Enough skin for a full TT? (Photos)

Question

I’m 38, 5’9” and 147 lbs. I have had a twin pregnancy and two singleton pregnancies and am done having kids. I’m currently signed up for a mommy makeover with a top surgeon who only does/specializes in body surgery, but am having second thoughts about the tummy tuck portion. I have very little loose skin, a long torso and a high belly button. My PS says I need a full TT due to significant diastasis above and below the navel. He said I will need either an inverted T scar or possibly floating vertical scar depending upon how far he can stretch my skin. I really want a low scar, and am concerned it will be too high (either the horizontal or vertical or both) due to lack of skin. That said, I’m tired of sucking in my stomach 24/7 to not look pregnant and have constant back pain when trying to lift weights, kids etc. Thoughts?

Chet Mays, MD · Answer

Thank you for your inquiry! You have excess abdominal skin and separation of your diastasis recti muscle making you a great candidate for an abdominoplasty procedure. We would love to see you in person and help you reach your goals. Schedule a consultation with a Board-Certified Plastic Surgeon like myself and we can create a surgical plan for you!

Jeffrey M. Darrow, MD · Answer

Thank you for your photos.  To flatten and tighten the foundation of your tummy, your diastasis needs to be repaired from xiphoid to your pubic bone.  You also wish to have the lowest scar possible.  Your options would be: 1)  an incision around your belly button, leaving your belly button in it’s original position, with subsequent closure of that small opening as a vertical incision between the lower abdominal horizontal incision and your belly button.  Your belly button is brought out through a new incision in the upper abdominal skin which has been pulled downward, and your belly button is in the same position, or 2). An Umbilical Float.  Your low abdominal incision is made, and the skin elevated up to your belly button. The stock of your belly button is then simply transected inside. There is no incision around the belly button on the outside and your belly button remains attached to your abdominal skin. Your abdominal skin is then elevated so your diastasis can be completely repaired. Your abdominal skin is then pulled downward to tighten the skin and  the stock of the belly button is sutured into the new position.  Your belly button has been “floated” down your tummy.  This works well in people who start out with a very high belly button.  An “umbilical float” would you the lowest scar possible, no additional scars on your skin, with the trade-off that you may feel your belly button sits slightly low.

Gary M. Horndeski, MD · Answer

At 5'9 and 147 lbs., your BMI is 22 and you quite thin.  After twin pregnancy, your fascia, which is the support layer of the abdominal wall, has been irreversibly damaged.  This is why you appear pregnant. 
You do not have excess skin but have very weakened fascia.  Suturing the fascia will be unsuccessful. 
I recommend an overlay of mesh and have been doing this procedure for 30 years.  You would benefit from mesh reinforcement of the lower abdominal wall.  This can be done through a transverse lower abdominal incision and minimal skin will be removed.  The fascia is tightened and mesh is laid on top of that.  The position of the umbilicus will probably stay the same.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

From the photos you appear to be a candidate for a standard tummy tuck.  This will remove excess subcutaneous fat and skin as well as correct abdominal wall laxity.  The result will be a flatter, tighter tummy.  For the best results see an experienced board certified plastic surgeon and be sure to discuss your concerns with regard to incision placement.

Daniel Barrett, MD · Answer

Dear Thoughtful284658,

based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because only after a thorough examination you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

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