Tummy Tuck Possible with Vertical Incision?

Question

I am due to have a abdominal hysterectomy with vertical incision in a couple of month's time. I have asked about cosmtic surgery or Tummy Tuck at same time, and the consultant has said he will look at it, but not definitely agreed.

	What cosmetically could be done with a vertical incision? Is it possible to have a Tummy Tuck with a vertical incision? I am worried that when they remove my enlarged uterus (looks about 6 months pregnant) due to multiple large fibroids, I will be left with lots of excess skin and saggy belly. I am also trying to lose some more weight prior to surgery as well. I've lost 30 lbs so far.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question about the possibility of combining a tummy tuck with a vertical incision used in a hysterectomy. Your inquiry about how these two procedures can work together is an important consideration for planning your surgeries.
Yes, a hysterectomy can be performed through either a vertical or horizontal incision. The vertical incision typically runs from the pubic area to the belly button, while a horizontal incision is generally placed lower on the abdomen, similar to a C-section incision.
For a tummy tuck (abdominoplasty), the incision type and placement depend on the specific needs and body contours of the patient. Individuals who have experienced massive weight loss often require a different surgical approach. In these cases, a vertical tummy tuck may be necessary, which involves an incision that extends from the pubic region to the lower sternum. While this can be effective in achieving a flatter abdomen and improved waistline, the downside is the visibility of the vertical scar.
Given these factors, most plastic surgeons would recommend the following approach:
Preference for Horizontal Incision: If possible, it's generally preferable to have the hysterectomy performed through a horizontal incision. This approach offers more favorable conditions for a subsequent tummy tuck.
Dealing with a Vertical Incision: If the hysterectomy can only be done with a vertical incision, you should proceed with the hysterectomy first. Then, ideally waiting 4 to 6 months, you can consider a horizontal tummy tuck. In a horizontal tummy tuck, the incision is made low in the pubic area, extending towards the hips. The surgical dissection goes up to the rib cage, the abdominal muscles are tightened, and the belly button is repositioned or recreated. This approach often allows for the removal of the skin and fat from the pubic region to the belly button, which may include the elimination of the vertical scar from the hysterectomy.
This approach typically results in a more aesthetically pleasing outcome, with a less visible scar. However, the final decision should be made in consultation with both your gynecologist and plastic surgeon, taking into consideration your specific medical and aesthetic needs.
I hope this helps clarify your options regarding tummy tuck surgery in relation to a vertical incision from a hysterectomy. Good luck with your decision-making process and future surgeries.
Sincerely,
Dr.  Katzen

Otto Joseph Placik, MD · Answer

Yes this is possible and as discussed by the other plastic surgeons, it is likely that the vertical scar could be eliminated. In the event that the vertical scar could not be eliminated, you could undergo a horizontal and vertical scar abdominoplasty also known as the fleur-de-lis abdominoplasty.
Discuss your options with a plastic surgeon as well as your gynecologist. Most are willing to work together as a team to accomplish your goals. There may be additional risks to a combined procedure such as blood loss or DVT but you sjhould discuss this with your surgeons.

Steven H. Williams, MD · Answer

Thanks for your question -
Typically if your vertical incision is below the belly button it is likely that all or most of the incision would be removed at the time of abdominoplasty.
Results will be best if you are at your goal weight.
Find a board certified plastic surgeon and discuss your issues in depth.
I hope this helps.

Michael A. Bogdan, MD, MBA, FACS · Answer

This is a good time to ask that question.  If you can coordinate surgery with a plastic surgeon and your gynecologist, they can arrange to do the hysterectomy at the same time as the tummy tuck, and you will end up with a normal tummy tuck scar.  Sometimes it is not appropriate to combine the operations, but if you try to coordinate the plan before hand, they should be able to agree on a scar that gives your gynecologist full exposure for the hysterectomy component of the operation, but is still a reasonable length / orientation to be fully removed in a follow-up tummy tuck. 
You certainly can remove skin and tighten the muscles through a vertical scar, but this is not idea because you will not be able to hide the scar in a 2 piece bathing suit.  Ask your gynecologist if they have worked with any plastic surgeons before for combined operations, and then arrange a consult with that surgeon to discuss these issues.

Richard P. Rand, MD, FACS (retired) · Answer

If your gyn surgeon felt comfortable with the plan and if your plastic surgeon felt you were a good candidate for a tummy tuck, these could be done possibly at the same time. The advantage is that it eliminates the vertical skin scar and has only one recovery.  The plastic surgeon starts the case by lifting the abdominal wall up to the level of the xyphoid thus exposing the entire abdominal midline.  The gyn surgeon then comes in and can open the midline even more than when they make a scar from umbilicus down.  The muscles are closed after the hysterectomy and then the tummy tuck is finished by the plastic surgeon.

Tummy Tuck Possible with Vertical Incision?

Answers (5)

Answer: Tummy Tuck at the time of Hysterectomy

Answer: Tummy Tuck at the time of Hysterectomy

Answer: You would need to coordinate this with a plastic surgeon and your gyn surgeon

Answer: You would need to coordinate this with a plastic surgeon and your gyn surgeon

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Tummy Tuck Possible with Vertical Incision?

Answers (5)

Answer: Tummy Tuck at the time of Hysterectomy

Answer: Tummy Tuck at the time of Hysterectomy

Answer: You would need to coordinate this with a plastic surgeon and your gyn surgeon

Answer: You would need to coordinate this with a plastic surgeon and your gyn surgeon

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Recommended reading

Everything you need to know about Tummy Tuck

Our mission is to create a world where every investment in modern beauty is Worth It.