoplasty, the surgeon may perform muscle plication, a technique that repositions these muscles and helps restore firmness to the abdominal wall. Correcting diastasis usually offers not only aesthetic benefits but functional ones as well. Many patients report improved core stability and body awareness after surgery,” says Dr Flávia Bonato.

2. The aim is not always weight loss

Despite often being linked to losing weight, abdominoplasty is not a weight-loss procedure. “In practice, the operation is intended to remove excess tissue and improve body contour in patients who are already close to their target weight. It is actually more common after weight loss,” the doctor states.

According to the plastic surgeon, this is increasingly common among people who have lost a substantial amount of weight, including through weight-loss medication, and are left with excess skin and abdominal laxity.

Dr Flávia Bonato emphasises that surgery should not be considered an alternative to healthy habits, such as a balanced diet and exercise. Results from the technique are generally more satisfactory when the patient’s weight is already stable and they want to address changes that lifestyle adjustments have not resolved.

3. Abdominoplasty is often combined with liposuction

A frequent question is whether the surgery removes fat. “Although small amounts can be removed along with the excess skin, body reshaping is generally enhanced when it is combined with liposuction,” says Dr Flávia Bonato.

This combination makes it possible to address both tissue laxity and deposits of localised fat at the same time. “The advantage of combining abdominoplasty with liposculpture is better treatment of the body contour, defining the waist more clearly and creating a more attractive silhouette,” highlights Dr Marcelo Rudy, a plastic surgeon and member of the Brazilian Society of Plastic Surgery.

Abdominoplasty may also be combined with other procedures. “Today, we can combine abdominoplasty, for example, with technologies from the IgniteRF platform, such as Quantum and Morpheus, with ultrasound liposculpture and with direct intramuscular fat injection,” the doctor says.

Dr Flávia Bonato points out that surgical planning considers the body as a whole, taking the balance between different structures into account. “Simply removing skin is not enough. We need to assess proportions, contours and volumes to achieve a natural, balanced result.”

4. The navel is usually repositioned

One aspect of the operation that often surprises patients is the treatment of the navel. The plastic surgeon explains that, in traditional abdominoplasty, the abdominal skin is pulled down after the excess has been removed. As a result, the navel must be brought out again in a new anatomical position.

“This is why the final appearance of the navel is an important stage of surgical planning. The navel is one of the details that draws the most attention in the final result. There are now techniques designed to create a discreet, natural appearance that is proportionate to the abdomen,” explains Dr Flávia Bonato.

5. Not every patient needs a full abdominoplasty

Although the traditional version is the best known, there are different forms of the procedure, including mini-abdominoplasty. “Mini-abdominoplasty is suitable for concerns below the navel. The choice between it and conventional surgery depends on how much skin needs to be removed, whether the patient has diastasis and, most importantly, whether the patient has concerns above the navel,” says Dr Marcelo Rudy.

According to Dr Flávia Bonato, tailoring treatment to the individual is one of the foundations of modern plastic surgery. “The largest operation is not always the best operation. Successful treatment depends on identifying each patient’s exact needs. In some cases, smaller procedures provide excellent results precisely because they respect the anatomical characteristics of that particular case,” she states.

Important care before and after surgery

Despite technical advances, abdominoplasty should always be recommended only after a detailed medical assessment. Dr Flávia Bonato also explains that medical history, the presence of diastasis, skin quality, body weight, lifestyle habits and the patient’s expectations all directly influence surgical planning.

“Another important consideration is the patient’s nutritional status before and after surgery. Adequate protein intake deserves particular attention, as these nutrients provide the amino acids needed for collagen synthesis, tissue repair and healing,” says the doctor.

For this reason, medical follow-up is essential. “Patients who have undergone major weight-loss journeys, including those who have used weight-loss medication, may have insufficient protein intake or loss of muscle mass, which must be identified and corrected before the procedure. After the procedure, protein supplementation may be recommended, depending on the patient,” she explains.

Surgery is only one part of treatment. According to Dr Flávia Bonato, recovery also relies on the body’s ability to promote healing. Nutritional adjustments and, where needed, support from a nutritionist may therefore be recommended to optimise protein intake and aid post-operative recovery.

“Modern plastic surgery seeks naturalness and proportion. The aim is not to transform the body completely, but to restore structures that have been altered by time, pregnancy or weight loss, returning comfort and harmony to the patient,” she concludes.

By Maria Paula Amoroso