Abdominoplasty or tummy-tuck involves removing excess lower abdominal skin and fat as well as tightening the rectus abdominis muscles (the six-pack). Patients that are good candidates for this surgery are those that been pregnant and/or lost a lot of weight. Stretching of the abdominal wall can cause the rectus abdominis muscles to spread apart. The rectus abdominis is a the muscle that is responsible for the six-pack appearance of a well toned abdomen and it can be brought back together at the same time as a tummy-tuck.
Full Tummy Tuck
A full tummy tuck involves removal of the skin and fat from the umbilicus (belly-button) to the pubic bone (the area where the scar for a Caesarian section normally sits). The remaining skin from the belly-button to the rib cage is then stretched down to close the defect. At the beginning of the operation, the belly button is freed up from the surrrounding skin and at the end of the operation, it is replaced in its natural position. This leaves a scar around the belly-button as well as a long scar in the lower abdomen usually from one hip to the other, although this can be hidden when wearing a bikini.
Not all patients are candidates for a full tummy tuck as there needs to be a significant amount of skin laxity to be able to bring the skin from the belly-button down to the pubis. Patients with only a modest amount of skin excess in the lower abdomen may be best suited to a mini tummy tuck.
Mini Tummy Tuck
A mini tummy tuck is the ideal operation if you have excess or saggy skin in your lower abdomen following childbirth or weight loss. This skin excess is usually resistant to all forms of exercise or dieting. It can be very frustrating to have lost the weight and to still have a lower abdominal fullness, or paunch, no matter how much exercise you do. The main problem is excess skin rather than fat. It loses its elastic recoil and no amount of dieting or exercise will cause it to shrink back. Surgery, in the form of a mini tummy tuck, will remove the excess skin but it will leave a scar. The scar is shorter than in a full tummy tuck and will be hidden in a bikini.
There is no scar around the belly button following mini tummy tuck but the belly button may be pulled down a bit.
A Fleur de Lys abdominoplasty is a more extensive procedure than a full tummy tuck. It is best suited to patients who have a significant amount of excess tissue around their abdomen. It has the advantage of removing tissue in a vertical as well as a horizontal direction but it has the disadvantage of extra scarring and potential wound healing problems. A full tummy tuck or mini tummy tuck removes tissue in a horizontal direction leaving a transverse scar in the bikini line. In order to remove tissue in a vertical direction, then a vertical scar is needed, which goes straight up the middle of the abdomen and meets the transverse scar to make an inverted T shape. This vertical scar cannot be hidden in a bikini and it can bring with it more wound healing problems, particularly where the two scars meet. For these reasons, it is usually reserved for patients who have had massive weight loss either through dieting or bariatric surgery (gastric banding or bypass procedures).
A reverse abdominoplasty ot tummy tuck tackles fullness in the upper abdomen and leaves a scar that runs in the inframammary fold (the fold in which the wire of a bra sits). It is usually reserved for people with a significant amount of redundant skin on the abdomen and is performed following a standard tummy tuck procedure. The two procedures cannot be performed at the same time and a minimum of six months is needed before considering a reverse abdominoplasty following full tummy tuck.
Any excess skin in the upper abdomen is usually pulled down during a full tummy tuck and so a reverse abdominoplasty is only rarely required.