What a 360 tummy tuck is

A standard abdominoplasty treats the front of the abdomen. Where the redundancy of skin continues around the flanks and across the lower back — which it usually does after large weight loss — correcting the front alone leaves the problem visible from every other angle.

What the 360 approach is

The incision is carried around the waistline rather than stopping at the flanks, so excess skin and fat are removed from the abdomen, the sides and the lower back in one operation. The waistline is addressed as a circumference rather than as a front.

Who it is for

• Skin laxity that extends around the waist rather than being confined to the front
• Fat deposits persisting on the flanks and back despite a settled weight
• Skin folds causing chafing, irritation or difficulty with hygiene
• A contour that is acceptable from the front and not from the side or behind

It is most often relevant after bariatric surgery or substantial weight loss, and after multiple pregnancies.

What it achieves

Relief from the chronic skin irritation that folds produce, and easier hygiene. Improved posture where the abdominal muscle has been repaired. Clothing that fits around the waist rather than at one point of it, and greater comfort exercising.

Against a standard abdominoplasty

The standard operation confines the incision to the lower abdomen and treats the front. The circumferential version extends around the waist and treats the back and flanks as well. It takes longer, and the recovery is correspondingly longer. Repair of separated rectus muscle may be included in either where it is present.

The operation

Under general anaesthesia. The patient is positioned prone first so the back and flanks can be addressed — skin excised and fat suctioned where indicated — then turned supine for the anterior part. Drains are placed to prevent fluid collecting, and a compression garment is applied at the end.

Suitability and preparation

It is not offered to current smokers, to patients whose diabetes is not controlled, or where there is significant unmanaged cardiovascular disease. Pre-operative assessment includes blood tests and, where the history warrants it, cardiological review. The extent of the operation makes that assessment more important here than for smaller procedures.

Recovery

Week one is restricted and needs help at home. Desk work is generally possible by about week three. Physically demanding activity waits at least six weeks. Swelling reduces over several months. Tightness and numbness around the scar are expected early and settle progressively.

Compression is worn continuously through the first weeks as instructed. Nicotine in any form is avoided entirely. Gentle walking is encouraged from the start to maintain circulation. Drain output is monitored where drains are in place, and the incisions are kept clean and dry.

The result over time

The scar fades over a long period and is sited to sit beneath underwear or swimwear. Some laxity returns with age, but the tissue removed does not come back, so the improvement is durable provided weight remains stable.