Different types of tummy tucks, Full Tummy Tuck, Mini Tummy Tuck, Reverse Upper Tummy Tuck

 

Many women, after one or more pregnancies, or massive weight loss will have changes in both the abdominal soft tissues (skin and fat) and the abdominal wall. This usually consists of loose, flaccid skin with (but sometimes without) stretchmarks, and outward bulging of the abdominal wall, especially below the belly button.

 

For most patients with these changes, no amount of diet or exercise will significantly improve the abdominal appearance. Most of these patients require a full tummy tuck,  A full tummy tuck involves removal of most or all of the skin and fat between the pubic area and the existing belly button, tightening of the rectus abdominis ('6-pack') muscles from the bottom of the sternum to the pubic bone, and creation of a new belly button. Often abdominal and hip liposuction is usually performed as well.

 

A few patients in my Raleigh, NC plastic surgery practice have severe post-pregnancy skin and soft tissue excess that cannot be adequately corrected by means of a horizontal, suprapubic incision alone. In select patients, a vertical midline incision can be added to allow removal of skin excess in a horizontal as well as vertical direction.   The technique is performed for patients in whom the resulting improvement in the overall abdominal profile outweighs the 'downside' of a midline surgical scar.

The nature of the tummy tuck surgery that will best suit each patient is determined during the consultation and  based on the physical examination and conversations with the patient. For all patients, I draw the proposed incisions on their body with a skin marker (it washes off easily) so that it is clear what the nature of the resulting surgical scars will be. 

The ‘Mini’ tummy tuck

In some women, the abdominal skin will contract after delivery and maintain a great deal of its natural tone. Abdominal bulging may be confined to the area below the belly button. In these patients, a mini-tummy tuck may be adequate, which involves a shorter suprapubic incision, no surgical alteration of the belly button, and a quicker recovery time.

In a mini-abdominoplasty, the rectus abdominis muscles may be tightened below the belly button only, if the abdominal "bulge" is confined to that area. If abdominal wall laxity extends above the belly button, it is possible to tighten the muscles all the way up to the level of the sternum (ribcage). To do this, the umbilical stalk is divided at its base, and then reinserted at its original location once the muscle-tightening sutures have been placed. The patient still keeps their 'original' belly button.

A mini-tummy tuck generally does not alter the blood supply of the abdominal skin as much as a full tummy tuck, and therefore more aggressive liposuction of the waist and back may be performed in many cases.

‘Reverse Upper’ abdominoplasty

Not infrequently I see patients in whom there is as much skin laxity in the upper abdomen as there is in the lower abdomen. In fact, some patients after pregnancy will have fairly 'toned' lower abdominal skin, but very lax and redundant upper abdominal skin. In these situations, the removal of skin in a vertically downward direction ( a conventional tummy tuck) is not adequate to correct the upper abdominal skin laxity. Such patients are often very good candidates for what I refer to as a 'reverse upper' abdominoplasty.

This surgical technique involves removing excess abdominal skin vertically upwards using incisions hidden in the inframammary folds underneath the breasts. In general, this operation is best reserved for patients with fairly full or at least slightly droopy breasts, which serve to nicely conceal the inframammary folds. An important part of this procedure is the placement of permanent lifting sutures that elevate the lower skin edge, following removal of excess skin, to the upper skin edge in the inframammary fold. These permanent sutures ensure that the resulting surgical scar remains hidden within the inframammary fold.

A great advantage of this procedure is that the patient's original belly button is preserved, and thus there are absolutely no surgical scars that are visible when wearing a two-piece swimsuit or typical underwear (bra and panties). Additionally, because this procedure generally requires less skin undermining and thus less interruption of the normal blood supply of abdominal skin, more thorough liposuction of the waist and back can be performed at the same time.

Many patients having this surgery, therefore, undergo a reverse upper abdominoplasty combined with a lower 'mini' abdominoplasty, tightening of the entire length of the rectus abdominis muscles, and liposuction of the circumferential trunk - and keep the belly button with which they were born. I usually refer to this operation as 'reverse upper / modified lower abdominoplasty'.

The ‘Internal Corset’ – a procedure to narrow the waist

The permanent sutures that are used to flatten and tighten the abdominal wall are typically placed in the midline. The rectus abdominis muscles, prior to pregnancy, are lined up immediately side-by-side. Expansion of the abdominal wall during pregnancy allows the muscles to stretch apart, leaving a weak layer of fascia (connective tissue) spanning the gap between the two muscles – the medical term for which is diastasis. The midline tightening sutures correct the diastasis and bring the rectus muscles back into a 'side-by-side' configuration, flattening the abdominal wall in the process.

Although this midline tightening dramatically enhances the abdominal profile, it often does adequately address the fact that pregnancy can also wreak havoc on the waist, turning what was formerly an 'hourglass' figure into something that is more cylindrical in shape. For several years now I have been using permanent 'internal corset' sutures, placed laterally in the abdominal wall, that draw the waist inward and restore some of the hourglass effect of abdominal concavity at the waistline in frontal view. The addition of these sutures to midline tightening, and in some cases in place of midline tightening, has allowed me to achieve even more impressive postoperative results.