Do I have enough skin to be removed? (Photo)

Ideally, when doing the “pinch test” to determine what skin can safely be removed from a patients lower abdomen, the thumb is placed just above the top of the pubic hair and the fingers just above the belly button. If you can easily approximate the thumb and finger, all the tissue between can be removed. You may not have that much laxity to your skin, but still wish to keep the horizontal part of your incision as low as possible so your surgeon realizes the belly button opening won’t be able to be removed and would be closed as a small vertical scar. One other option is to have your tummy tuck incision slightly higher up your lower abdomen, which would make it easier to approximate the upper and lower skin, without the need for the T part. Have a detailed discussion with your plastic surgeon about which would be best for you. Best wishes.

You are a good candidate for a tummy tuck. It looks like there is some muscle stretching in the mid-lower abdomen, and you have loose skin above your belly button. While surgeons always discuss the possibility of a vertical scar if the belly button hole does not reach down, you will still benefit. Also, while it is possible to not have a vertical scar, if you do need a vertical scar, the trade-off for a flat, smooth tummy is still valid.

Hello Sashy87, thank you for your question regarding your upcoming mommy makeover and concerns about the amount of skin available for removal.

From your description and the photos provided, it appears that the core issue affecting the contour of your abdomen is the weakened lower abdominal musculature. This is common among women post-pregnancy, and addressing this through muscle repair is essential for achieving a more toned and flat abdomen.

Muscle Repair: Your rectus abdominis muscle, which has likely been stretched or separated due to pregnancy, needs suturing from the xiphoid process down to the pubic region. This will help tighten your abdominal wall and correct the bulge that typically persists when the muscles have loosened.

Skin Removal: Concerning the skin removal, while you do have some excess lower abdominal skin, it’s not excessive. This is why your surgeon has recommended an inverted T tummy tuck. This procedure involves a horizontal incision across the lower abdomen (similar to a traditional tummy tuck) combined with a vertical incision. This vertical component helps remove and tighten vertical excess skin and is particularly useful in cases like yours where horizontal skin laxity alone is not sufficient.

Vertical Scar: The small vertical scar below your belly button that your doctor mentioned will likely be where your belly button was repositioned. This is a common aspect of the inverted T technique and helps in managing the excess skin without creating excessive horizontal tension.

It’s understandable to feel anxious before such a transformative procedure. However, based on your surgeon's approach, it sounds like they have tailored the procedure to suit the specific conditions of your abdominal anatomy—focusing on muscle repair and appropriate skin removal.

Discuss all your concerns with your surgeon prior to surgery to ensure all your questions are answered and you feel comfortable moving forward. This planning and communication will help achieve the best possible outcome for your mommy makeover.

I hope this explanation helps ease your anxiety and provides clarity on what to expect from the surgery. Good luck with your procedure!

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon