Will I Need a Small Vertical Incision for my Tummy Tuck? (photo)

I am aware of the issue of leaving a T scar after a tummy tuck and I agree that is would be nice to avoid it. There are very few cases in which I have found this necessary and believe your case can be done without the T scar. You C section scar may appear low, but it will migrate superiority with a tummy tuck. Many surgeons tell their patients there might be a small vertical scar to make sure they are fully informed prior to surgery, even though it is not needed in the vast majority of cases.

As the old adage goes,"Plastic surgery is a constant battle between blood supply & beauty". Judging from the pictures you have posted, the C section scar is really low and as pointed out by the plastic surgeons you have consulted it would be difficult to pull the skin all the way down. So, in my opinion too, it would be best to go with a small vertical scar during the procedure to ensure a safe outcome (in terms of wound healing).

The vertical component will fade over a period of time and will hardly be a cause of concern in the long run. All the best with your procedure.

Even though your C-section scar is low, the normal location of the lower incision for an abdominoplasty is about 5-6 cm above the clitoral hood. And it appears as if your C-section scar would be removed with the surgery anyway. I would suggest that you will likely not require the vertical incision. With that being said, you still have a small risk of requiring that incision, so you need to be prepared for it, just in case. It really is impossible to tell for sure with photos alone.

Thank you for your pictures. Based on your pictures I think that you will end up with a small T closure. This can't be position within the panty line. I believe that you'll get a great improvement of your abdominal contour. Best wishes.

Dr. ES

Great question!

There are a number of issues here.

If you want to position the incision through the previous caesarian scar (which you should) then I think it likely that you would end up with a small T scar. However, after a year or so, the vertical  stem of the T may be removed once the tissues soften up, leaving you with a normal transverse scar. Whenever I anticipate this, I position the belly button a little higher than normal because the second operation (removing the stem of the T in a transverse ellipse) will bring it down a little.

You appear to have an umbilical hernia and this should be fixed.

Lastly, your abdomen bulges significantly and this is not all due to subcutaneous fat. There may well be a permanent intra-abdominal component. Despite muscle tightening, and the removal of loose skin, you may still be left with a convex abdomen. Intra-abdominal fat cannot be removed. It may only be reduced by diet.

It is sometimes not possible to know if a T scar is needed until the time of surgery.  Most of the time, however,   it is fairly predictable who will and who won't.  Usually it is patients who do not have a lot of loose skin but their main issue is bulging of the abdomen caused by post pregnancy diastasis of the rectus muscles.  These people frequently will need a T scar but the trade off for the scar is a much better abdominal shape.  There are a number of ways to deal with the scar and get excellent results as far as contour and scarring are concerned.  It is always good to be prepared for a T scar and hope that you don't need it.  It should still be OK since even the T scar will be low on your abdomen and likely to be easily covered in your bikini line.  You can check out the photos on the link below to see if there are any body types that resemble yours which may give you insight into what you may expect.  Also you seem to have an umbilical hernia which should be discussed as well.

Because there is a long distance between the umbilicus and the C-section incision, you may be able to limit the abdominoplasty scar by having a small vertical incision. 

Your umbilical hernia should also be repaired at that time.

                      A high umbilicus coupled with a low C section scar should involve consideration of a vertical scar.  However, in your case you appear to have a great deal of abdominal wall laxity that when repaired may allow for more effective length to avoid the vertical scar.  Find a plastic surgeon with ELITE credentials who performs hundreds of tummy tucks each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

It's very possible that you may require a vertical incision but usually the scar heals well and is lower on your abdomen.  In women without a prior scar, the alternative would be to make the scar higher.  A higher horizontal scar is more difficult to camouflage than a small vertical one.Quintessa Miller MD FACSSan Antonio Plastic Surgeon

Its tough to answer this question just based on a photo.  I would defer the answer to the plastic surgeons who examined you and informed you they may need a lower midline scar.   This may be needed because 1) they are trying to place your transverse tummy tuck scar as low as possible and 2) you may have limited excess skin above your belly button.   Best wishes,

Dr. Basu

Houston, TX