Tummy tuck Revision after two more c sections 10 years post my first tummy tuck. Just skin removal? (photo)

Dear Mama Meg,
it is hard to tell for sure without an examination. If you had two pregnancies there is a chance that you have muscle separation. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Even though your photo is inadequate to answer your question, I can tell you after a quarter century of doing this that you will need a full tummy tuck with all the bells and whistles, including a retightening of your abdominal wall and resection of excess skin. Like everyone on the planet who's not a plastic surgeon, obstetricians have no idea about abdominal wall changes after pregnancy, and making a diagnosis of 'no diastasis' has no bearing on your abdominal contour. Suffice it to say that you will need replication. In addition, my tummy tucks have very low incisions, always lower than c-section scars or other surgeons' previous tummy tuck scars. So, that wide and depressed scar you have now would be eliminated, and the resulting scar would be fine and flat, making a smooth transition from lower belly to pubic mound. How can I be so sure? Because very few surgeons used progressive tension sutures (PTS) ten years ago, and many still don't use them today. These are crucial for optimizing skin tension (especially above the belly button), reducing tension at the incision, and negating the need for drains. Also, I use a taping system after surgery for three or more months, that mechanically supports your incision so that the resultant scar is finer.

Your photo is very limited so the amount of excess skin present cannot be determined. Go in for a consultation and see what can be done. I would suggest losing all the weight you want to first, and then have surgery.

Once you have reached your goal weight schedule a consultation with a board certified plastic surgeon near you. Your abdominal wall may not have separated, but it may have stretched. Your surgeon will be able to advise if a full revision or just skin removal is needed at that time.

It would be very beneficial to be able to see your entire abdomen as to ascertain how much skin you have and what your muscle tone is like. I would venture to say that after two more pregnancies and 10 years from your last abdominalplasty, you most likely will need a second round of abdominalplasty. As far as the muscle tightening is concerned they can either be determined by your Plastic Surgeon or decide upon intraoperatively and of course the goal of the tightening would be that if you wish to have a flatter abdomen and of course a morecurvaceous core. You're definitely going about it the right way by first losing all the weight that you desire and then consulting with a board-certified plastic surgeon that should be able to devise a plan aligned with what your goals are. I would definitely bring in some core exercises during the weight loss. To see if you can strengthen the core and possibly avoid the need for muscle tightening. Good luck with your weight loss suffers and congratulations on the two new additions.

Obstetricians have a very different way of assessing muscle separation than plastic surgeons.
They typically assess muscle separation by seeing if there is space between the two rectus muscles.
Muscle separation means a lot more than the two rectus muscles sitting apart.
To plastic surgeons muscle separation means the abdominal wall is bulging.
There’s no way you’re going to feel muscle separation after a tummy tuck.
The muscle layer was sutured, but that doesn’t mean that the new pregnancies were unable to stretch your abdominal wall.
If your muscle wall is bulging, then you may need re-tightening of your muscle wall.
If your muscle wall is straight, making a B line between your sternum and your pubic bone, then your muscle wall does not need tightening.
I suggest scheduling in person consultations with plastic surgeons in your community when the time is right.
Best,
Mats Hagstrom, MD