How is the amount of skin removed in tummy tuck determined?

Generally the amount of skin removed in a tummy tuck is close to the distance from your belly button to your pubic area. This of course may very depending on the laxity of your skin in general. In some cases the skin just above the belly button can be removed during a tummy tuck, but not in all cases. An exam in person with an experienced plastic surgeon can determine how much skin can be removed in your case.Best wishes,Dr.Bruno

Each plastic surgeon has his or her own unique technique for determining the amount of skin resection appropriate for each patient.  That being said, if you were my patient, I undermine all the way up to the bottom of the sternum, and at times, if necessary, onto the ribs for a distance for about 1 to 1-1/2".  In surgery, after repairing the muscle separation (rectus diastasis), we flex the table to 30 - 35 degrees at the hip, therefore allowing the greatest amount of skin removal and still allowing the patient to stand up straight after 8-9 days.  Since every patient has a different amount of elasticity and since I want to keep the scar as low as possible, I draw three horizontal lines in the mons pubic area.  The first line, which is the one I incised at the beginning of the surgery, is a fail safe position and usually higher than I end up placing the incision at the end of the surgery.  The second line is lower than the first, and I consider it in baseball terms, "a three bagger" meaning it's good but not absolutely what I want.  The third line is two finger breadths or approximately 1" above the vagina.  This allows a very low scar and an increased upward pull on the vulva which very often corrects stress incontinence.  These three lines are directly above the vagina and within the pubic hair area.The lateral lines up from these three lines is always directly in the crease between the thigh and the abdomen.  This keeps the incision low and pretty much guarantees coverage of the abdominoplasty scar by the smallest bikini.  This plus the abdominal muscle repair yields a flat abdomen which looks great in a bikini or low rise jeans and an open midriff.  

That's a great question, and neither measurements nor estimations are the best way to determine how much skin to remove. Using measurements to decide how much to remove is inherently flawed, because taking out a symmetric piece of skin is no guarantee you are leaving behind a symmetric abdomen.  Also, whatever measurements you get depend on how much stretch you put on the skin when measuring.  Many patients have a little more skin on one side than the other, and/or more stretchiness on one side than the other, and the surgeon needs to factor this in. It's what you leave behind that matters. Also, estimations are nice, but not precise. Generally speaking in most full tummy tuck candidates, especially if they have had kids or lost significant weight, the skin between the upper border of the belly button and the lower incision will be removed. I tailor the amount of skin I take out based on the amount of skin excess and the degree of laxity present. I start with marking the tummy tuck incision along the lower abdomen with the patient in the standing position. I prefer to plan for the incision to sit low, so it can be hidden in a bikini, and to be smooth and symmetric. (as opposed to the jagged incisions you can see if you look online at a bunch of before and afters) Planning this incision is a criticial step in how the final incision will look. I pull the skin up with the amount of tension I estimate will be on the skin after the excess is removed. Doing this allows me to put the scar in a position most likely to be hidden. Skipping this step means the incision will sit higher or possibly more irregularly than I want. The interesting thing here is most patients do have some small asymmetry in how much skin is present side to side, so this must be accounted for not only during marking of the lower incision, but also in marking the upper incision. This lower incision is made, and the flap of skin and underlying tissue is elevated all the way towards the xiphoid (lower part of your breastbone) and margins of the ribs on either side of the xiphoid, carefully going around the belly button. Then any hernia repair or rectus diastasis repair is performed. After, the bed is flexed so the patient is bent forward at the waist to allow for removal of the excess skin. The incision marking the upper border of skin removal is then drawn out, placing equal amount of tension on the skin on right and left sides when marking, to obtain the most symmetric result. The amount of skin will vary patient to patient, and not all patients have enough laxity or looseness to get that amount out, and in those cases there are variations made in technique. The term mini-tummy tuck is often confusingly used to refer to different surgeries, so this is more surgeon specific. For example, some do a full dissection and repair and only limit the length of the scar (so basically a short scar tummy tuck) whereas others do only skin tightening and repair of the lower abdomen. The way the belly button is managed is also very surgeon specific, and looking at before and afters is a good way to see how this can differ. Seeing a board certified plastic surgeon in person would allow for a history and physical to tell you how much skin would be expected to be removed for you in particular.

Hello,One of the most important aspects of a great tummy tuck is scar placement. In the most modern of tummy tucks, the incision is at the border between two 'aesthetic units': the thigh and the abdomen, and very low across the pubic triangle.  The initial incision determines scar placement, but the 'final cut' is made based on how much skin is mobilized and re-draped. Traditionally, and for most surgeons today, scar placement is compromised based on how much excess skin the patient has; not enough and the belly button 'hole' in the skin flap will not be excised, so the incision is placed higher, which is a mistake!! Priority should always be placed on scar placement, and if the belly button hole can't be excised, it should be closed vertically.  A small, vertical midline incision is superior to a single horizontal long scar across the abdomen that's in the wrong place (too high). Another important feature is progressive tension sutures, which allows for maximum tightening in the upper abdomen, a place that typically has wanted for more. In addition to better upper abdominal tightening, progressive tension sutures limit the need for lower belly over tightening, also a common problem, which can lead to thickened scars and even breakdown of the incision and open wounds. Finally, progressive tension sutures eliminate the need for drains, which is placed virtually in every tummy tuck patient, and is actually the cause of the number one complication of tummy tucks, seromas. Go visit a few ABPS certified/ASAPS member surgeons with decades of experience who specialize in body contouring. Best of luck!

I usually determine this in the operating room. After the skin is dissected, I flex the bed and then drape the skin downwards and mark how much skin can be excised with appropriate tension. I then remove the skin and close the incision. 

Thank you for your excellent question. While the amount of skin can be estimated prior to surgery, the real decision is made at the time of surgery. The goal is to remove as much skin as possible without putting undue tension on the skin flaps and the closure. Make sure you see a local board certified plastic surgeon for a consultation.Best of luck!

The amount of skin that might be removed can be estimated prior to surgery, but it is only during the procedure that the surgeon can determine how much skin to excise, or cut out. The goal is to cut out as much skin as possible with the waist flexed moderately, while still allowing for a good closure of the wound, so that it will heal nicely. 

The amount of skin removal in a TT depends upon the surgeon's technique and the patient's tissue characteristics.  A great deal of skin above the belly button may be removed in some patients with a lower belly button or a great deal of skin laxity. A TT will remove most of the stretch marks below the belly button.  Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Hello!  Thank you for your question!  Typically, the incision is designed to be hidden within your panty or bikini line and ideally about 7cm or so from the introitus. Once this lower line is determined, during the procedure, after the abdominal tissue has been raised, you are placed in a flexed position and the amount of excess skin that may be removed safely is marked and excised. For full abdominoplasties, the belly button is then re-inset into the appropriate position. Preoperative markings are usually just an estimate and are confirmed intraoperatively. Hope that this helps!  Best wishes!  

Great questions.  The amount of skin and soft tissue removal is really based on the amount that is available for removal.  Typically a full tummy tuck allows for an extensive amount of skin removal.  That is from the pubic area to the belly button and from hip to hip.  So usually the belly button is the upper limit but occasionally it's a little higher or a little lower depending on the location of the belly button and amount of skin excess.  Measurements are always taken to make sure the distances above and below and left and right are equally.  Mini tummy tucks take less skin and typically below the belly button and less width.  This is also measured.