Would a mini TT work for my goals? Or would I need a full? (Photos)

Question

I’ve had consult with a plastic surgeon as well as general surgeon. I have a smaller sized hernia at my belly button, as well as an almost 4 finger Diastis separation at my belly button. CT scans have confirm my separation is at belly button and below. I don’t think I have extra skin above my belly button to remove. It’s mostly at or below my belly button. Originally, the plastics said fully TT (before knowing CT results). Now they are saying they can do a mini TT and fix my belly button. However, he did say because my belly button sinks inward, and has no volume, I could maybe need a fat graft later if I didn’t like it? But he’d be able to remove c section scar and some skinny under belly as well. My other option is no TT, and go through the general surgeon. However, they said they wouldn’t do the surgery robotically, and would remove hernia and repair muscle with a vertical incision on my stomach. It would be about the size of my pointer finger I guess. However, he mentioned he didn’t know that I’d like how the scar would heal, even after trying to fix my “distorted” belly button. I’d love to get some opinions as to whether the mini would be worth it, or try and go general surgery route based on my figure and needs.

Frank Agullo, MD · Answer

You have a hernia. It is likely to be amenable to a repair during your tummy tuck. The fact that your belly pooches out in profile is also amenable to a tummy tuck.

You are lean and do not appear to have much of an excess of skin in your lower abdomen. For this reason I would consider a mini tummy tuck, and you are the rare patient it is actually built for. The fix I use involves removing the skin that hangs over your c-section scar. This incision also gives access to allow your hernia to be repaired and your rectus muscles to be plicated (sewn together) to flatten out your profile. The skin above your belly button needs to be lifted in order to repair the rectus from the xyphoid to the pubis, otherwise, you will have upper abdominal bulging.

If your plastic surgeon is willing to do the hernia repair and plication himself and is willing to plicate all of it, I think a mini tummy tuck would be my recommendation.

The general surgery route would leave you with a vertical scar in the middle of your abdomen, which would be particularly noticeable on your otherwise flat abdomen, and would not improve the appearance of your c-section scar.

#StayBeautiful,
@RealDrWorldWide

Gerald Minniti, MD, FACS · Answer

The majority of plastic surgeons are still focused on removing the hole that exists in the abdominal skin of a full tummy tuck as part of the skin excess to be removed, avoiding a relatively short vertical scar. This prioritization creates problems for not just many people like you, but for people who are considered good candidates for a full tummy tuck. Surgeons in this camp believe that placement of the long scar should vary depending on how much skin excess a person has above their belly button, leading to long scars that are essentially too high and forever too noticeable. Instead, ignoring skin excess above the belly button and focusing on proper placement of the long scar, which should match the underlying deep anatomy of the lower abdomen (the pubic bone, the anterior hip bones, and the inguinal ligaments joining those bones), gives the patient a very low, long incision that becomes virtually invisible. The resulting vertical scar also becomes invisible too, even when it may appear above a tiny bikini. For women like you, it's even worse. Nothing short of a full tuck will allow the proper tightening of the abdominal wall as well as reconfiguring the appearance of the belly button into one that looks normal. Get your full tuck by a surgeon who is not afraid of the small vertical scar.

Would a mini TT work for my goals? Or would I need a full? (Photos)

Answers (2)

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