What Plastic Surgeons Are Actually Looking For During Your Tummy Tuck Consultation

When most people think about a tummy tuck consultation, they assume it’s all about “how much loose skin” they have. And to be fair, that’s usually the part you notice first — the skin laxity, the lower belly overhang, the changes that pregnancy or weight fluctuations create over time.

But the truth is, when I meet with a patient for a tummy tuck consultation, the skin is only a small part of my evaluation. It matters, of course, but it doesn’t tell the full story. To create a safe plan — and a beautiful, long-lasting result — I need to understand the entire landscape of your abdomen: the skin, the fat, the connective tissue, the underlying muscles, any prior surgeries, and any medical factors that might affect the way your body heals or our ability to perform the procedure safely.

A high-quality tummy tuck is not simply just a skin removal procedure. It is a procedure that treats your core as a whole-- including each layer of tissue from your rectus muscles to the outer, visible skin. And the consultation is the most important part of that process.

As a Seattle-based plastic surgeon who performs abdominoplasties weekly, here is what I am truly evaluating during your consultation — and why these factors matter far more than you may realize.

Understanding Your Skin: It’s Not Just the Amount — It’s the Location

Loose skin is often the first thing patients bring up during their consultation. Many people have spent months examining their abdomen in the mirror, pulling the skin tighter with their hands, wondering if they might be a candidate for a “mini tummy tuck” or if they need something more extensive. But what truly guides surgical planning is not the amount of loose skin — it’s the location of that skin and how far the laxity extends. While the amount of loose skin typically will determine the length of your scar, the location of the loose skin typically determines the type of tummy tuck we perform.

If the loose skin is confined mostly to the lower abdomen below the belly button, a mini tummy tuck can be an option, but it is far less common than people expect. A mini tummy tuck cannot address loose skin above the umbilicus, cannot reposition the belly button, and cannot repair muscle separation above the belly button. So if you have laxity both above and below the navel (which is the case for the majority of patients post-pregnancy), a full abdominoplasty is almost always the right choice.

When the laxity extends horizontally and vertically, or when there is circumferential skin excess after significant weight loss, you may benefit from a more extended approach, such as an extended abdominoplasty, a fleur de lis abdominoplasty (with a vertical incision), or even a full body lift. During your consultation, I evaluate all of this carefully: how your skin drapes, the quality of the dermis, the degree of stretch marks, and how the tissues move with different positions. Every one of these factors influences incision placement, the type of tummy tuck you’re best suited for, and the final contour we can achieve.

Identifying Hernias: Why This Matters for Both Aesthetics and Safety

You may be surprised to learn how many patients have small hernias without realizing it. Pregnancy, abdominal pressure changes, past surgeries, and genetics all contribute to weakened fascia that can allow internal abdominal tissue to protrude through the fascia.

During your consultation, I’m evaluating for hernias in several key areas: around the belly button (umbilical hernias are extremely common), above or below the umbilicus along the midline, and occasionally along previous incision sites.

If a hernia is present, it’s important for me to identify it so I can plan to either repair it during your tummy tuck if it is small, or plan for you to have it repaired by a general surgeon prior to your tummy tuck. If a careful evaluation is not performed and a hernia not identified before surgery, there is a risk of bowel injury and further complications during your tummy tuck.

In certain cases, where it is unclear what lies beneath the skin, imaging such as a CT scan may be ordered prior to surgery to better assess your anatomy and the appropriate course of action to ensure safe, comprehensive, and long-lasting result.

Evaluating Rectus Diastasis: The Hidden Change Most Moms Don’t Realize They Have

One of the most common phrases I hear during consultations is, “I work out, I eat well, but I still can’t get my stomach flat.” And in many cases, the reason is rectus diastasis — the separation of the abdominal muscles that happens during pregnancy.

Rectus diastasis simply means the connective tissue between your abdominal muscles has stretched, creating a gap. This gap makes it impossible to achieve a flat abdomen through exercise alone and in many women, no amount of planks or crunches can re-approximate the muscles without the help of surgical repair.

During a tummy tuck consultation, I’m assessing not just whether you have diastasis but how severe it is, where it is widest, and how far it extends vertically. A more significant separation may require more internal suturing (i.e more tim in the operating room) and may even require the addition of mesh for added support. Repairing this separation during surgery helps restore core stability, improves posture, and recreates a natural internal corset that contributes significantly to the final aesthetic contour. This is also one of the reasons a tummy tuck can be so transformative for postpartum patients — you’re not just seeing a cosmetic change; you’re experiencing a functional improvement.

Assessing Your Previous Scars: How Past Surgeries Shape Your Tummy Tuck Plan

Prior surgical scars are one of the most important factors in determining tummy tuck candidacy, and they’re something many patients don’t think much about before their consultation. However, scars can dramatically alter the blood supply to certain areas of the abdomen, which then influences incision placement, flap design, and overall risk.

C-section scars, for example, usually pose no issues and are typically removed with the tummy tuck to create a new, lower scar on the abdomen. Laparoscopic scars typically aren’t problematic, but depending on their location and depth, they can tether tissue and create minor irregularities that must be addressed during surgery. They also pose a risk for small hernias.

Vertical midline scars — such as those from prior abdominal surgery — require more careful evaluation. These scars can change the vascular patterns of the abdominal wall and occasionally mean a patient is not an ideal candidate for a standard tummy tuck. Larger scars from more traumatic, urgent surgical issues can also harbor hernias, which need careful evaluation. In more complex cases, preoperative imaging may be required to better assess the internal anatomy and the overall safety of performing a tummy tuck. My job during your consultation is to identify these variables, explain how they matter, and create a plan that protects your safety while optimizing your aesthetic result.

Understanding Your Fat Distribution: Why Liposuction Is Often Combined With a Tummy Tuck

A tummy tuck tightens skin and repairs the abdominal wall, but it does not remove fat outside of the tissue that’s directly excised. For many patients, the most natural and flattering results come from combining liposuction with a tummy tuck. This approach allows me to sculpt the waistline, address the flanks, smooth the upper abdomen, and contour the silhouette in a way that skin tightening alone cannot achieve.

During your consultation, I look not only at where fat is deposited but how it’s distributed. Some patients carry more centrally; others carry on the flanks or lower back. Some need only minor contouring; others benefit from a more comprehensive 360-degree approach. These decisions shape everything from surgical time to recovery expectations.

A tummy tuck can create a flat abdomen — but liposuction helps create a beautiful shape. Understanding the balance of both is essential for achieving the results most patients envision.

How All of These Factors Come Together to Create Your Surgical Plan

A tummy tuck is a highly individualized procedure. There is no “standard” version, no universal template, and no one-size-fits-all approach. Your surgical plan emerges from a detailed understanding of your anatomy, your goals, your medical history, and your safety profile.

This is why your consultation with me is thorough. I’m evaluating all the layers of your tissue, how your skin elasticity affects incision design and tummy tuck type, and how your medical and surgical background influences your risk profile. I’m analyzing the relationship between your abdominal wall, your fat distribution, and your skin quality. All of this helps me create a plan that is not only safe but elegant — one that enhances your natural shape, strengthens your core, and removes your areas of concern with a long-lasting, stable result.

Why Choosing the Right Surgeon Matters

Every surgeon approaches tummy tucks differently. Some take a more uniform approach; others specialize in complex cases or postoperative reconstruction. My philosophy is rooted in anatomy, safety, and aesthetics. I want you to understand every step of the process: what I’m looking for, why it matters, and how it shapes the result you can expect.

A high-quality tummy tuck does more than remove skin. It restores your abdominal architecture. It reinforces your core. It improves comfort and posture. And yes — it dramatically changes the way clothing fits and the way you move through the world.

Your body tells a story during your consultation. My job is to listen to that story, understand it fully, and translate it into a surgical plan that aligns with your goals and protects your long-term wellbeing.

Considering a Tummy Tuck in Seattle?

If you’re thinking about a tummy tuck, a personalized consultation is the best place to begin. It’s where we discuss your concerns, evaluate your anatomy, explore your options, and determine whether a tummy tuck and/or which type is the right approach for you.

I’d love to guide you through that process, answer your questions, and help you understand exactly what’s possible for your body.

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Dr. Megan Dreveskracht is a Seattle-based Female Plastic Surgeon who specializes in Aesthetic Surgeries of the Breast, Body & Face. To schedule your consultation, call 206.860.5582 or fill out a contact form here.