Do I agree to an inverted T abdominoplasty for the best results? Please help as I need many opinions to make the best decision

Hello, thank you for your inquiry and photos. It is a bit hard to determine without and in person evaluation, based on your photos and weight loss there seems to be excessive skin so it is possible that a inverted T fleur de lis would be needed for best results. I recommended seeking a board certified plastic surgeon for in person consultation to discuss details. Best of luck

As you can see from the drawing that you have provided on the inferior T abdominoplasty, the area that is excised resembles a fleur de lis design (if the lines were slightly curved outward rather than straight) which is why we call this type of procedure a fleur de lis abdominoplasty (FDL TT).  You have severe stretch marks that extend higher on your abdomen than most, but this does not necessitate a FDL TT.  You appear to be a great candidate for a traditional abdominoplasty.  Some have suggested "floating" your belly button to avoid external scars or recreating the belly button at a later date, both of which seem like a bad idea which will only give you an unnatural appearance with time.  You will be well served by a traditional tummy tuck with a low scar that can be hidden in a bikini, anything beyond that, based on your pics, will only inhibit your long-term result.  Best of luck!

Hello and thank you for your question. You do not need an inverted T incision.  Based on your photographs, you are a great candidate for a tummy tuck with liposuction.  This can be done through a low and short incision, all completely below the bikini line.  The belly button can be designed to look natural and have no scars on the exterior.   Your muscles can also be plicated resulting in a flat abdomen.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.  

Best wishes and good luck.


Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon
 

Thank you for your question and photos. I personally would NOT do an inverted T abdominoplasty on you. If you were my patient, I would do VASER liposuction 360 degrees with a low incision abdominoplasty, removal of your belly button completely and reconstructing it at a later date (1 months out). This type of procedure will give you an hourglass figure. You might benefit from fat grafting to the buttocks (although no photo is included to see your sides or back). A standard abdominoplasty or inverted "T" abdominoplasty is only a 2D procedure as opposed to addressing your whole torso, which is a 3D procedure. See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

From the photos you appear to be a good candidate for a tummy tuck. An extended tuck without the inverted T incision will give you a significant improvement. The trade off is that you may still have a little looseness of skin above the belly button. I encourage you to visit with a few board certified plastic surgeons to listen to opinions as an in person assessment will enable the best recommendation.

an inverted T would be best for removing that and improving your waist at the trade off of the vertical scar.  To those who say they can get you a great outcome without the vertical scar, if you choose that route, please get in writing what the anticipated goals are and if not met, then what will they do for you to achieve your desired outcome.  This isn't needed with the inverted T because the loose, lax skin is removed.  There is some excess at the upper vertical scar that may need a revision but when it comes to removing skin, you cannot beat the inverted T.  

The decision whether to go for the Fleur-de-lis inverted T incision really comes down to whether or not the vertical incision will improve the result enough to make the added scar worth it. Standard Tummy tucks remove skin in the vertical direction so can get rid of stretch marks below the belly button tighten the skin nicely. Many patients with large weight losses have extra skin in the horizontal direction and adding a vertical incision is the only way to address these issues (skin and stretch marks above the belly button). Looking at your pictures, it appears you have some extra skin there but the result from a standard Tummy tuck would tighten the skin nicely, albeit the Fleur-de-lis would do that better, but with the compromise of a midline scar. I have had patients choose either way, in fact, one yesterday was willing to forego the "best skin tightening" result to avoid the scar. However, the midline scar allows your surgeon to really pull the skin inward and define your waist much better. It can be a difficult decision. Best of luck. It sounds like you have seen a very experienced surgeon.

The choice of a standard abdominoplasy vs inverted T depends greatly on where a patient has excess tissue.  An inverted T or “fleur de lis” procedure is most applicable to patients with horizontal and vertical skin excess commonly associated with large amounts of weight loss.  There are other ways to also treat excess in both directions without a vertical scar by performing a circumferential abdominoplasty also known as a belt lipectomy.  To learn more about both options I recommend a consultation with a board certified plastic surgeon familiar with all varieties of abdominoplasty.  

I rarely see the need for the inverted T incision.  I work very hard to avoid that as I want my patients to be able to wear any swimsuit they want after undergoing this procedure.  Consult with a highly experienced board certified plastic surgeon to discuss all your options.

In patients with your anatomy we can get a very nice TT with the standard low incision. However it would take the inverted T incision if you want to get rid of the bad skin above the belly button, otherwise that skin would be moved down to the lower abdomen. So more scar and less skin with stretch marks or vice versa. You have a choice.