Abdominoplasty

What is an abdominoplasty?

An abdominoplasty removes loose, excess skin from the abdomen and tightens the abdominal wall. Where the vertical abdominal muscles have separated — a condition called rectus diastasis — they are repaired and brought back together with internal sutures.

Pregnancy and significant weight gain stretch both the skin and the connective tissue between the abdominal muscles. Skin that has lost its elasticity will not retract, and separated muscles may not rejoin with exercise and/or physiotherapy. This is why physiotherapy often fails to resolve a persistent lower abdominal bulge.

Patients commonly consider abdominoplasty for:

• Loose or hanging skin across the abdomen
• Muscle separation following pregnancy, causing a persistent bulge or weakened core
• Excess skin remaining after major weight loss
• Stretch marks on skin below the navel, which might be removed along with that skin
• Skin irritation or rashes in the fold beneath an overhanging apron of skin
• Weakened abdominal wall contributing to lower back discomfort

Am I a suitable candidate?

Suitability is determined during a consultation following examination. Generally, candidates are:

• At a stable weight, and have been for several months
• Finished having children — future pregnancy can undo a muscle repair
• Physically healthy, with well-controlled medical conditions
• Non-smokers, or willing to stop well before and after surgery — smoking substantially increases the risk of wound breakdown and tissue loss in this procedure in particular
• Realistic about the scar, which is long, permanent and unavoidable
• Able to accommodate a recovery period of several weeks with restricted activity and lifting

Patients who have had significant weight loss, including after bariatric surgery, should be nutritionally stable with adequate protein and iron levels before surgery, as this affects wound healing.

Referral requirement. All patients require a referral from a GP or another specialist before their first consultation. If it is deemed that your surgery is cosmetic in nature and you do not qualify for a Medicare (MBS) item number, a referral is still required, in line with Australian requirements introduced in July 2023. Where surgery is for a functional or medical indication, a different pathway may apply — this is clarified during your consultation.

Psychological screening and cooling-off. Where surgery is cosmetic, Dr. Anavekar screens all patients for body dysmorphic disorder (BDD) as part of the assessment. A second consultation is required before any decision to proceed, and a minimum seven-day cooling-off period applies after that second consultation and before surgery can be booked, as required under AHPRA guidelines.

Abdominoplasty techniques

Full abdominoplasty

The most common technique. A horizontal incision is made low across the abdomen, generally within the bikini line, from hip to hip. Skin is lifted, separated muscles are repaired, excess skin and fat are removed, and a new opening is created for the navel to retain its position on the abdomen. Suited to patients with loose skin both above and below the navel.

Mini abdominoplasty

A shorter incision addressing only skin below the navel. The navel is not repositioned, and muscle repair is limited to the lower abdomen. Suited to a narrow group of patients whose looseness is confined below the navel.

Extended abdominoplasty and fleur-de-lis

Where excess skin extends around the flanks, the incision is extended towards the back. A fleur-de-lis technique adds a vertical incision, removing a vertical wedge of skin to address horizontal excess as well. These are typically used after major weight loss, and produce more extensive scarring in exchange for a substantially better contour.

Muscle repair (rectus diastasis repair)

Where the abdominal muscles have separated, they are drawn back to the midline and secured with internal sutures. This flattens the abdominal profile and restores abdominal wall integrity. Muscle repair is a significant contributor to post-operative discomfort — it is what makes the first week demanding.

Combined with liposuction

Liposuction is often used alongside abdominoplasty to refine the flanks and improve the overall contour. Suitability depends on your tissue and the extent of skin removal.

What is involved

Before surgery

Before surgery, you’ll have more than one consultation, where photographs and measurements are taken, and the proposed incision is drawn and explained so you have a clear picture of where the scar will sit and how low it can be placed. Where a Medicare rebate may apply, some form of imaging confirmation of muscle separation may be required, along with documentation of any prior physiotherapy.

You must cease smoking, and cease medications and supplements that increase bleeding risk. Because this surgery carries a meaningful risk of blood clots, your individual risk is assessed and preventive measures planned.

On the day

Surgery is usually performed under general anaesthetic administered by a specialist anaesthetist, in an accredited private hospital. The length of your operation depends on your anatomy, the technique used, whether muscle repair is performed, and whether liposuction is combined. Most patients stay one to three nights.

Excess skin and fat are removed, muscles repaired where indicated, drains often placed, and the incision closed in layers. A compression garment is applied.

After surgery

You will be encouraged to mobilise early to reduce clot risk, though you will initially walk slightly bent forward. Pain relief is prescribed. Drains, where used, are removed once output falls. You will need help at home — this is not a procedure to recover from unassisted, particularly with young children.

Your recovery

Recovery from abdominoplasty is longer and more demanding than most patients expect. The following is a general guide only.

Compression garments are typically worn for six to eight weeks. Numbness across the lower abdomen is normal early on and may take a year or more to resolve — in some patients a degree of altered sensation is permanent.

Potential benefits

Abdominoplasty may:

• Remove loose, excess or hanging abdominal skin
• Repair separated abdominal muscles and improve core strength
• Flatten the abdominal profile
• Remove stretch marks located on the skin that is excised
• Resolve skin irritation and rashes beneath an overhanging skin fold
• Improve fit and comfort in clothing
• Improve confidence in physical activity

Outcomes vary between individuals and cannot be guaranteed. Results depend on your anatomy, skin quality, healing and the agreed surgical plan. Future pregnancy or significant weight change can alter the result.

Costs and Medicare

The total cost includes the surgeon's fee, the anaesthetist's fee, hospital fees, garments and follow-up care.

Abdominoplasty performed purely for appearance does not attract a Medicare rebate. However, a Medicare item number may apply in specific circumstances — most commonly for repair of significant rectus diastasis following pregnancy (MBS item 30175), where defined clinical criteria are met. These criteria typically relate to the degree of muscle separation, documented symptoms, the time elapsed since pregnancy, and evidence that physiotherapy has been attempted without adequate resolution.

A separate item number (MBS item 30166 or 30177) may apply where a substantial overhanging apron of skin is causing recurrent skin infection or ulceration, generally following major weight loss.

Where an item number applies, private health insurance may contribute to hospital costs, subject to your level of cover and waiting periods.

Eligibility is assessed individually and cannot be confirmed before consultation. We encourage you to check with your private health fund and Medicare about your eligibility for relevant rebates ahead of your appointment, as this can give you a clearer picture of your likely out-of-pocket cost. Bring any imaging reports measuring muscle separation, and records of physiotherapy or treatment for skin problems, as these support the assessment.

You will receive a written quote setting out all costs and any expected rebates before committing to surgery. For questions about fees or health fund cover, contact the practice on 03 9075 0005.

Why Evolve

Dr. Namrata Anavekar is a Fellow of the Royal Australasian College of Surgeons and a specialist plastic and reconstructive surgeon. She graduated with honours from Monash University and completed the Australian Plastic Surgery Training Program, with rotations through St Vincent's Hospital, The Royal Children's Hospital, The Alfred and The Austin, followed by an international fellowship in Switzerland and France.

Dr. Anavekar is a board member of the Australasian Society of Aesthetic Plastic Surgeons (ASAPS) and has authored multiple research publications. She holds several public and private hospital appointments, and is a professional member of ASAPS, the Australian Society of Plastic Surgeons (ASPS), the Royal Australasian College of Surgeons (RACS), the Australian Medical Association (AMA), and the International Society of Aesthetic Plastic Surgery (ISAPS).

She consults from Bulleen and Sunbury, Melbourne.

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