In short
- You reach this step when the laxity or the diastasis extends past the navel, not when the problem “is big”.
- The excess skin of the whole lower abdomen is removed, the caesarean scar is excised, the adherent plane is released and the recti are brought together along their whole length if needed.
- The navel is repositioned: because the skin around it moves, it has to be relocated, and that leaves a small scar around it.
- 🔑 It corrects the contour, not the weight. It is an operation on skin and wall, not a weight-loss operation.
- Liposuction is associated almost always, because there is nearly always contour to refine and the result is better with it.
- If the pubis has descended, correcting it is done in the same operation, not as a second one.
- ⚠️ Seroma is the most frequent complication of this surgery, and there are measures that demonstrably reduce how often it happens.
A full abdominoplasty is the step that applies when the laxity extends past the navel. If there is excess skin above it too, or if the separation of the recti reaches up there, there is no way of correcting it working only below: the wall has to be lifted as far as the ribs and the navel repositioned. That is what separates this operation from the mini tummy tuck, not its size.
This page explains when it comes to this, what it corrects, what it costs and what it includes. The detail of the general technique, the full risks and the week-by-week recovery are on the abdominoplasty page, which owns them.
This page is the topmost step on the ladder set out in how the surgery is decided.
When it is necessary to go this far
The boundary is anatomical and is checked by examination, standing and lying down:
- There is excess skin above the navel too, not only below it.
- The diastasis extends above the navel, and not only in the lower segment.
- The apron descends and reaches the mons pubis or goes beyond it.
It is grade 4 of the classification published in 2026, which for that picture — a very large bulge reaching the pubis, excess fat and skin across the whole wall, supra- and infra-umbilical diastasis, deep depression — proposes a full abdominoplasty with resection of the scar and the apron and plication of the recti along their whole length (Pelosi, 2026).
🔑 What matters is not the coincidence of wording, but the variable: that classification moves from grade 3 to grade 4 for exactly the same reason that here you move from the mini to the full one — how far the diastasis extends. A criterion for indicating theatre and a published anatomical classification arriving at the same boundary.
What is done
- The excess skin of the lower abdomen is excised, and with it the caesarean scar.
- The wall is lifted as far as the costal margin, which is what makes it possible to tighten from above.
- The adherent plane is released across the whole area of the old scar.
- The recti are brought together — the plication — along their whole length, where the diastasis requires it.
- The navel is repositioned in its place on the moved skin.
- It is closed in layers, including Scarpa’s fascia, and the scar is transverse and low.
- Liposuction is associated almost always, to refine the contour of what remains; and if the pubis has descended, correcting it goes in the same operation.
That closure in layers has measured support: preserving Scarpa’s fascia is among the measures that independently reduce the formation of seroma in abdominoplasty (Seretis, 2017).
What it corrects and what it does not
| Corrects | Does not correct |
|---|---|
| The excess skin of the whole lower abdomen | Weight: it is not an operation for losing weight |
| The apron falling over the scar | Visceral fat, the kind inside the abdomen |
| The old scar, which is excised whole | Stretch marks outside the skin that is removed |
| Adhesion to the deep plane | The quality of the remaining skin |
| Diastasis along its whole length, by plicating | A later pregnancy altering the result |
⚠️ On stretch marks it is worth being exact, because it is a frequent expectation: the ones in the skin that is removed go — usually those in the lowest part — and the ones above stay, and may move downwards as the skin is tightened.
The scar and the navel
The scar is transverse and low, placed on the line covered by underwear, and it is longer than the caesarean one because it has to take in all the excess skin and spread the tension.
And there is a second, small one, around the navel, a consequence of repositioning it. It is the one that most surprises anyone not expecting it, which is why it is said beforehand.
The caesarean scar disappears because it is excised. The centre’s scar protocol then works on the new one, from the first month; it is covered in the scar after operating.
Risks
Before the risks, it is worth placing the operation. The sequelae of a caesarean are corrected on a ladder of steps, and each one is climbed only when the previous one falls short: first the one that does not go through theatre — massage for the adhesion and the laser protocol for the scar; then scar revision, when all there is is an adherent scar; then the mini tummy tuck, when there is excess skin below the navel as well; and this one, the full abdominoplasty, when the laxity or the diastasis extends past it. To any of them a pubic lift is added in the same operation if the pubis has descended. The whole ladder, with what each step corrects, is in how the surgery is decided.
This is the operation of greatest extent of the four, and its risk profile reflects that.
Seroma is the most frequent complication. A meta-analysis of nine prospective studies and 664 patients put it at 19.5% without preventive measures and 7.5% with them (Seretis, 2017). It is managed with a drain or with aspirations in clinic and rarely changes the final result.
The rest: healing problems — considerably more likely in smokers — haematoma, infection, altered sensation in the lifted skin (usually temporary, although it can last months) and venous thrombosis, the serious risk, which is prevented with prophylaxis and early mobilisation.
The timings worked to. Walking from the day of surgery — early walking is what prevents thrombosis, which is why it is insisted on — suture removal and return to driving at two weeks, the gym at a month starting gradually and abdominal exertion from two months. The medication is a painkiller, prophylactic antibiotics in some cases and heparin according to each patient’s risk factors. ⚠️ These are the general timings: yours are given by your surgeon at the review appointment. How to organise it if there are small children at home is in recovery with small children.
⚠️ The full account of risks, work-up and week-by-week recovery is on the abdominoplasty page, which owns that information. Here you get the version that belongs to the indication, not the whole manual.
The price and what it includes
Around €8,000 for the abdominoplasty with liposuction, and the final price varies with the case: how much skin has to be removed, whether the plication has to run the whole length, the anatomical particularities of each abdomen and whether a pubic lift is added. It is fixed after the assessment, not before.
It is the top end of what it costs to treat a caesarean sequela. The bottom end is the €1,900 from which scar revision starts, and between the two sits the mini tummy tuck: they are steps on the same ladder, not different operations competing with one another.
What it includes. The surgery, the anaesthetic and the inpatient stay — a full abdominoplasty is always done with an overnight stay — a year of follow-up, the review appointments and the dressings. And whatever the procedure needs: the post-operative girdle and the epifoam. There are no extras that appear later.
What it does not include: the post-operative massage and the radiofrequency. They are left out deliberately, because there is no need to have them here: they can be done at any centre, and for many patients the one near home is more convenient. They are also offered at the clinic, in treatment packages.
⚠️ No result is claimed here for radiofrequency, because none is on record.
🔑 And one clarification that saves a badly made comparison: excision of the caesarean scar goes inside it. It is not added separately, because the scar is in the skin that is removed.
Book an appointment
You can book your own appointment. Pick the day and time from the free slots in the diary, in a panel that opens right here, without leaving this page.
Frequently asked questions
How do I know whether I need the full one and not the mini?
By how far the laxity extends. If there is excess skin or diastasis above the navel, the mini route does not reach: the wall has to be lifted to the ribs and the navel repositioned. It is checked by examination standing and lying down, not from a photograph.
Will it get rid of my tummy?
It removes the excess skin and corrects the wall. What it does not do is reduce weight or act on the fat inside the abdomen, so the result also depends on the starting point. It is worth being at a stable weight before surgery.
Does the caesarean scar go?
Yes: it is in the skin that is removed, so it is excised. What is left is the new scar, transverse and low, and a small one around the navel from having repositioned it.
And the stretch marks?
The ones in the skin that is removed go, usually the lowest ones. Those in the upper part stay, and may move downwards as the skin is tightened.
How much does it cost and what does it include?
Around €8,000 with liposuction, and it varies with the case: how much skin has to be removed, the anatomical particularities and whether a pubic lift is added. It includes the surgery, the anaesthetic, the inpatient stay — the full one is always done with an overnight stay — a year of follow-up, review appointments and dressings, plus the girdle and the epifoam. Left out are the post-operative massage and the radiofrequency, which can be done at any centre.
Can I have children afterwards?
Yes. What you need to know is that a later pregnancy harms the result and that the diastasis can reappear, while the available literature describes no relevant complications from having had the surgery. It is a conversation about when to have surgery, and it is had beforehand.
How long do I have to wait after the caesarean?
At least six months. Before that, the wall goes on changing: much of the diastasis resolves on its own during the first year, and that is precisely the variable that decides whether it is necessary to go above the navel.
Sources
- Pelosi MA 2nd, Pelosi MA 3rd, Romero R. The cesarean apron: description, proposed pathophysiology, classification, and prevention through Scarpa fascia closure at cesarean delivery. American Journal of Obstetrics and Gynecology. 2026;233(6S):S118-S128. PMID 41485815 — It defines grade 4 — a bulge reaching or passing the mons pubis, excess fat and skin across the whole wall, supra- and infra-umbilical diastasis — and proposes a full abdominoplasty with resection of the scar and the apron and plication of the recti along their whole length. The variable that moves a case from grade 3 to grade 4 is the same one used in this practice. Verified on 29-08-2026.
- Seretis K, Goulis D, Demiri EC, Lykoudis EG. Prevention of seroma formation following abdominoplasty: a systematic review and meta-analysis. Aesthetic Surgery Journal. 2017;37(3):316-323. PMID 28158391 — Nine prospective studies and 664 patients: seroma in 19.5% of the control group against 7.5% with preventive measures (OR 0.26; 95% CI 0.10-0.67). Preservation of Scarpa’s fascia, tissue adhesives and progressive tension sutures each reduce it independently. Verified on 29-08-2026.
- Forester E, Sadiq A. Comparative analysis of the efficacy and functionality of abdominoplasty versus minimally invasive techniques in the surgical treatment of diastasis rectus abdominis in postpartum women. Surgical Endoscopy. 2023;37(12):9052-9061. PMID 37950027 — Review of twelve studies: no significant differences in seroma, infection or haematoma between abdominoplasty and minimally invasive approaches, with limited data on the latter and the choice determined by the result the patient is after. It places abdominoplasty against the alternatives that do not remove skin. Verified on 29-08-2026.
- Sperstad JB, Tennfjord MK, Hilde G, Ellström-Engh M, Bø K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine. 2016;50(17):1092-1096. PMID 27324871 — Cohort of 300 first-time mothers: diastasis falls from 60.0% at 6 weeks to 32.6% at a year. It supports the minimum interval before indicating the step, because the variable that decides it is still changing. Verified on 29-08-2026.
Book your consultation
If you have been told that yours “is already an abdominoplasty” and you want to know whether that is so, what decides it is the examination: whether there is excess skin above the navel too and how far the diastasis extends. It is a short assessment and out of it comes a specific indication, with its quotation and with what is included.
Clinical confirmation by the surgeon
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Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
