A tummy tuck (also called abdominoplasty) is a cosmetic procedure to improve the appearance of the belly area. When we are living with type 2 diabetes mellitus (T2DM), surgery of any kind carries greater risks than normal. A tummy tuck is a cosmetic, voluntary procedure, and we must balance the benefits and hazards carefully before we choose to have it.
A smooth and flat abdomen is much desired for an attractive appearance and is often achieved by weight control, diet, and exercise. However, this may not always be possible. Situations like advanced age, heredity, earlier surgery, pregnancy, and significant weight loss make the usual ways ineffective, and we may have to choose surgery [1].
A tummy tuck is a surgical procedure to achieve our goal of an aesthetically appealing and slimmer appearance. The surgeon will remove sagging skin, tighten the abdominal muscles, and correct a bulging belly [2]. This gives us a firm, toned belly, improving self-confidence. How safe is this surgery for people with diabetes?
Risks of Having a Tummy Tuck with T2D
Apart from the usual risks of surgery and anesthesia, people with diabetes have additional risks. The risk of major complications is significantly higher. Our hyperglycemia (high blood sugar levels) increases the risk of infection, longer hospital stays, complications, and death. People with diabetes undergoing a tummy tuck have twice as high a risk of major complications as people without diabetes (6.1% versus 3.0%) [3].
We must be especially careful about these additional risks {4}:
- Infections at the site of the procedure
- Fluid, electrolyte, and kidney problems
- Heart problems
- Slow healing
- Hematomas
Can a Type 2 Diabetic have a Tummy Tuck?
Our doctors will often discourage us from having cosmetic surgery because of the additional risks. Cosmetic surgery is also a major undertaking, needing frequent testing of blood sugar and HbA1C levels to ensure good control of diabetes.
During the surgery, too, your anesthetist has to monitor the blood glucose level closely. Careful titration of your insulin dosing is crucial to keep your blood glucose levels in the safe range.
However, if you choose to have the surgery in a well-equipped hospital, a tummy tuck should be safe even if you have type 2 diabetes. The rate of surgical site infections is 4.5%, which is higher than in people without diabetes, but such infections are not often life-threatening. The risk of major complications is 3.1%, and our doctor and hospital will usually be able to manage these complications and discharge us in good health.
Requirement of Diabetic Tummy Tuck
We need careful preparation before any surgery. Some requirements before we can have any surgery:
Have diabetes well under control. We may need to switch temporarily from oral antidiabetic medicines to insulin injections. Injectable insulin is better for managing diabetes during the time we cannot eat and drink [5].
If we are taking metformin for T2DM, our doctor may advise us to stop. This medicine can cause a complication called lactic acidosis in the period around surgery.
Our doctor may adjust the dose of insulin if we are already taking it when surgery becomes necessary. More frequent measurement of blood sugar is required to keep levels in the safe range.
We should meet a dietician to have a carefully prepared meal plan. It is essential to have blood sugar well-controlled.
Our surgeon will probably arrange a meeting with an anesthesiologist before surgery. They will be in charge of administering insulin to control our blood sugar level while surgery is in progress.
Frequently Asked Questions (FAQ)
Can Diabetics Get Liposuction?
Liposuction is a procedure in which a surgeon removes a mass of fat from under the skin. It is the second most popular cosmetic procedure worldwide, after breast augmentation. Also called body contouring, it removes excess fat from the chin, neck, arms, back, thighs, abdomen, and other areas. It is done under local anesthesia or after rendering us unconscious.
Liposuction by itself is not more dangerous in people with diabetes. The complication rates of this fat-removal procedure are similar in people with and without diabetes [3]. However, when liposuction is combined with other procedures such as tummy tuck or others, the complication rates are higher. Common complications are infection at the surgery site, blood clots (venous thromboembolism, VTE), hematoma, and lung disorders [6].
Liposuction has benefits beyond appearance for people with diabetes. This procedure enhances insulin sensitivity, helping with diabetes control [7]. Removal of masses of fats also provides weight loss, improved body image, and a change in depression scores.
Can Diabetics Get Breast Implants?
Breast implants are often used to reconstruct breasts after breast cancer surgery. They may also be used as an elective procedure for cosmetic reasons. Breast augmentation surgery is the most popular cosmetic procedure worldwide.
Like all surgery, breast implants also carry higher risks for people with diabetes. In particular, delayed wound healing happens in almost a quarter (22.2%) of people with diabetes having breast implants. Autologous breast reconstruction, using its own tissue, is safer [8]. Overall, the incidence of complications after breast implants is 2.3% in people with diabetes, compared to 1.4% in those without [3].
Can a Diabetic get a BBL (Brazilian Butt Lift)?
A Brazilian Butt Lift is a cosmetic procedure to enhance the prominence of the buttocks. It consists of sucking out some fat from a part of the body, usually the thighs, flanks, or abdomen. Your surgeon injects it into the buttocks to create a rounded and pleasing shape. Like all surgery in people with diabetes, infection and other complications are likely to be more frequent. It is vital to have your blood sugar and HbA1C levels within normal levels when embarking on this procedure.
This surgery is associated with bruising, swelling, and some bleeding. The dangerous complication is a fat embolism, the entry of fat particles into circulation. This is associated with dangerous complications and even death. People with non-fatal embolisms may also need prolonged intensive care, long-term problems, and incomplete recovery [9].
Can Diabetics Get Botox?
Botox, or botulinum toxin, is a purified bacterial toxin that paralyzes muscles. We can get Botox injections on the face to smooth wrinkles and crow’s feet for a more youthful and attractive appearance. Regular needles are used for these injections, and we can take this treatment without fear as long as our diabetes is under control.
Final Thoughts
Surgery carries extra hazards for people with diabetes. We may need surgery for a medical condition or may opt for surgery for cosmetic reasons. Surgery with type 2 diabetes (T2DM) should never be undertaken lightly. In all cases, we are exposed to the risks of anesthesia, drug reactions and interactions, and poor wound healing.
After any surgery, we may have additional problems because of T2DM. Blood sugar may be hard to control because:
- Inability to eat soon after surgery and anesthesia
- Vomiting
- Stress of surgery
- Pain and discomfort
- Poor activity
- Medicines that raise or lower blood sugar
Wound healing often takes longer because of diabetes. We should be prepared for a longer stay.
Infections at the surgery site are more likely. We should be careful about signs like fever, redness, pain, pus oozing, and swelling. It is vital to take measures to prevent bed sores.
With enough care before, during, and after surgery, we can safely have the cosmetic procedure of our choice. People with diabetes also have the need and right to look attractive and have good self-esteem.
References
- American Society of Plastic Surgeon. Tummy Tuck (Abdominoplasty). https://www.plasticsurgery.org/cosmetic-procedures/tummy-tuck
- American Board of Cosmetic Surgery. Tummy Tuck/Abdominoplasty. https://www.americanboardcosmeticsurgery.org/procedure-learning-center/body/tummy-tuck-guide/
- Bamba R., Gupta V., Bruce Shack R., Grotting J.C., Higdon K. Evaluation of Diabetes Mellitus as a Risk Factor for Major Complications in Patients Undergoing Aesthetic Surgery. Aesthetic Surgery Journal 2016; 36 : 598–608. https://doi.org/10.1093/asj/sjv241
- National Library of Medicine: “Preparing for surgery when you have diabetes.” https://medlineplus.gov/ency/patientinstructions/000702.htm
- Diabetes Care: Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2019. https://diabetesjournals.org/care/article/42/Supplement_1/S173/31340/15-Diabetes-Care-in-the-Hospital-Standards-of
- Kaoutzanis, C., Gupta, V., Winocour, J., Layliev, J., Ramirez, R., Grotting, J. C., & Higdon, K. Cosmetic Liposuction: Preoperative Risk Factors, Major Complication Rates, and Safety of Combined Procedures. Aesthetic Surgery Journal 2017; 37: 680–694. https://doi.org/10.1093/asj/sjw243
- Perez R. A. Liposuction and diabetes type 2 development risk reduction in the obese patient. Medical hypotheses, 68(2), 393–396. https://doi.org/10.1016/j.mehy.2006.06.048
- Hart, A., Funderburk, C. D., Chu, C. K., Pinell-White, X., Halgopian, T., Manning-Geist, B., Carlson, G., & Losken, A. The Impact of Diabetes Mellitus on Wound Healing in Breast Reconstruction. Annals of plastic surgery. 2017; 78 : 260–263. https://doi.org/10.1097/SAP.0000000000000881
- Mofid, M. M., Teitelbaum, S., Suissa, D., Ramirez-Montañana, A., Astarita, D. C., Mendieta, C., & Singer, R. (2017). Report on Mortality from Gluteal Fat Grafting: Recommendations from the ASERF Task Force. Aesthetic surgery journal, 37(7), 796–806. https://doi.org/10.1093/asj/sjx004
