Abdominoplasty &
Abdominal Wall
Reconstruction

Restoring function. Improving form.

Abdominoplasty is often thought of as a cosmetic operation. In my practice, it is used primarily as part of abdominal wall reconstruction to restore strength, support and function while removing redundant skin and improving abdominal contour.

I am not a plastic surgeon. My focus is the abdominal wall itself: its muscles, fascia, hernias, separation and function.

When can abdominoplasty be useful?

Pregnancy, major weight loss and previous abdominal surgery can leave a combination of problems affecting both appearance and function.

  • Rectus divarication or muscle separation
  • Ventral or incisional hernia
  • Laxity of the abdominal wall
  • Redundant lower abdominal skin
  • Distortion around previous scars
  • Functional weakness or reduced core support
  • Skin irritation in redundant folds

The abdominal wall comes first

Rectus divarication repair The widened midline is reconstructed with fascial plication. In selected patients, additional mesh reinforcement may be used.
Ventral or incisional hernia repair The hernia is repaired using the technique most appropriate to its size, anatomy and surrounding abdominal wall.
Mesh reinforcement Permanent or long-term resorbable mesh may be used where additional reinforcement is appropriate. Mesh choice is individualised.
Skin & soft tissue reconstruction Once the deeper abdominal wall has been reconstructed, excess skin and soft tissue can be removed to improve both function and contour.
Surgical Options

Two approaches

Mini abdominoplasty

Preserves the native umbilicus

  • An ellipse of excess skin immediately below the umbilicus is excised.
  • The native umbilicus is preserved.
  • The deeper abdominal wall is repaired or reinforced as required.
  • The umbilical cicatrix is reattached at the completion of the reconstruction.
May suit:
Patients whose skin excess is predominantly below the umbilicus, with a relatively normal upper abdomen, including selected patients with rectus divarication or a small associated hernia.
Full abdominoplasty

Creates a neo-umbilicus

  • A larger ellipse of abdominal skin and soft tissue is excised, extending from the region of a Pfannenstiel incision to just above the umbilicus.
  • The native umbilicus is excised.
  • The abdominal wall is reconstructed as required.
  • A new umbilicus, or neo-umbilicus, is created at the appropriate position during closure.
May suit:
Patients with more extensive skin redundancy or abdominal wall laxity, including significant rectus divarication, larger hernias or more complex abdominal wall reconstruction.

Function before cosmetics.

My aim is not to perform a cosmetic tummy tuck with a hernia repair added to it. The operation is planned as an abdominal wall reconstruction, with the abdominoplasty used to help achieve the strongest and most functional repair while also improving abdominal contour.

What might improve?

  • Abdominal wall support and core stability
  • Central abdominal bulging
  • Discomfort related to hernia or divarication
  • Ability to exercise and remain active
  • Skin irritation from redundant folds
  • Abdominal contour and clothing fit

Who may be suitable?

  • Significant rectus divarication
  • Ventral or incisional hernia
  • Changes after pregnancy
  • Changes after significant weight loss
  • Persistent abdominal bulging
  • Previous abdominal surgery

A stable, healthy weight is generally preferable. Prehabilitation, nutrition and strength training may be important, and weight-loss therapy may form part of the plan where appropriate.

Recovery

  • Walking is encouraged early
  • Avoid heavy lifting and strenuous abdominal exercise for approximately 6 weeks
  • Temporary swelling, bruising, numbness and altered sensation are common
  • Drains and a binder or compression garment may be used

Recovery is longer than for an isolated hernia repair and varies according to the extent of reconstruction.

Risks & limitations

  • Bleeding, infection and seroma
  • Delayed wound healing or skin-edge problems
  • Altered sensation, scarring or asymmetry
  • Venous thrombosis
  • Hernia or divarication recurrence
  • Possible need for further surgery
I am a general surgeon with a particular interest in abdominal wall reconstruction, not a specialist plastic surgeon. My priority is a safe, durable and functional reconstruction. Cosmetic contour is important, but a particular cosmetic result cannot be guaranteed.

Book an abdominal wall assessment

Assessment looks at the abdominal wall as a whole: hernia, rectus muscles, fascia, scars, skin and soft tissue, weight, fitness and your goals.

The aim is to choose the smallest operation that reliably addresses the underlying problem while considering both function and form.

Book an assessment