Abdomen · Procedure

Some of it was
never fat.

Three separate structures make an abdomen look flat, and suction can only act on one of them. Fat responds to a cannula. Skin that has been stretched past its recoil does not. And the sheet of tendon down the midline that the two halves of the rectus muscle are anchored to — once that has widened, nothing placed inside the abdomen or applied to its surface will narrow it again.

This page is about the two structures liposuction cannot reach. It is deliberately not a page about how much better you will feel afterwards. It is about how the separation is actually measured, why the exercise literature is more discouraging than the fitness industry admits and more discouraging than surgeons admit too, what repairing it does to your thrombosis risk, and what the price difference between two versions of this operation tells you about where your own skin excess sits.

FeeFrom ¥1,320,000¥1,584,000 with umbilical transposition
Stay in Japan2–3 weeksMinimum, after surgery
AnaesthesiaGeneral¥165,000, additional
Final contour~12 monthsScar maturation continues beyond it

The Distinction

Three layers, one of which answers to a cannula.

Lie flat and lift your head a few centimetres off the pillow. If a soft ridge or a trough appears down the middle of your abdomen, you are looking at the linea alba — the fibrous seam where the two rectus muscles meet — and it is wider than it was. Now stand, and pinch the skin below your navel. If it lifts away as a loose apron and stays creased when you let go, that is the second problem. Neither of those is fat, and neither of them is going to be improved by removing any.

This matters more than it sounds, because the commonest disappointment in abdominal surgery is not a poor liposuction result. It is a technically good liposuction result on an abdomen whose actual problem was one of the other two layers. Fat was removed, the measurement improved, and the abdomen still projects when the patient stands sideways — because what was projecting was the wall, and because the skin that was resting on the fat now has less to rest on.

Where the sculpting is discussed How fat is separated and removed — ultrasound as energy, cannula diameter, depth, evenness — is set out on HD VASER Liposuction and VIBROFIT. This page assumes that conversation has already happened and asks the question that follows it: whether suction alone is going to be enough, and what to do when the examination says it is not.

Assessment

The separation is measured badly, almost everywhere.

Rectus diastasis is conventionally defined as an inter-recti distance greater than two centimetres. That number is in a European Hernia Society guideline, and the guideline itself is unusually candid about its own foundations: the panel recorded that the literature on definition, classification, symptoms and outcomes was limited in quality, and that this led to weak recommendations for the majority of the questions they set out to answer.

The two-centimetre threshold is also, on the imaging evidence, too narrow. A computed-tomography study of 329 asymptomatic adults found a separation exceeding two centimetres in fifty-seven per cent of the general population, with the eightieth centile at 34 mm above the umbilicus. The authors’ conclusion was not that half the population needs an operation. It was that the definition over-diagnoses and should be revised.

Postpartum, the picture moves further. In eighty-four first-time mothers measured by ultrasound at four timepoints, the normal range six months after delivery was 17–28 mm two centimetres above the navel — wider than in women who have never been pregnant, and different at every level of the abdomen. A single number taken at a single point does not describe an abdominal wall.

The method most often used is the least reliable one Fifty postnatal women were measured by two independent assessors using callipers, tape and finger-widths against ultrasound. Callipers agreed to within six millimetres and had inter-rater reliability up to 0.99. Finger-widths — the method almost every patient has had used on them — had limits of agreement of eighteen millimetres and inter-rater reliability as low as 0.44. If you have been told you have a “three-finger gap”, you have been told very little.

What is examined here instead: the separation at three defined levels rather than one, with you relaxed and then contracting; whether the linea alba merely thins under load or actually bulges, which is a different finding; whether there is a hernia in it, which changes the operation and is looked for specifically; the pinch thickness of the fat above it; the length and quality of the skin envelope with you standing, not lying; the position of the umbilicus relative to the excess; and whether any of your existing scars — caesarean scars in particular — are tethered.

Before Surgery Is Discussed

What exercise can and cannot do, honestly in both directions.

The strongest reason for a surgeon to be careful here is that the answer is genuinely unflattering to both sides of the argument.

Conservative treatment has been tested properly and it does not close a separated linea alba. A systematic review of sixteen randomised trials in 698 postnatal women found that abdominal exercise reduced the inter-recti distance by 0.43 cm, and stated the conclusion plainly: conservative interventions do not lead to clinically significant reductions. A second review of seven trials found 0.63 cm and graded the evidence very low quality. A 2017 review of twenty articles put it more bluntly still — complete resolution of the separation following a physiotherapy programme is not described anywhere in the literature.

That is the case for surgery. Here is the case against overselling it. When the same trials measured whether narrowing the gap made any difference to how the patient functioned, it did not. Pooling nine randomised trials in 450 women, exercise narrowed the separation by 8.05 mm — and the effect on disability score was +0.82, with a confidence interval crossing zero and a p-value of 0.75. A second review found the same for both disability and pelvic-floor distress scores. The anatomy moved. The person did not.

The honest inference Exercise will not close the gap, so if closing the gap is what you want, an operation is the only thing that does it. But the fact that closing it does not reliably change function should make you suspicious of any clinic that sells this operation to you as a treatment for your back. There is no randomised trial of plication for back pain. There is no controlled trial, and no sham comparator. The entire published basis is one uncontrolled series of thirty patients whose average baseline disability score was 2.94 out of 24, plus a single case report. That is not a reason to do this operation. The appearance and the mechanical feel of the wall are reasons. Your back is not.

Continence is a similar story with a slightly better number and a worse caveat. A review of thirteen studies and 719 patients found urinary incontinence in 72.8 per cent before surgery and 38.9 per cent afterwards, with 54.98 per cent improved and 35.17 per cent unchanged — and 6.80 per cent worse. No randomised trial, and no consistently validated instrument. Meanwhile three separate epidemiological cohorts found no relationship between having a diastasis and having incontinence at all, and one of them found pelvic organ prolapse to be more common at six weeks in the women without a separation. If continence is your main complaint, the person to see first is a urogynaecologist, not a plastic surgeon.

The Trade That Is Rarely Named

Repairing the wall is not a free addition.

The muscle repair is priced separately here — ¥132,000 — and that is not an accounting quirk. It is separately priced because it is a separate decision, and it should be made deliberately rather than assumed.

In 2024 a single surgeon published 1,370 consecutive abdominoplasties in which 1,089 had the rectus plicated and 281 did not. Venous thromboembolism occurred in 2.3 per cent of the plicated group and 0.36 per cent of the unplicated group — even though the unplicated patients were, on the conventional scores, the higher-risk group. Matching 225 pairs who differed only by whether the muscle was repaired gave 5.3 per cent against zero. On regression, plication carried an odds ratio of 16.76. The proposed mechanism is straightforward and physiologically credible: tightening the abdominal wall raises intra-abdominal pressure, and raised intra-abdominal pressure impedes venous return from the legs. A separate prospective study measured exactly that — intra-abdominal and airway pressures both changed significantly after plication.

The counter-evidence is real and must be shown. A systematic review the following year found a matched retrospective study in which venous thromboembolism ran at 1.5 per cent with plication and 1.7 per cent without — effectively identical — and the only prospectively Doppler-screened series, 188 abdominoplasties all plicated, recorded a single event at 0.5 per cent.

How this is handled here rather than argued about Two studies disagree, one of them by a factor of sixteen, and the honest position is that the question is unresolved. What is not unresolved is the direction in which caution points. The plication is discussed with you as an addition with its own risk rather than as part of the package; the tension used is the least that achieves a flat, competent wall rather than the most the tissue will tolerate; general anaesthetic is planned without deep muscle paralysis where the anaesthetist agrees it is achievable; and where the separation is modest and the complaint is mainly skin, not repairing the muscle is offered as a real option and not as a lesser one.

There is a further finding worth knowing before you consent. Thirty post-bariatric patients were followed with quality-of-life scoring after abdominoplasty; the nine who had a rectus plication reported significantly more bloating than the twenty-one who did not, and frequent bloating tracked with worse vitality and worse general-health scores. A tighter abdominal wall is a smaller container. Most people never notice. Some do.

Choosing the Operation

The price tells you where your skin excess is.

There are three versions of this operation on the fee schedule, and the differences between them are not tiers of quality. Each treats a different distribution of the same problem, and the fee follows the distribution rather than the other way round.

VersionWhen it appliesWhat the scar isFee
Without umbilical transpositionThe excess skin lies entirely below the navel. The navel itself is still where it should be and does not need to be moved.A low transverse scar. The umbilicus is untouched.¥1,320,000
With umbilical transpositionThe excess extends above the navel. The skin above it has to be brought down, which means the navel must be released and brought back out through a new opening.A low transverse scar plus a small scar around the navel.¥1,584,000
Reverse abdominoplastyThe excess is in the upper abdomen, with a satisfactory lower abdomen. Uncommon, and usually after weight loss rather than after pregnancy.Scars hidden in the creases under the breasts.¥1,110,000
Added to any of the above where indicated
Abdominal wall repairPlication of the linea alba, where the separation is the problem rather than the skin.None of its own — performed through the same access.¥132,000

Read that table backwards and it becomes a diagnostic tool. If you are quoted the more expensive version, it is because your excess extends above the navel — and a surgeon quoting you the cheaper one for that anatomy is proposing to leave the upper half of the problem behind. The reverse also holds: if all of your loose skin is below the navel, paying for umbilical transposition buys you an additional scar and nothing else.

When the separation is the whole problem and the skin is not Where the linea alba has widened but the skin above it is still good — which is more common in women who were lean before pregnancy and have stayed lean since — the repair can be done endoscopically, through short access incisions rather than a full transverse scar, with an instrument fee of ¥220,000. In a multicentre comparison of 85 abdominoplasties against 85 endoscopic repairs at twelve months or more, both were viable, and the authors concluded the choice should follow what the patient actually needs corrected. It buys you the muscle repair without the long scar. It does not remove one square centimetre of skin.

And one option that is not surgery at all. Where the skin is merely lax rather than genuinely surplus — where it retracts when you stand but sits poorly when you sit — helium plasma subdermal treatment (¥385,000 alone, ¥330,000 when performed with liposuction in the same session) contracts the underside of the skin without excising any. In a randomised trial of 76 patients it improved excess-skin appraisal scores significantly at 6, 12 and 24 months. It is a different order of intervention from an abdominoplasty and should not be confused with one: it tightens, it does not remove.

Combination

Suction and excision in the same operation.

Adding liposuction to an abdominoplasty was for years considered to be pushing the blood supply of the skin flap too far. The largest comparative dataset available — seventeen trials and 14,061 patients — says the opposite. Lipoabdominoplasty had fewer total complications than traditional abdominoplasty, with a relative risk of 0.85; haematoma 0.56; seroma 0.69. Pooled rates across the whole set were seroma 4.1 per cent, haematoma 0.8 per cent, deep vein thrombosis 0.2 per cent.

The mechanism is not that the fat removal is harmless but that the technique changes what is undermined. Where suction is used to thin the flanks and the upper abdomen, less of the flap has to be lifted off the wall to achieve the same redraping, and the perforating vessels that supply it are left in place rather than divided.

Set against that, the largest insurance-claims database in aesthetic surgery reports a gradient in the other direction: abdominoplasty alone 3.1 per cent major complications, with liposuction 3.8 per cent, and 10.4 per cent once liposuction and further body-contouring procedures are added on top. Both findings can be true. Adding liposuction to the abdomen you are already operating on behaves differently from adding a second and third operation to the same anaesthetic. What that means for a combined plan, with the hour-by-hour figures, is set out on Mommy Makeover.

Who

Who it suits, and who it does not.

The Operation

What actually happens.

  1. Marking, standingThe scar line is drawn with you upright and then checked with you seated, because a scar planned on a flat table sits differently on a person who bends. Where you wear underwear or swimwear is marked with you, not for you. The midline is marked from the xiphoid to the pubis and the separation is marked at the levels at which it was measured.
  2. Suction first, where suction is being usedThe flanks, upper abdomen and waist are treated before any incision, so that the flap that has to be redraped is already the thickness it will finally be. Depth and evenness are handled as described on the liposuction pages; the point here is only the order.
  3. Access and selective underminingThe lower flap is raised. Above the umbilicus the dissection is kept to a central tunnel wide enough to expose the linea alba and no wider, so that the perforating vessels lateral to it are preserved. What is not lifted does not need to re-establish a blood supply, and does not make serous fluid.
  4. The umbilicus, where it is being movedReleased on its stalk with its blood supply from the round ligament and the deep vessels kept intact, and later brought out through a new opening whose shape is planned rather than cut freehand. The single randomised trial in this area compared two opening designs in forty patients and found a significant difference in position, size, shape and naturalness — and was, by its own authors’ admission, too small to say anything at all about stenosis or necrosis.
  5. Plication, where the wall is being repairedThe two rectus sheaths are brought together in the midline under continuous slowly-absorbable suture, working from above the umbilicus downward, with the anaesthetist informed before it is tightened because it changes ventilation pressures. The endpoint is a flat, competent midline, not maximum tension. There is no randomised trial of one suture material against another anywhere in this field, and the two long-term imaged studies that exist — one with non-absorbable suture, one with absorbable — contain twelve patients each and have never been compared with one another.
  6. Scarpa’s fascia and progressive tensionThe deep fascial layer of the lower abdomen is preserved where the operation allows it, and the flap is quilted down to the wall in successive rows as it is advanced, closing the space rather than draining it. Both measures are discussed in the evidence section below, including the trial that found no difference.
  7. Closure and the scarLayered closure with the tension carried by the deep layers rather than the skin. The flap is advanced with the table flexed, and how much skin is removed is decided at that moment rather than from the pre-operative marking.

Recovery

Two to three weeks in Japan, and one instruction that recently changed.

The instruction nobody can support with evidence You will be told not to lift anything heavy for six weeks. That advice is given here too, and it should be said plainly that a search of the indexed literature for controlled data on activity restriction after abdominoplasty returns nothing at all. No trial randomises early against delayed activity. No study defines a weight limit. The six-week rule is inherited practice, chosen because the fascial repair regains most of its strength in that window and because the cost of being wrong in the cautious direction is low. It is offered as a reasoned convention, not as a finding.

Evidence

What the published data shows.

The least flattering figures are included deliberately. Where two studies contradict each other, both are shown.

StudyFinding
Insurance-claims database, 25,478 abdominoplasties within 183,914 aesthetic proceduresMajor complications 4.0 per cent, against 1.4 per cent for all other aesthetic surgery. Of 1,012 events: haematoma 31.5 per cent, infection 27.2 per cent, thromboembolism 20.2 per cent. Risk rose with male sex, age 55 or over, body mass index 30 or over, and multiple procedures.
Same database, later period, 55,596 abdominoplasties across seven typesMajor complications 2.1 per cent, differing significantly by type, with fleur-de-lis the highest. After adjustment, combination with other procedures was not an independent risk — directly contradicting the study above on that specific point.
National surgical database, 1,778 cosmetic abdominoplastiesComplications 6.0 per cent overall; 8.9 per cent in obese against 4.5 per cent in non-obese; deep vein thrombosis 1.3 against 0.1 per cent; unplanned readmission odds 2.75.
Cross-validation of two independent registries, 7,310 and 3,350 abdominoplastiesInfection reported at 3.5 per cent in one and 0.7 per cent in the other for the same operation. A five-fold discrepancy that exists only because the registries capture differently — a reason to distrust any single quoted complication rate, including the ones on this page.
Randomised, double-blind, four-arm trial of drains and progressive tension sutures, 60 patientsClinical seroma 35 per cent, ultrasound-detected seroma 90 per cent, with no significant difference between any of the four arms. Progressive tension sutures added 50 minutes of operating time. The only true head-to-head randomised trial in this area, and it is negative.
Meta-analyses of progressive tension sutures, 24 studies and 750 patients — but only two randomised trialsSeroma relative risk 0.34 against drains. Confidence intervals on the secondary outcomes are extremely wide (reoperation 0.03–9.77), and the authors state larger high-quality studies are needed. A separate meta-analysis of 4,295 patients found no difference in any individual complication with or without tension sutures, drains or fascial preservation.
Cadaveric lymphatic mapping, 8 hemiabdomensThe lower abdominal lymphatic collectors pierce Scarpa’s fascia within two to three centimetres of the inguinal ligament in 95 per cent of specimens. Preserving that fascia therefore does not preserve them. Whatever benefit fascial preservation has, the standard lymphatic explanation for it is wrong.
Randomised trial of fascial preservation, 160 randomised, 99 assessed, mean follow-up 44 monthsScar quality scores no different between groups. Upper abdominal sensibility better with preservation; no difference below the umbilicus, where two-thirds of all patients remained altered at 3.5 years.
Consecutive series of 1,370 abdominoplasties by one surgeonThromboembolism 2.3 per cent with rectus plication against 0.36 per cent without; matched pairs 5.3 per cent against zero; plication odds ratio 16.76. Adding two risk-score points for plication improved the score’s discrimination from 0.651 to 0.826.
Systematic review of the same question, three large studiesA matched retrospective study found 1.5 per cent with plication against 1.7 per cent without. The only Doppler-screened prospective series, 188 plicated abdominoplasties, recorded 0.5 per cent. The same review argues that risk scores lack a scientific foundation and that chemoprophylaxis raises bleeding without lowering thromboembolism.
Outpatient accreditation database, 42 consecutive deaths after cosmetic surgery54.8 per cent of all deaths followed abdominoplasty; 38.1 per cent of causes were thromboembolic; and in 25 of the 42 cases the pre-operative thrombosis risk assessment was incorrect or entirely absent. A separate outpatient audit of 1.14 million procedures found 23 deaths, 13 of them from pulmonary embolism, with abdominoplasty the procedure most commonly involved.
Outpatient thromboembolism audit, 414 events95.5 per cent occurred in patients whose risk score was between 2 and 8 — scores that would not trigger anticoagulation under current recommendations. In a separate 333-patient series run on a full prophylaxis protocol, both pulmonary emboli occurred in patients scoring only 4.
Comparative meta-analysis of lipoabdominoplasty, 17 trials, 14,061 patientsFewer total complications than abdominoplasty alone (relative risk 0.85), fewer haematomas (0.56) and fewer seromas (0.69). Pooled seroma 4.1 per cent, deep vein thrombosis 0.2 per cent.
Long-term imaging of the muscle repair, two series of 12 patients eachNo recurrence on computed tomography at 32–48 months and at 76–84 months, despite mean interval weight gain of 4.5 kg and 6.5 kg. Twenty-four patients, one surgeon, one centre — this is the entire long-term imaged evidence base for plication. A review of 24 studies and 931 patients reported recurrence at 5 per cent, seroma 7 per cent, abdominal numbness 6 per cent and chronic pain 4 per cent.
Post-bariatric series with the national risk calculator applied, 205 abdominoplastiesObserved serious complications 20 per cent, any complication 26.3 per cent, return to theatre 18.8 per cent — against a calculator prediction of 0.1–8.6 per cent. The authors conclude the calculator does not reliably predict outcomes in this population. Weight-loss patients are not the same population as post-pregnancy patients.
Chinese post-bariatric lipoabdominoplasty series, 23 patientsOverall complications 34.8 per cent, of which hypertrophic scarring was 30.4 per cent and dominated everything else. The most relevant single finding on this page for patients of East Asian ancestry, and the reason scar management here begins before you leave rather than at the first sign of a problem.
Patient-reported outcomes after abdominoplasty, 95 cases scored by patients and by cliniciansBoth improved, but patients reported significantly greater improvement than their clinicians did. Clinicians scored outcomes worse where body mass index exceeded 30, where more than a kilogram of tissue was removed, and where a complication had occurred. None of those variables affected how the patients scored themselves.

These figures describe published study populations authored by others. They do not describe results at this practice and are not a prediction of your individual outcome. Full citations are listed at the foot of this page.

What Is Not Known

Five questions this operation cannot answer.

Each of the following was searched for deliberately in the indexed literature before this page was written. The absence is reported rather than filled in.

Why this section exists Because a page that only shows the evidence supporting the operation is not informing you, it is selling to you. The gaps above are not reasons to avoid an abdominoplasty; the operation does reliably what it is designed to do. They are reasons to be suspicious of precision that nobody has earned.

Afterwards

Pregnancy after an abdominoplasty.

The question is asked at almost every consultation and the answer is better than most people expect, with a caveat about how thin the evidence is.

The only systematic review on the subject collected 17 studies and 237 patients who became pregnant after abdominoplasty, at a mean interval of 3.75 years. Rectus plication had been performed in 89.74 per cent of those in whom it was recorded. Mean gestational age at delivery was 38.90 weeks; preterm delivery 9.85 per cent; low birthweight 7.22 per cent; caesarean 43.63 per cent. There were no maternal or neonatal deaths in any included study, and the review’s conclusion was that pregnancy should not be contraindicated after abdominoplasty.

What it could not tell anyone: every included study was a case report or small series, there was no control group, mean follow-up was 8.5 months, and the review does not report how often the separation recurred after the subsequent pregnancy — which is the actual question a patient is asking. Three cases of a lower-than-expected spinal anaesthetic block were noted, which is worth your obstetric anaesthetist knowing about. Where mesh has been used, the single indexed case of caesarean delivery afterwards recorded 1,500 mL of blood loss.

The practical position: a pregnancy after this operation is safe on the available evidence, and it will probably undo part of the result. If you intend to have another child, the sensible plan is to have the child first.

Fees

What it costs.

The version of the operation follows the anatomy, and the fee follows the version. Where liposuction is performed in the same session it is charged by area, and where the abdominal wall is repaired that is a separate line rather than an inclusion.

ProcedureFee (JPY, incl. tax)
Tummy tuck, without umbilical transposition¥1,320,000
Tummy tuck, with umbilical transposition¥1,584,000
Reverse abdominoplasty¥1,110,000
Abdominal wall repair (rectus plication)¥132,000
Endoscopic instrumentation, where the repair is performed endoscopically¥220,000
Umbilicus, performed alone
Umbilicoplasty, skin excision¥330,000
Umbilicoplasty, skin excision with two internal sutures¥440,000
Vertical umbilicoplasty, two internal sutures¥110,000
Liposuction, where performed in the same session
Upper abdomen, lower abdomen or flank, per area¥275,000
Abdomen in full (upper, lower and flanks)¥770,000
Waist, per area¥275,000
Skin tightening without excision
Helium plasma, alone (10 × 10 cm)¥385,000
Helium plasma, with liposuction in the same session (10 × 10 cm)¥330,000
Additional
General anaesthesia¥165,000
Standard set (anaesthetic, medication, compression garment)¥66,000
Blood tests¥11,000
Supplement, body mass index 25–30¥55,000
Supplement, body mass index 30 or above¥110,000

All figures are standard prices, not monitor prices, current as of August 2026 and subject to change. Your written quotation is the binding figure and is issued before you book travel. See the full fee schedule and process for international patients.

Guarantee

Not covered, and why that is the honest answer.

Abdominoplasty does not carry the one-year guarantee offered by this practice. The guarantee covers VASER liposuction, VASER 4D, Condense Rich fat transfer breast augmentation and gynaecomastia surgery. Where liposuction is performed in the same session as your abdominoplasty, that component is covered; the excision and the muscle repair are not.

The reason is worth stating rather than leaving as a line in a table. A guarantee is a promise about something the surgeon controls. What an abdominoplasty result does over a year is governed by how your skin scars, how your weight moves and whether your abdominal wall is asked to stretch again — and of those three, the surgeon controls none. Offering a guarantee over them would be offering something that could not be honoured, and the more useful thing to give you instead is the correct expectation before you book: the scar is permanent, it will be more visible in the first year than in the third, and in East Asian skin the published hypertrophic scarring rate is the single commonest problem after this operation.

What is provided regardless of the guarantee: review by your operating surgeon, in person while you are here and remotely once you have gone home, and a scar-management regimen that starts before you leave rather than after something goes wrong.

Risks

What can go wrong.

This is elective surgery, it is not covered by health insurance in Japan, and it carries the highest major-complication rate of any common aesthetic operation. The specific figures are in the evidence table above rather than being softened here.

Questions

Frequently asked.

Can liposuction alone give me a flat stomach?

Only if fat was the whole problem. Suction removes fat; it does not remove skin, and it cannot narrow a linea alba that has widened. If your abdomen projects when you stand sideways with your abdominal muscles relaxed, or if skin lifts away as an apron when you pinch it, then part of what you are seeing will still be there after excellent liposuction. The examination that separates these is done in person and takes a few minutes.

Can I close the gap with exercise instead?

Not meaningfully. Sixteen randomised trials in 698 postnatal women found abdominal exercise narrowed the separation by 0.43 cm, and the authors’ own conclusion was that conservative treatment does not produce clinically significant reductions. A separate review of twenty studies stated that complete resolution following physiotherapy is not described anywhere in the literature. That said, exercise is worth doing first for reasons that have nothing to do with the gap, and it is what we would recommend for the first twelve months after a delivery.

Will this fix my back pain?

It might, and nobody can tell you the odds honestly, because there is no randomised trial, no controlled trial and no sham comparator for muscle repair as a treatment for back pain. The published basis is a single uncontrolled series of thirty patients with mild baseline scores. What the exercise trials did measure is discouraging in the other direction: narrowing the separation did not improve disability scores. Have this operation for the wall and the contour. If it helps your back, treat that as a bonus rather than as the plan.

How wide does the separation have to be before it is worth repairing?

There is no defensible cut-off. The conventional two centimetres is present in fifty-seven per cent of asymptomatic adults on computed tomography, and a large review specifically stated that the inter-recti distance could not be identified as an indicator for choosing a technique. The decision here is made from what the wall does under load rather than from a number: whether it merely thins or actually bulges, whether it is competent when you sit up, and how much of your complaint comes from it rather than from skin or fat.

Does the muscle repair increase my risk of a blood clot?

Possibly, and this is discussed rather than glossed over. A consecutive series of 1,370 abdominoplasties found thromboembolism in 2.3 per cent of plicated patients against 0.36 per cent of unplicated, with an odds ratio of 16.76 on regression. A systematic review of the question found a matched study reporting 1.5 against 1.7 per cent — effectively no difference — and a Doppler-screened prospective series at 0.5 per cent. The evidence is genuinely contradictory. Because it is, the plication is treated as a decision with its own risk, tightened to competence rather than to maximum, and priced separately so that it is visible as a choice.

Why is the version with umbilical transposition more expensive?

Because it is a different operation for different anatomy, not a better version of the same one. If your excess skin sits entirely below the navel, the navel does not need to move and you should not pay to move it. If the excess extends above the navel, the upper skin has to be brought down, which means the navel must be released and brought out through a new opening. The quotation you receive therefore tells you something factual about your own abdomen: ¥1,584,000 means the excess is above the navel, and ¥1,320,000 means it is not.

Can I have the muscle repaired without the long scar?

Yes, endoscopically, through short access incisions, with an instrument fee of ¥220,000 in addition to the repair. In a multicentre comparison of 85 abdominoplasties against 85 endoscopic repairs at twelve months or more, both were viable and the choice followed what the patient needed corrected. The limit is absolute and worth stating clearly: an endoscopic repair removes no skin at all. It suits someone whose wall has separated but whose skin is still good, and it does not suit anyone whose main complaint is loose skin.

Do I need drains?

Sometimes. Fluid collection is the commonest complication of this operation, and the two things that reduce it are quilting the flap down to the wall as it is advanced and preserving the deep fascial layer. Whether a drain is added on top is decided by how much surface was undermined and whether liposuction was performed in the same session. It is worth knowing that the only genuinely randomised, double-blind, four-arm comparison — sixty patients, drains against tension sutures against both against neither — found no difference between any of the arms, with clinical seroma at 35 per cent and ultrasound-detected seroma at 90 per cent across the whole study.

How long will I be numb?

Longer than you are probably expecting. In a randomised trial with a mean follow-up of 44 months, two-thirds of patients still had altered sensation below the umbilicus at three and a half years. Preserving the deep fascia improved sensation in the upper abdomen but made no difference below the navel. This is not a complication; it is a normal consequence of the operation, and it is included here because it is the item patients most often say they were not told about.

How long do I wear the compression garment?

One month, then a guided weaning. That is shorter than the usual advice and it was shortened deliberately. A randomised trial of 120 patients compared one, three and five months and found one month non-inferior on the anatomical measurement at six months, with prolonged compression delaying the resolution of swelling, reducing venous flow, raising intra-abdominal pressure, slowing functional recovery and being significantly less comfortable — for identical satisfaction at a year. It is the only controlled trial of garment duration in existence and it has not yet been replicated, which is stated here for the sake of accuracy.

How long do I need to stay in Japan?

Plan for two to three weeks after surgery, which is longer than for breast surgery and deliberately so. Abdominoplasty patients present to emergency departments and are readmitted more often than patients having any other aesthetic procedure, and the complications that matter — fluid collection, wound problems, thrombosis — declare themselves in the first two weeks. You will not be cleared to fly until you have been examined in person. Planning, timing and travel are set out on the international patients page.

Is a tummy tuck after major weight loss the same operation?

No, and the figures are different enough that the two should not be quoted together. In a series of 205 post-weight-loss abdominoplasties, serious complications ran at 20 per cent and return to theatre at 18.8 per cent, against a national calculator prediction of 0.1–8.6 per cent. In a propensity-matched comparison, delayed wound healing occurred in 34.6 per cent of weight-loss patients against 16.5 per cent of others. A weight-loss abdomen usually needs more tissue removed, sometimes needs a vertical scar as well, and is assessed as a separate operation with its own quotation.

Can I get pregnant afterwards?

Yes, on the evidence available. The only systematic review found 237 pregnancies after abdominoplasty at a mean interval of 3.75 years, with mean delivery at 38.90 weeks, preterm delivery at 9.85 per cent, and no maternal or neonatal deaths in any included study. Its conclusion was that pregnancy should not be contraindicated. What it could not report was how often the separation recurred afterwards — and it almost certainly does. If another child is planned, the better order is child first, operation second.

Should this be combined with breast surgery in one anaesthetic?

Sometimes, and the deciding variable is operating time rather than the number of procedures. In 1,753 combined cases, each additional hour raised the odds of a complication by 21 per cent, with no measurable increase until 3.1 hours and a threefold rise after 4.5. The other figure that matters is thrombosis: in a database of 129,007 procedures, the combination of a body procedure with a breast procedure had the highest rate in the entire dataset at 0.28 per cent, against 0.04 per cent for a single procedure. The full argument, and what is combined here and what is not, is on Mommy Makeover.

What does it cost?

¥1,320,000 without umbilical transposition and ¥1,584,000 with it; a reverse abdominoplasty is ¥1,110,000; the abdominal wall repair is ¥132,000 in addition. General anaesthesia (¥165,000), the standard post-operative set (¥66,000) and blood tests (¥11,000) are additional, and a supplement applies at a body mass index of 25 or above. Liposuction in the same session is charged by area. All of these are standard prices rather than monitor prices, and your written quotation is the binding figure.

Is it covered by the one-year guarantee?

No. The guarantee covers VASER liposuction, VASER 4D, Condense Rich fat transfer breast augmentation and gynaecomastia surgery. If liposuction is performed in the same session, that component is covered and the excision and muscle repair are not. The reason is that what an abdominoplasty result does over a year depends on scarring, weight and whether the wall is stretched again, and a surgeon cannot honestly guarantee any of the three. Review by your operating surgeon and a scar-management regimen are provided regardless.

References

Selected literature.

Retrieved from PubMed. The figures quoted above come from these studies, which describe study populations authored by others rather than results at this practice.

  1. Hernández-Granados P, Köckerling F, et al. European Hernia Society guidelines on management of rectus diastasis. Br J Surg. 2021;108(10):1189–1191. doi:10.1093/bjs/znab128
  2. Kaufmann RL, Reiner CS, Dietz UA, et al. Normal width of the linea alba, prevalence, and risk factors for diastasis recti abdominis in adults, a cross-sectional study. Hernia. 2022;26(2):609–618. doi:10.1007/s10029-021-02493-7
  3. Mota P, Pascoal AG, Carita AI, Bø K. Normal width of the inter-recti distance in pregnant and postpartum primiparous women. Musculoskelet Sci Pract. 2018;35:34–37. doi:10.1016/j.msksp.2018.02.004
  4. Benjamin DR, Frawley HC, Shields N, et al. Relationship between the diastasis of the rectus abdominis muscle and measurement methods. Musculoskelet Sci Pract. 2020;49:102202. doi:10.1016/j.msksp.2020.102202
  5. Benjamin DR, Frawley HC, Shields N, et al. Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women — a systematic review and meta-analysis. Physiotherapy. 2023;119:54–71. doi:10.1016/j.physio.2023.02.002
  6. Gluppe S, Engh ME, Bø K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Braz J Phys Ther. 2021;25(6):664–675. doi:10.1016/j.bjpt.2021.06.006
  7. Capoccia Giovannini S, et al. Exercise for diastasis recti abdominis: a systematic review and meta-analysis of anatomical and functional outcomes. Hernia. 2026;30(1). doi:10.1007/s10029-026-03671-1
  8. Abdullah B, et al. Effectiveness of exercise on diastasis recti abdominis: a systematic review and meta-analysis. Physiother Res Int. 2025;30(2):e70038. doi:10.1002/pri.70038
  9. Mommers EHH, Ponten JEH, Al Omar AK, et al. The general surgeon’s perspective of rectus diastasis: a systematic review of treatment options. Surg Endosc. 2017;31(12):4934–4949. doi:10.1007/s00464-017-5607-9
  10. Restifo RJ. Rectus plication and venous thromboembolism in abdominoplasty. Aesthet Surg J. 2024;44(12):NP870–NP882. doi:10.1093/asj/sjae139
  11. Swanson E. Rectus plication and venous thromboembolism risk: a systematic review. Ann Plast Surg. 2025;94(3):378–383. doi:10.1097/SAP.0000000000004149
  12. Rostami K, et al. Changes in intra-abdominal and airway pressure following rectus plication in abdominoplasty. World J Plast Surg. 2025;14(1):52–58. doi:10.61186/wjps.14.1.52
  13. Bienert M, et al. Quality of life after post-bariatric abdominoplasty. Handchir Mikrochir Plast Chir. 2022;54(2):106–111. doi:10.1055/a-1720-1681
  14. Patel NG, et al. The effect of abdominoplasty with rectus plication on back pain. Ann Plast Surg. 2023;90(6S Suppl 5):S704–S706. doi:10.1097/SAP.0000000000003500
  15. Karunaratne YG, et al. Abdominoplasty and urinary incontinence: a systematic review. Aesthetic Plast Surg. 2025;49(23):6632–6639. doi:10.1007/s00266-025-05178-z
  16. Bø K, Hilde G, Tennfjord MK, et al. Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis. Neurourol Urodyn. 2017;36(3):716–721. doi:10.1002/nau.23005
  17. Fei H, et al. The relationship of severity in diastasis recti abdominis and pelvic floor dysfunction. BMC Womens Health. 2021;21(1):68. doi:10.1186/s12905-021-01194-8
  18. Nahas FX, Ferreira LM, Augusto SM, Ghelfond C. Long-term follow-up of correction of rectus diastasis. Plast Reconstr Surg. 2005;115(6):1736–1741. doi:10.1097/01.prs.0000161675.55337.f1
  19. Nahas FX, Ferreira LM, Mendes JA. An efficient way to correct recurrent rectus diastasis. Aesthetic Plast Surg. 2011;35(1):43–48. doi:10.1007/s00266-010-9554-2
  20. Van Kerckhoven L, Gieön E, et al. Rectus diastasis: a systematic review of treatment options. J Plast Reconstr Aesthet Surg. 2021;74(8):1870–1880. doi:10.1016/j.bjps.2021.01.004
  21. Castagneto-Gissey L, et al. Minimally invasive repair of rectus diastasis with concomitant ventral hernia: a systematic review and meta-analysis. Hernia. 2025;29(1):264. doi:10.1007/s10029-025-03430-8
  22. Moharaq HS, et al. Onlay mesh versus suture plication in obese multiparous women: a computed tomography study. Aesthetic Plast Surg. 2023;48(9):1778–1789. doi:10.1007/s00266-023-03743-y
  23. Medina C, et al. Abdominoplasty versus endoscopic plication for rectus diastasis: a multicentre comparison using the BODY-Q. JPRAS Open. 2024;41:411–419. doi:10.1016/j.jpra.2024.06.011
  24. Andrades P, Prado A, Danilla S, et al. Progressive tension sutures in the prevention of postabdominoplasty seroma: a prospective, randomized, double-blind clinical trial. Plast Reconstr Surg. 2007;120(4):935–946. doi:10.1097/01.prs.0000253445.76991.de
  25. Rao A, et al. Progressive tension sutures versus drains in abdominoplasty: a systematic review and meta-analysis. Aesthet Surg J. 2024;45(1):71–83. doi:10.1093/asj/sjae171
  26. Ho D, et al. Seroma prevention in abdominoplasty: a meta-analysis of 4,295 patients. J Plast Reconstr Aesthet Surg. 2020;73(5):828–840. doi:10.1016/j.bjps.2019.11.066
  27. Li H, et al. Comparative efficacy of seroma prevention techniques in abdominoplasty: a Bayesian network meta-analysis. Aesthetic Plast Surg. 2026;50(12):4717–4729. doi:10.1007/s00266-026-05610-y
  28. Tourani SS, Taylor GI, Ashton MW. Scarpa fascia preservation in abdominoplasty: does it preserve the lymphatics? Plast Reconstr Surg. 2015;136(2):258–262. doi:10.1097/PRS.0000000000001407
  29. Novais Ferreira Filho J, Costa-Ferreira A, et al. Scarpa fascia preservation in abdominoplasty: randomized clinical trial of long-term results. Plast Reconstr Surg. 2020;146(2):156e–164e. doi:10.1097/PRS.0000000000007024
  30. Winocour J, Gupta V, Ramirez JR, et al. Abdominoplasty: risk factors, complication rates, and safety of combined procedures. Plast Reconstr Surg. 2015;136(5):597e–606e. doi:10.1097/PRS.0000000000001700
  31. Chaker SC, et al. Abdominoplasty by type: complication profiles from 55,596 cases. Aesthet Surg J. 2024;44(9):965–975. doi:10.1093/asj/sjae060
  32. Sergesketter AR, et al. Complications after aesthetic surgery: an analysis of 214,504 cases from the TOPS database. Plast Reconstr Surg. 2023;151(6):1169–1178. doi:10.1097/PRS.0000000000010148
  33. Alderman AK, Collins ED, Streu R, et al. Benchmarking outcomes in plastic surgery: national complication rates for abdominoplasty and breast augmentation. Plast Reconstr Surg. 2009;124(6):2127–2133. doi:10.1097/PRS.0b013e3181bf8378
  34. Klimitz FJ, et al. Obesity and outcomes in cosmetic abdominoplasty: an ACS-NSQIP analysis. Aesthetic Plast Surg. 2025;50(3):1227–1237. doi:10.1007/s00266-025-05428-0
  35. Bamba R, Gupta V, Shack RB, et al. Evaluation of diabetes mellitus as a risk factor for major complications in patients undergoing aesthetic surgery. Aesthet Surg J. 2016;36(5):598–608. doi:10.1093/asj/sjv241
  36. Gupta V, Winocour J, Shi H, et al. Preoperative risk factors and complication rates in cosmetic surgery in overweight and obese patients. Aesthet Surg J. 2016;36(6):718–729. doi:10.1093/asj/sjv268
  37. Niu EF, et al. The effect of obesity on complications in cosmetic abdominal body contouring: a systematic review and meta-analysis. Aesthetic Plast Surg. 2023;48(11):2121–2131. doi:10.1007/s00266-023-03602-w
  38. Bucknor A, Egeler SA, Chen AD, et al. National mortality rates after outpatient cosmetic surgery. Plast Reconstr Surg. 2018;142(1):90–98. doi:10.1097/PRS.0000000000004499
  39. Keyes GR, Singer R, Iverson RE, Nahai F. Incidence and predictors of venous thromboembolism in abdominoplasty. Aesthet Surg J. 2018;38(2):162–173. doi:10.1093/asj/sjx154
  40. Keyes GR, Singer R, Iverson RE, et al. Mortality in outpatient surgery. Plast Reconstr Surg. 2008;122(1):245–250. doi:10.1097/PRS.0b013e31817747fd
  41. Claytor RB, et al. Venous thromboembolism prophylaxis in abdominal body contouring: a 333-patient protocol series. Aesthet Surg J Open Forum. 2025;7:ojaf024. doi:10.1093/asjof/ojaf024
  42. Asiry S, et al. Universal chemoprophylaxis in abdominoplasty: thromboembolism and haematoma outcomes. JPRAS Open. 2025;46:305–315. doi:10.1016/j.jpra.2025.09.017
  43. Buğra A, et al. Forensic autopsy findings in liposuction-associated deaths. Leg Med (Tokyo). 2025;79:102740. doi:10.1016/j.legalmed.2025.102740
  44. Xia Y, Zhao J, Cao DS. Safety of lipoabdominoplasty versus abdominoplasty: a systematic review and meta-analysis. Aesthetic Plast Surg. 2019;43(1):167–174. doi:10.1007/s00266-018-1270-3
  45. Saldanha O, Saldanha Filho O, Saldanha CB. Lipoabdominoplasty with anatomical definition. Clin Plast Surg. 2023;51(1):45–57. doi:10.1016/j.cps.2023.06.011
  46. Abbaszadeh A, et al. Comparison of two umbilicoplasty techniques in abdominoplasty: a randomized clinical trial. Aesthetic Plast Surg. 2024;49(1):243–250. doi:10.1007/s00266-024-04405-3
  47. Bruno A, et al. Compression garment duration after abdominoplasty with diastasis repair: a randomized controlled trial. Aesthetic Plast Surg. 2026;50(7):2633–2646. doi:10.1007/s00266-026-05616-6
  48. Stahl S, et al. Patient-reported anaesthesia expectations and early activity milestones after outpatient lipoabdominoplasty. Aesthet Surg J. 2026 (advance online). doi:10.1093/asj/sjag138
  49. Schulz T, et al. Validation of the ACS-NSQIP risk calculator in post-massive-weight-loss abdominoplasty. JPRAS Open. 2024;43:347–356. doi:10.1016/j.jpra.2024.12.002
  50. Amro C, et al. Abdominoplasty after weight-loss surgery versus without: a propensity-matched analysis of outcomes and quality of life. Plast Reconstr Surg. 2025;157(3):464–473. doi:10.1097/PRS.0000000000012384
  51. Zhou X, et al. Lipoabdominoplasty in Chinese post-bariatric patients. Aesthetic Plast Surg. 2024;49(3):824–832. doi:10.1007/s00266-024-04606-w
  52. Kitching ST, et al. Patient-reported versus clinician-reported outcomes after abdominoplasty. JPRAS Open. 2025;43:438–457. doi:10.1016/j.jpra.2025.01.004
  53. Henderson J, et al. Long-term weight regain after trunk-based body contouring. Plast Reconstr Surg. 2023;152(5):817e–827e. doi:10.1097/PRS.0000000000010370
  54. Karunaratne YG, et al. Pregnancy after abdominoplasty: a systematic review. Aesthetic Plast Surg. 2023;47(4):1472–1479. doi:10.1007/s00266-023-03423-x
  55. Barone M, et al. Helium plasma treatment for skin laxity in massive weight loss patients: a randomized controlled trial. Aesthetic Plast Surg. 2025;49(8):2260–2268. doi:10.1007/s00266-024-04655-1
  56. Hardy KL, Davis KE, Constantine RS, et al. The impact of operative time on complications after plastic surgery. Aesthet Surg J. 2014;34(4):614–622. doi:10.1177/1090820X14528503
  57. Edmondson SJ, et al. Patient-reported outcome measures in postpartum abdominoplasty: a review. Hernia. 2021;25(4):939–950. doi:10.1007/s10029-021-02470-0

Next

Find out which of the three layers is your problem.

The consultation is held online, in English, before you commit to any travel. You will be told which structure is actually generating the shape you dislike, whether the muscle repair is being recommended and on what grounds, which version of the operation your skin excess requires, and what each of those costs — including, where it applies, that liposuction alone would serve you better and more cheaply.

Start an enquiry Costs, stay and process
Important Notice Abdominoplasty, performed alone or in combination with liposuction or repair of the abdominal wall, is elective aesthetic surgery and is not covered by health insurance in Japan. Outcomes, recovery time and risks vary between individuals and cannot be guaranteed. The fees shown are standard prices in Japanese yen including consumption tax, are not monitor prices, are current as of August 2026 and are subject to change; general anaesthesia, the standard post-operative set, blood tests and a body-mass-index supplement are additional, and your written quotation is the binding figure. Abdominoplasty carries a higher rate of major complications than any other common aesthetic operation, and published mortality audits attribute a majority of deaths after outpatient cosmetic surgery to it, predominantly from thromboembolism. Potential risks and side effects include, but are not limited to, deep vein thrombosis and pulmonary embolism which may be fatal, seroma, haematoma, infection, wound dehiscence, delayed healing, skin or fat necrosis, permanent scarring which may widen, thicken or become hypertrophic or keloid and which occurs more frequently in East Asian and darker skin, altered or permanently reduced sensation of the abdominal skin which in long-term follow-up persists in a majority of patients below the umbilicus, umbilical malposition, distortion, narrowing or loss, contour irregularity, dog-ears, asymmetry, residual skin laxity, recurrence of rectus diastasis particularly after further pregnancy or weight gain, abdominal bloating and altered abdominal sensation after muscle repair, chronic pain, the need for revision surgery, and complications of general anaesthesia including those associated with prolonged operating time. Rectus plication has been associated in one large consecutive series with a substantially increased rate of venous thromboembolism, while other published evidence has found no such increase; the evidence is contradictory and is discussed in full above. Abdominoplasty does not carry the one-year guarantee offered by this practice; where liposuction is performed in the same session, that component is covered. Clinical figures cited on this page describe published study populations authored by others; they do not describe results at this practice and are not a prediction of individual outcome. Your suitability will be assessed individually during consultation.