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"  A tummy tuck? Are you crazy?&amp;quot; That&amp;#039;s how I would have responded five years ago if anyone had asked for my personal take on belly-flattening plastic surgery. As a longtime marathoner and triathlete, I&amp;#039;ve always taken pride in competing and keeping my body lean in the process. Resorting to non-natural means to fit into skinny jeans? Not me. But after giving birth to my second child in 2009 (a 10-pound baby boy), I was left with separated abdominal muscles, a common post-pregnancy problem called diastasis recti. As a result, my belly bowed out, making me look five months pregnant even after I&amp;#039;d lost all the weight I&amp;#039;d gained. &amp;quot;Is there anything I can do?&amp;quot; I asked my ob/gyn at my six-month postbaby checkup, pointing to my Buddha belly in despondence. &amp;quot;Nope,&amp;quot; he said jovially. &amp;quot;If it bothers you, just don&amp;#039;t look in the mirror.&amp;quot; Wow, thanks, doc.  No way was I going to shroud my mirrors in mourning for my previously flat stomach. Instead I took to the Internet to research my options. What I found: An enormous number of moms like me are turning to plastic surgery. The number of tummy tucks done in this country has climbed 88.7 percent since 2000, to 110,323 in 2009. Almost half (44 percent) of these procedures are done in women in their 20s and 30s, a sharp shift from a decade ago. &amp;quot;Ten years ago, we were doing these procedures on postmenopausal women,&amp;quot; says Phil Haeck, M.D., a Seattle plastic surgeon and president of the American Society of Plastic Surgeons (ASPS). &amp;quot;Now, the average woman having a tummy tuck in my practice is a young mom under the age of 35 with two small children. She feels that she gave up a lot with changes in her body during and post-pregnancy, and she doesn&amp;#039;t want to wait years to reestablish how she used to look. She wants her prebaby body back now.&amp;quot;  The belly pooch has been a fact of motherhood for eons, so why does it suddenly feel like something we can&amp;#039;t live with? Is surgery the only real solution? And what does it really involve? To answer these questions, I dug in and interviewed plastic surgeons, psychologists, fitness experts, and women who have been through the procedure. Here&amp;#039;s what any woman considering a tuck \u2014 and that includes me \u2014 should know before she goes under the knife.  EXACTLY WHAT A TUMMY TUCK INVOLVES A patient will &amp;quot;have more discomfort than with many other cosmetic-surgery procedures,&amp;quot; says Rod Rohrich, M.D., chair of the department of plastic surgery at the University of Texas Southwest Medical Center in Dallas. &amp;quot;With many other procedures, you&amp;#039;re back on your feet within a day or two, but with a tummy tuck, it will be about 10 to 14 days before you can do regular activities.&amp;quot; There are a few variations on the procedure, depending on whether or not your stomach muscles have separated (and how severely) and the volume of extra fat and loose skin you have. During the most common procedure \u2014 the traditional tummy tuck \u2014 a horizontal cut is made between the pubic bone and the navel that can range from a few inches to the entire length of the abdomen. Next, the skin is pulled back, fat is removed, and ab muscles are repaired. The skin flap is then stretched down and taut (think pulling taffy), a new hole is made for your belly button, and excess skin is cut away. (See &amp;quot;What the Surgery Looks Like&amp;quot; at right.) Other variations include the &amp;quot;mini&amp;quot; tuck, which focuses on the pooch below the belly button and doesn&amp;#039;t require as much skin or fat removal, and a lipoabdominoplasty, in which the same incisions as a traditional tummy tuck are made, but lipo is used to remove and contour fat. With all of these methods, the skin is purposely overtightened afterward, causing patients to walk bent over for the first several days until it loosens up. &amp;quot;My head was actually looking at the carpet \u2014 it was almost at a right angle to my legs,&amp;quot; recalls Sarah*, 34, a stay-at-home mom who had a tummy tuck last winter. &amp;quot;I had to sleep sitting up because I literally couldn&amp;#039;t lie down.&amp;quot;  After surgery, a thin tube may be placed under the skin in the groin area to drain any excess blood or fluid that may collect in the abdomen for the first week. &amp;quot;The drains were pretty gross,&amp;quot; confesses Mike, 41, whose wife had a tummy tuck five years ago. &amp;quot;They&amp;#039;re filled with a mixture of blood and fluid, and guess who has to empty it each day since his wife can barely get out of bed?&amp;quot;  No matter which type of tuck you get, the pain will be intense. &amp;quot;I was definitely surprised at how painful it was, even though my doctor had warned me,&amp;quot; Sarah says. &amp;quot;I knew I had to get up and out of bed to avoid a blood clot, but it was tough. I had a breast augmentation at the same time, and I couldn&amp;#039;t care for my young kids for three weeks. My husband had to do everything. Despite all of this, though, it was worth it.&amp;quot;  Because most women are on hefty doses of pain meds postsurgery, they aren&amp;#039;t able to drive for a week to 10 days \u2014 although if they have a relatively sedentary job, they can go back to work after two or three weeks. While most of the swelling is gone within a month, it can take up to six months for it to disappear completely and up to a year for full sensation to return in your stomach. &amp;quot;At four or five weeks, I was still pretty swollen by the end of the day,&amp;quot; says Beth Allums, 36, a single mom and teacher in Richmond, VA. &amp;quot;People had told me that the first few months are swell hell, but psychologically it&amp;#039;s shocking to see.&amp;quot; For Kelly Burke, 36, a stay-at-home mom from San Clemente, CA, the numbness was the strangest part. &amp;quot;I just started getting sensation back in my stomach a couple weeks ago,&amp;quot; says Kelly, who had a tummy tuck last October. &amp;quot;I was really itchy around my incision area, so I&amp;#039;d scratch, but I wouldn&amp;#039;t be able to feel myself doing it.&amp;quot; COSTS AND RISKS The average tummy tuck will run you $5,000, though some of the women I spoke to spent upward of $8,000. And there are unavoidable risks, like infections or necrosis \u2014 a complication in which skin does not get enough blood, so it turns black and dies. Beth Allums is one of the approximately 5 percent of tummy-tuck patients who develop a necrosis. &amp;quot;My doctor is keeping a close eye on it, and in a couple months I&amp;#039;ll have to have another surgery for him to go in and cut out the dead tissue,&amp;quot; she says. &amp;quot;It&amp;#039;s this small little black spot on my lower abdomen. Yeah, I don&amp;#039;t love looking at it, but I know it will get corrected eventually.&amp;quot; Other risks include cosmetic imperfections such as oddly shaped or fake-looking belly buttons or &amp;quot;dog flaps&amp;quot; \u2014 little areas of excess skin that droop over the hip bone. Revision abdominoplasty to fix things like these may need to be done for 5 percent of patients, according to one study.  The most serious risk of the surgery, however, is blood clots, which some studies show can happen in as many as 5 percent of cases. &amp;quot;You&amp;#039;re more at risk to get a blood clot with a tummy tuck than with other types of cosmetic surgery because you spend much more time lying down recuperating, so blood can pool in your veins and pelvis,&amp;quot; Seattle surgeon Phil Haeck explains. Those who smoke or have a previous history of clots have an increased risk of incurring one after a tummy tuck. Amanda Blaine, 26, of Edmonton, Alberta, had a history of clots and was warned of the risks by her doctor, but decided to go ahead with a tummy tuck anyway. She had been very overweight for years and, after losing 140 pounds, was left with 2.2 pounds of excess skin on her belly. &amp;quot;I could hold it together and squish it like a big doughnut, and I had a giant belly button that didn&amp;#039;t look normal or natural,&amp;quot; Amanda says. The surgery went smoothly, but sure enough, about three weeks after, she started having back and shoulder pain and difficulty breathing. Amanda headed to the emergency room, where a new clot was discovered. She received IV injections of blood thinners and was released the next day, but will need to stay on blood-thinning medication for at least the next six months. Still, she doesn&amp;#039;t regret her decision to have the surgery. &amp;quot;I would do it again in a heartbeat,&amp;quot; she says. &amp;quot;Just to look down and see a normal-looking belly button and a flat stomach is so worth it.&amp;quot; Amanda was lucky: Blood clots are deadly about 30 percent of the time.  A FINAL REALITY CHECK Plastic surgeons stress that a tummy tuck won&amp;#039;t cure all of a woman&amp;#039;s belly woes. &amp;quot;I&amp;#039;m up front with all my patients: I tell them this surgery won&amp;#039;t give them back the stomach they had at age 18,&amp;quot; says Robert Grant, M.D., plastic surgeon-in-chief at New York-Presbyterian Hospital. &amp;quot;They&amp;#039;ll still have a scar, which usually goes from their hip bone at the top of the pubic area to the other hip bone. We can make it low enough that a woman can hide it with a pair of bikini bottoms, but it&amp;#039;s still there.&amp;quot; A tummy tuck also won&amp;#039;t get rid of stretch marks. Perhaps most important, women must get to within 10 pounds of their ideal weight before surgery and stick to a healthy lifestyle afterward, as weight loss or gain can worsen stretch marks and increase the amount of excess skin on your abdomen, or cause abdominal muscles to separate again. &amp;quot;I tell my patients it&amp;#039;s the 50 percent rule: We do 50 percent of the work, and the other half comes from patients keeping their weight down through diet and exercise,&amp;quot; Rohrich says.  As for me, well, I&amp;#039;m pregnant again, and at my last doctor&amp;#039;s appointment, my ob/gyn informed me that not only do I have separated ab muscles but I also have a hernia, which will definitely require surgery to repair. If I have to have an operation after giving birth anyway, it&amp;#039;s tempting to have an abdominoplasty at the same time. My husband tells me that he loves me no matter what my belly looks like. He says he thinks I&amp;#039;m beautiful, but he&amp;#039;ll support me whatever I choose to do. And given all I&amp;#039;ve learned, the mommy-tuck decision is not one I&amp;#039;ll make lightly.   WHAT&amp;#039;S BEHIND THE &amp;quot;MOMMY TUCK&amp;quot; CRAZE? Psychologists say we can partly blame a celebrity-obsessed culture that&amp;#039;s given us a distorted view of what post-pregnancy bodies should look like for the uptick in tummy tucks. &amp;quot;Women see stars give birth and a few weeks later appear on People showing off their bodies,&amp;quot; says Sheenah Hankin, Ph.D., a New York City psychologist. But the celebrities themselves don&amp;#039;t always look that way in real life. Kourtney Kardashian, for example, said that a tabloid airbrushed her postbaby body.  We might also chalk up some of the surge to being a society that is used to the instant gratification we get at the click of a computer mouse. &amp;quot;It&amp;#039;s conditioned us to expect everything to happen fast,&amp;quot; says Helen Coons, Ph.D., a clinical psychologist in Philadelphia. &amp;quot;So women are often impatient with the time it takes to return to their pre-pregnancy shape, even though it&amp;#039;s normal.&amp;quot; That said, some women can never naturally get their shape back, no matter how many years they spend on the treadmill or doing crunches. Excessive weight gain or pregnancy with multiples can leave behind extra skin that won&amp;#039;t respond to diet or exercise. And these days, more women fall into that boat: The percentage of women who gained more than 40 pounds for a singleton pregnancy rose 29 percent between 1990 and 2005, to a total of 20 percent, according to the National Center for Health Statistics. The twin birth rate has also increased by 42 percent since 1990. Kelly Burke says she started thinking about a tummy tuck the moment she learned she was having twins. &amp;quot;I gained 75 pounds during my pregnancy, and after I got back to my normal weight, I had so much extra skin I could literally pick it up,&amp;quot; she says. &amp;quot;It reminded me of a Shar-Pei dog.&amp;quot; Kelly got what some doctors have dubbed &amp;quot;the mommy makeover&amp;quot; \u2014 a tummy tuck plus breast implants \u2014 last October. (See the before and after, at left.)  Another possible reason for the trend? &amp;quot;The stigma associated with this procedure has mostly vanished,&amp;quot; says Angelo Cuzalina, M.D., president of the American Academy of Cosmetic Surgery. &amp;quot;Moms exchange plastic surgeon phone numbers like they would their ob/gyn or pediatrician.&amp;quot; Emily McBee, 37, heard about tummy tucks from other moms at her son&amp;#039;s Cub Scout events. &amp;quot;No one hid it \u2014 all the women I talked to were very open,&amp;quot; Emily recalls. &amp;quot;It didn&amp;#039;t seem tacky or stripper-esque. They were just moms like me.&amp;quot; Psychologists are torn about what this trend means for women. Some question why moms feel the need to re-create their prebaby bodies at all. &amp;quot;Women need to be clear about what is motivating them,&amp;quot; Coons says. &amp;quot;If she had a poor body image before her pregnancy or is struggling with depression or in her marriage, then the surgery is just a Band-Aid; it won&amp;#039;t resolve her issues long-term. Also, women now tend to forget that shape changes are natural as we age.&amp;quot; Adds Joan Chrisler, Ph.D., a professor of psychology at Connecticut College: &amp;quot;Research has consistently shown that men have a much kinder and more positive view of their wives&amp;#039; bodies than the women do themselves. So give yourself a break!&amp;quot; (It&amp;#039;s true: The men REDBOOK spoke to said they were fine with their wives&amp;#039; bodies before they had surgery. &amp;quot;Her stomach didn&amp;#039;t bother me, but the fact that it bothered her did,&amp;quot; says Mike, whose wife had a tuck five years ago.)  Still, other psychologists believe that if done for the right reasons, plastic surgery can be emotionally healthy. &amp;quot;If a woman is simply unhappy with how her stomach looks, the research shows it may help her have a more positive body image,&amp;quot; says Jean Fain, M.S.W., a Harvard psychotherapist who specializes in body image. Even Coons agrees that a woman who is otherwise content, takes care of herself physically, and has the support in place \u2014 financial, social, and emotional \u2014 to help her through the recovery process may be a good candidate. &amp;quot;She just has to realize that no surgical result is permanent. Gravity and age will catch up with her body eventually.&amp;quot;  WHAT THE SURGERY LOOKS LIKE (see diagram above) 1. Cuts are made at the bikini line, around the navel, and down the middle of the lower abdomen.  2. Flaps of skin are pulled back so that fat can be removed and to expose abdominal muscles.  3. The ab muscles are stitched together to repair any separation between the two main strips of muscle.  4. The skin is pulled back down and stretched very taut. Excess skin is cut away.  5. Incisions are stitched closed, and tubes are placed under the skin in the groin to drain blood and fluid. 3 STEPS TO TAKE BEFORE SURGERY If you&amp;#039;re considering having a tummy tuck, use this checklist to make sure your procedure is done safely. 1. Ask yourself if you&amp;#039;re a good candidate for surgery.  Abdominoplasty isn&amp;#039;t recommended for women who may get pregnant again or who are more than 10 pounds over their ideal weight, as pregnancy or weight loss may result in more excess skin or stretch marks. Smokers shouldn&amp;#039;t have this surgery, due to increased risk of blood clots. If you have other risk factors, such as a history of blood clots, your doctor should weigh the pros and cons of treating you by using a risk assessment scale called the Caprini Risk Assessment Model.  2. Thoroughly research any doctors you&amp;#039;re considering. They should be board-certified by the American Society of Plastic Surgeons; go to plasticsurgery.org to check. You can also call your state medical board to see if any lawsuits have been brought against him or her.  3. Talk through all the risks and possible complications.  A surgeon should be up front with you about the risks, which include blood clots, scarring, numbness, and the death of skin or fat tissue (necrosis). If he isn&amp;#039;t, consider another doctor. Also ask to see before and after photos of previous patients. Your doctor should provide not only these, says surgeon Phil Haeck, M.D., but also the names of three to five patients you can speak with about their experience. Make those calls and ask about pain, recovery time, and scarring, not just happy results. Have questions about tummy tucks? Email your q&amp;#039;s or comments to plastic surgeon Drew Ordon, M.D., cohost of The Doctors, at askthedoctors@redbookmag.com. Then look for his answers at redbookmag.com/tummyqs.  DON&amp;#039;T TAKE THIS RISK In recent years, a growing number of women have flocked to countries such as Mexico and Brazil to get all types of plastic surgery on the cheap (it&amp;#039;s got a name: medical tourism). Surgeons in the United States frown on this trend in general, but they are particularly alarmed when it comes to tummy tucks performed abroad. &amp;quot;A woman&amp;#039;s risk of incurring a blood clot, which is already higher than with other cosmetic surgeries, is magnified even more by the long airplane ride home,&amp;quot; says plastic surgeon Robert Grant, M.D. &amp;quot;When you&amp;#039;re sedentary that long, blood pools in your leg veins and pelvis, increasing the chances of a clot that could turn into a life-threatening pulmonary embolism.&amp;quot; And should you incur a complication after arriving home, your prospects of getting the best medical attention are slim, says plastic surgeon Rod Rohrich, M.D. &amp;quot;When a problem happens with a surgery performed in the United States, you can call that doctor&amp;#039;s office and get seen immediately. When a medical-tourism patient has complications, they are often treated as a pariah \u2014 no plastic surgeon wants to be on the hook for fixing another doctor&amp;#039;s mistakes.&amp;quot; Bottom line: No savings is worth the risk of potentially life-threatening complications thousands of miles from home. YES, YOU CAN FLATTEN YOUR BELLY WITHOUT SURGERY! &amp;quot;Clients ask me all the time about tummy tucks,&amp;quot; says Kathy Kaehler, a trainer and food coach who has worked with famous moms like Julia Roberts and Cindy Crawford. &amp;quot;I ask them, &amp;#039;Is the scar and recovery worth it just to walk around in a bikini?&amp;#039; I have three kids, including twins I gained 80 pounds with. But I exercise most days, with a focus on ab work, and over time I&amp;#039;ve gotten a toned stomach. Is it what it was before? No. Do I wear Spanx to hold it in sometimes? Yes. But I feel good about it.&amp;quot; (See two of Kaehler&amp;#039;s favorite exercises at right.)  Even women with diastasis recti \u2014 a separation of the muscles down the front of the belly \u2014 can improve the look of their stomachs with certain ab moves, says Jill Boissonnault, Ph.D., a spokesperson for the American Physical Therapy Association. &amp;quot;During pregnancy, the connective tissue that holds those muscles together may stretch out \u2014 that tissue can&amp;#039;t be repaired by working out. But research shows that exercises that focus on pulling the muscles in, like some Pilates moves, can bring the muscles closer, flattening your stomach.&amp;quot; However, some common exercises, like crunches or regular sit-ups, could make diastasis worse. So if you have muscle damage, Boissonnault suggests using a fitness program specifically designed to correct it. (Take the quick diastasis test \u2014 and get safe moves to help fix it \u2014 at redbookmag.com/postbabyabs). You could also work with a physical therapist certified in women&amp;#039;s health concerns, she says. &amp;quot;It&amp;#039;s hard work, and some people&amp;#039;s muscles rebound better than others, but everyone can get a flatter-looking stomach.&amp;quot; "^^<http://www.w3.org/2001/XMLSchema#string>
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