What kind of tummy tuck do I need?

Every week in my office I see patients for abdominoplasty (also called tummy tuck) consultations who are confused about the difference between the “mini” tummy tuck and a full tummy tuck- it’s not just about the incision.

Most patients of course want a mini tummy tuck because the perception of the smaller scar is most attractive.  While the mini tummy tuck is a great option in the right person, it is important to remember that the purpose of this operation, and the limitation of this operation, is to remove extra skin limited to the area below the belly button.  The mini tummy tuck does not address any tissue excess above the belly button, has limitations on how much fat can be resected with the operation, and does not address the abdominal muscles.

After pregnancy in particular, many women have a stretched out abdominal musculature- actually it is the tissue between the rectus muscles of the abdomen that gets stretched and weakened, and this is called a diastasis.  You can often feel this diastasis with a double leg lift exercise that I have all of my tummy tuck patients do during their plastic surgery consultation.  If you lie on your back and lift both of your legs off of the floor, feel your tummy and see if there is a weak area or depression between your muscles in the midline of your abdomen.  If so, this is a diastasis.   This stretched tissue, with normal upright posture, creates a fullness in the abdominal area that may or may not have fat and/or extra skin associated with it.

In correcting a diastasis, sutures are put in the muscles to bring them together and re-create a flat, strong abdominal wall.  This requires exposure of the abdominal wall, which requires the lifting of the skin and fat of the abdomen off of the muscle layer.  This, in turn, requires a longer incision and also a release of the belly button with an incision around it so it can stay in place where it belongs.  What I’m describing of course is a full abdominoplasty which is indicated in many patients seeking a flatter stomach following pregnancy.

In the right patient, a mini abdominoplasty is an awesome operation that removes some lower abdominal extra skin.  In a patient who has extra skin above her belly button or a diastasis, a mini-tummy tuck can be a very bad idea.  When there is skin excess above the belly button that is not addressed, a mini-abdominoplasty can create a pulled and hooded look to the belly button and an abnormal contour of the central abdomen, and I saw a patient for a revision of this situation just the other day.  In a woman who has a diastasis that is not addressed and a mini-tummy tuck is performed instead, the result is bound to be poor as the remaining abdominal bulge is likely to continue to annoy the patient.

So, if you have just have some extra skin in your lower abdomen, or you have fat in your belly region, or you’ve had pregnancies that have resulted in a bulge to your abdomen that you just can’t get rid of, come and talk to me about your options and I will be happy to explain which option would be best for your particular situation.  I always want to tailor the plastic surgery to the particular issues that each patient presents, and do the right thing for her using any of the tools we have to create a rejuvenated appearance.

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