Not happy with my atypical operation. Could I have a big tummy tuck? (Photo)

Question

Hello In 2023 I had an atypical stomach operation and I am not satisfied. I have been through 2 pregnancies, one of which was a twin pregnancy. The skin both above and below the bellybutton level was/is very loose/soft. I also got an umbilical hernia, and my stomach also seems to go inwards at the abdominal muscles. 1. Do you think I could have had a big tummy tuck? 2. Can I have a new operation, that Can make the result better? In relation to bellybutton, scar, loose skin, muscles?

Daniel Butz, MD · Answer

A revision abdominoplasty would improve your results and address yours concerns re: skin laxity, muscle separation and scar location. How low the scar can be placed might be limited by the previous surgery - if they removed skin above the belly button that could limit what we have left to work with. When you're sitting up there does seem to be adequate laxity to make a big improvement though. 
Get a few consultations from board certified plastics surgeons to ensure you're getting the best option for your situation.

Gary M. Horndeski, MD · Answer

It appears you have enough excess skin to undergo a tummy tuck, which will excise the old scar.

Best Wishes,

Gary Horndeski, M.D.

Arif Eroglu, MD · Answer

Hello; During your surgery, an incomplete transverse incision was made at the belly level. When I look at your first appearance, with Lipoabdominoplasty; it looks like a Full Abdominoplasty and muscle repair can be done at the same time. When such a surgery is performed; in the best case scenario, at underwear level; an incision scar; in the worst case scenario; at the level of underwear, an incision scar and in the midline; placed perpendicular to it; you would have another incision scar; which is around 3-4 cm long. Currently, it is not possible to do this; because, there is no looseness left in your upper abdomen; as well as a horizontal incision at the level of the belly button; it limits for all possible surgery options. An incision; that is made at the underwear line; with the incision above; there is a possibility of tissue necrosis; which is developing in the area in between. Due to this reason, even if a Mini Tummy Tuck procedure is attempted; there would be a risk of developing necrosis.

J. Timothy Katzen, MD, FACS · Answer

Hello Enthusiastic791587,

Thank you for your question and for sharing your concerns. Given your history of two pregnancies, including a twin pregnancy, it's understandable to have loose skin both above and below the bellybutton, as well as an umbilical hernia and muscle laxity.

A revision tummy tuck can indeed help address the issues you're experiencing. During the revision, the surgeon can remove excess skin to tighten the abdomen. Additionally, muscle plication can be performed to ensure that your abdominal muscles are tight and to correct any rectus diastasis (separation of the abdominal muscles) that might be contributing to your concerns.

This procedure can also improve the appearance of your bellybutton and the placement of scars, providing a more aesthetically pleasing result. It’s important to consult with a board-certified plastic surgeon who has experience in revision surgeries to discuss your specific goals and to ensure the best possible outcome.

I wish you the best in your journey towards achieving your desired results.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS

Ajaya Kashyap, MD · Answer

Thank  you for your query. I would definitely recommend a regular tummy tuck to improve the results of your procedure and hide the scar better, as well as to tighten the muscles and the skin. Please find an experienced board certified Plastic surgeon who can examine you and help you with all your concerns. All the best!

George Marosan, MD · Answer

Thank you for your question and photos. Yes, this is a very atypical or unusual approach for a tummy tuck and umbilical hernia repair. Based on these photos, you will need a full tummy tuck with a low pubic bone level incision. You seem to have lots of skin in the lower abdomen and most likely that high horizontal scar can be removed. This is determined based on an in person consultation and physical examination. I do these surgeries in our certified in office surgery suite under deep intravenous sedation. See a board certified plastic surgeon for an in person consultation/evaluation. Good luck.

Miguel Mota, MD · Answer

I’m sorry but you should’ve gotten a traditional tummy tuck in the first place. I actually love atypical procedures, this is why I like the inverted tummy tuck so much….. but I never seen this! 
When patients seem to not have enough skin for a traditional tt we can either do a mini tt, or the following option I will list bellow.
1st option: A tradicional TT with a higher then usual scar or 
2nd option: A traditional tt with a small one inch vertical scar on the pubic part of the horizontal scar (in order to help the skin reach down as much as possible) or
 3rd option: A traditional tt with the small vertical scar “floating” between the belly button and the tt scar. These were all better options back then and they are your only options now as well.

Best of luck,
Dr. Miguel Mota

Tek Przylecki, MD, FACS · Answer

Hello,Gaging from the photos, you may be a candidate for a tummy tuck that could move your transverse scar lower. However, to see how low that scar could be positioned and to see if your rectus abdominus muscles should be plicated (repositioned and sewn more midline), you need a physical examination. In general, a tummy tuck would incorporate your scar and remove the tissue between your belly button and lower abdomen just above your mons/pubis while repositioning your belly button. I hope this helps answer your question. As always, seek evaluation by a board certified plastic surgeon. Best of luck on your journey!

Ronald J. Edelson, MD · Answer

Your situation could be improved with a standard tummy tuck. However, in order to deal with the current scar your new scar might be a bit higher than in a typical tummy tuck. But the scar can be brought down lower than it currently is

Gene Sloan, MD · Answer

Assessing a patient by photos instead of an in-person exam is never ideal. But I have seen many patients with pre-operative anatomy similar to yours. Judging by your preoperative photos, I would have recommended a more conventional abdominoplasty approach with an incision around the umbilicus and a lower abdomen horizontal incision. Umbilical hernias are commonly repaired by that approach. You don’t have a lot of redundant upper abdominal skin, so you would have ended up with a short vertical scar from the umbilical defect being pulled lower towards the horizontal scar. Your umbilicus appears to sit a little low, so I would not try to float the umbilicus. You appear to have good upper abdominal muscle tone, so I probably would have limited muscle tightening to the lower abdomen.

That approach would place the horizontal scar lower and reduce the folding you see at your current scar. However, it would not eliminate all the extra skin that you see while sitting. Stretch marks indicate that the skin has lost its elasticity. So the skin would still behave that way to some degree, but perhaps less and certainly lower down where it would be better hidden in midriff revealing clothing.

Unfortunately, at this point. I do not have a good solution for your current problem. With the length of that horizontal scar, I certainly would not attempt correcting it by a conventional abdominoplasty.

Not happy with my atypical operation. Could I have a big tummy tuck? (Photo)

Answers (14)

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