Hello, my plastic surgeon said that he would be hesitant to do a full tummy tuck on me because my skin is quite taut above the belly button and the only real loose skin is below the belly button. He feels that I would end up with a scar that would be higher than desired and/or likely a vertical scar as he doubts he would be able to pull the belly button hole down far enough to have a nice, low scar. He feels that a mini will be adequate for me. What circumstances dictate a mini vs full?
How Much of a Limiting Factor is Very Little Loose Skin Above the Belly Button in Having a Full Tummy Tuck?
Doctor Answers 8
Mini or full tummy tuck?
Thank you for the question and pictures.
The plastic surgeon you have seen has brought up some valid concerns in regards to positioning of the abdominoplasty incision and the potential need for a short vertical scar. However, having said that, I think you will likely be an excellent candidate for a full tummy tuck procedure.
In my opinion, the mini tummy talk is an operation that produces very limited results and is very rarely indicated. It involves a shorter incision but does not address the majority of the abdominal wall issues present for most patients who present consultation. For example, the area of skin excised is quite small. The abdominal wall musculature is addressed below the umbilicus leaving the upper number wall potentially lax. The appearance of the umbilicus is not necessarily addressed sufficiently.
For most patients who have had pregnancies and/or weight loss a full abdominoplasty is necessary to achieve the desired results. Of course, there are downsides (including a longer scar and probably a longer recovery time) but for most patients the benefits outweigh the downsides. It is not unusual to see patients who've had mini tummy tuck surgery present for revisionary surgery.
I hope this helps.
Mini vs. Full abdominoplasty
Thank you for submitting pictures with your question.
The pictures suggest you need plication of your rectus muscles in the mid line (Diastasis repair) to tighten your belly. Mini tummy tucks are usually the exception rather than the rule. Whenever you have loose skin folds ("Hooding") over the umbilicus you are better served with a (full) abdominoplasty. It is rare that the "above the umbilicus skin" is so tight that you cannot remove the skin underneath the belly button completely. You want the best result you can achieve !
In any case the surgeon who examines you can determine best. Nevertheless you may consider a "second" ( or third ) opinion as mentioned by my colleagues.
Full tummy tuck vs mini
I would have to pinch the upper abdominal skin to be sure, but in the majority of patients with your apparent problem, I am able to remove the old belly button site. It is unusual to be so tight and taut so as not to be able to do that. I have only had a few where the upper abdominal tissues are stiff so the belly button hole cannot be removed. In some of the patients the result is quite tight and it might be 2 or more weeks before the skin relaxes enough so you can stand up straight. I believe that you have too much looseness for a mini-tuck to hhave a satisfctory result.
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Tummy Tuck With Loose Skin Only Below the Belly Button
Without the benefit of an exam to assess the degree of skin laxity and the positioning of particular anatomic points it is difficult to provide an accurate assessment. Based on your photos I believe that you would be an appropriate candidate for a full tummy tuck. It is possible, however, that the limitations your plastic surgeon discussed with you may affect your final result. I reserve a mini-tummy tuck for a very small subset of women who have minimal lower abdominal skin laxity and muscle bulging below the belly button. I do not believe you would be very happy with a mini-tummy tuck based on your photos. Another opinion from a board-certified plastic surgeon may be very beneficial. I wish you all the best with your result!
Get a second opinion
There is usually more than one way to skin a cat, that includes doing tummy tucks -- see another doctor, If you have had children, I have ALWAYS been able to remove all the skin below the belly button with a low incision and the rest comes down nicely.
Mini Tummy Tucks After Pregnancy
Mini tummy tucks may have value in other plastic surgeons' practices, but I have never found them valuable in anyone who has delivered a child. From your pictures, I feel you would be an excellent candidate for a full tummy tuck (abdominoplasty). Your leaning forward picture shows muscle separation both below and above your belly button (umbilicus), and there is loose skin in the upper portion of your abdomen. To me, this means you need a full abdominoplasty.
When I was early in my practice of plastic surgery, I did several mini abdominoplasties on post pregnancy women, and neither I nor they were very satisfied with the results. I recommend, as others have, that you get a second opinion as I feel a mini tummy tuck would leave you with loose skin above your belly button, especially when you sit down.
Mini vs. Full Tummy Tuck
A full abdominoplasty will allow access to the loose skin, fascia(muscles), and fatty tissues above the belly button. However, there are anatomic and physical limits to how much of these tissues are tightened. If there is significant loose skin between the breasts and belly button, even conventional full abdominoplasties may not address this concern. Alternative procedures such as a "reverse" abdominoplasty" and vertical midline incisions can be considered but the scars are very difficult to conceal.
Full tummy tuck versus mini tummy tuck
Your photos are helpful but don't fully delineate your situation. This would best be determined by an examination. You clearly have loose skin and protuberance of your abdomen below your umbilicus; above it can't be well discerned.
What your plastic surgeon has apparently discussed with you as you relate is/can be true. If you don't have any excess skin above the belly button and no laxity, a mini-tummy tuck usually will be the better choice. Conversely, if there is both laxity and a protrusion related to underlying muscle laxity, then a full tummy tuck would usually be more appropriate.
You may want to seek a second opinion from a board certified plastic surgeon and then determine what makes sense to you (among other issues).