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

I'm a 33 year old 5'6 130 lbs mother of two. I've had 2 csections and my scar is very low. I'm getting different answers from different surgeons regarding having a "T" scar. 2 have told me that I will have to have a small vertical incision because my csection scar is really low and there is not enough skin to pull down and another has told me that he is able to do it without the vertical scar. Based on what you can see from my pictures, what do you think?

Doctor Answers 26

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

Dear AM,
Thank you for your post.  It is probably a close call if there are multiple surgeons saying different things.  The surgeons who are saying that there will be a 'T' Scar are telling you this incase there is a 'T' scar.  They will, of course, not place a 'T' scar there if it is not needed.  I would advise you to go with the surgeon that seems the most competent and you are the most comfortable with, not just the one saying what you want to hear.  This may be the same person, but don't not choose the other surgeons because they are preparing you for a possibility. 
Best wishes,
Pablo Prichard, MD

Phoenix Plastic Surgeon
5.0 out of 5 stars 47 reviews

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

Your examining surgeons have it all over those of us offering opinions based only on photos. I have a little disconnect with your reported height and weight and the photos, making me all the less comfortable offering advice without an exam.

Your c-section is low, but that is not an issue. Your navel seems a bit high, and the skin from chest to navel looks inadequate to reach all the way to the current scar. There are a number of ways to deal with that.  I have seen patients who went to surgeons who promised no vertical scar, and true, they don't have one, but the entire horizontal scar is so high that it cannot be hidden in two-piece swimsuits or undies.  Not a breast solution.

An alternative in some cases is a "umbilical float" where the navel is lifted off the abdominal wall (this would allow easy repair of the hernia I think I see in the photo), and repositioned a bit lower. This is a compromise, to be weighed against the benefits of no vertical scar and no umbilical scar. 

Often the best choice is to accept the vertical incision.

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Tummy Tuck Scar Options

The distance between your belly button and your existing c-section scar is considerable. Knowing this your options are to have a new incision (scar) placed above the c-section scar to avoid having a vertical scar or accept the distinct possibility that a small vertical scar may be needed if the c-section scar is used. You have to decide whether two low horizontal scars or a vertical scar is preferable to you.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

I Need a Small Vertical Incision for my Tummy Tuck?

Thank you for the question and pictures. Based on your pictures, it is easy to understand why a plastic surgeon consult has discussed the potential need for a vertical scar with you. As you have noted, your C-section scar and your umbilicus is relatively high on your torso.

 Your choice would be, using a  higher incision to perform the  tummy tuck operation ( you would then have a 2 scars  present)  or accept the possibility that a vertical scar may be necessary to avoid too much tension on the midsection of your tummy tuck closure.

 My best advice to you would be to choose your plastic surgeon carefully.  Allow him/her to communicate your goals and preferences carefully.  Doing the before mentioned steps will allow you to achieve a very nice result  with tummy tuck surgery,  even if a short vertical scar is necessary.

Tummy Tuck surgery involves a significant physical and emotional recovery ( often underestimated by surgeons and patients alike); a few words of advice may be helpful:

1. Make sure you are doing the procedure for the right reasons (for yourself)  and that you have realistic expectations.  Be aware that an improvement in the “problem area” may not translate to an overall improvement in your life   situation.  You are bound to be disappointed with results of the procedure if your motivation for doing the surgery is not internally driven.

2. Time your surgery carefully; generally, it is not a good idea to have surgery done during or immediately after a stressful period in life (for example divorce or death of a loved one). The additional stress of surgery will undoubtedly be  more challenging to deal with if a patient's emotional reserves our already exhausted. Remember, that an improvement in your physical appearance will not translate to an improvement in your life situation.

3. If possible speak to patients who have undergone similar procedures and query them about the toughest times of their recovery period. Any practical hints previous patients can provide may be very helpful.

4. Make sure you are aware of potential complications that may arise how to reach your surgeon if necessary.
5. Make sure you have a strong and patient support system (several people if possible) in place who have time/patience to take care of you. Arrange for professional nursing if any doubt exists regarding the availability and/or stamina  of your caretakers.

6. Be patient with the healing process, understanding that it will take several weeks to months to feel “normal” again. It may also take many months/year to see the end results of your surgery.

7. Be prepared to distract your mind with things of interest such as books, magazines, and movies.

8. Expect less of yourself; do not go back to work, school or chores too early and let others take care of you (for a change).

9. Pick your surgeon carefully (a well experienced board-certified plastic surgeon) and trust in his/her advice. Keep in close communication with your surgeon and do not hesitate to communicate questions/concerns and the   emotional swings that you may experience.

10. Resume all medications that you were using preoperatively when cleared by your plastic surgeon and stop the use of narcotics and sedatives as soon as feasible after surgery.

11. Keep in mind the end results as you go through the tougher emotional times after your surgery.

 I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,486 reviews

Vertical scar needed for abdominoplasty?

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 FACS
San Antonio Plastic Surgeon

Quintessa Miller, MD, FACS
Fort Walton Beach Plastic Surgeon
5.0 out of 5 stars 6 reviews

Will a small vertical scar be needed?

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

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 209 reviews

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

Your problem is not whether you need a vertical scar or not.  The problem I see from your photos is mainly the fact that you have intra-abdominal obesity and not the typical redundancy which responds best to TT.  It is not possible to say without examining you, but if in addition to the intra-abdominal obesity you have weakness of the abdominal wall, a standard TT may not be adequate and you may need mesh re-enforcement to prevent recurrence of this bulge.  Whether a vertical resection will improve your outcome can only be determined at the time of surgery.  So I would tell my surgeon to go ahead with the additional vertical portion if he feels it necessary at the time of surgery.

Ruben B. Abrams, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 19 reviews

Tummy tuck questions

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.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Tummy tuck scar

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.

Sameer Karkhanis, MS, DNB
India Plastic Surgeon
4.9 out of 5 stars 126 reviews

Small Vertical Incisions & Tummy Tucks

Thank you for your question and photos.  If two surgeons recommended that you compromise with a small vertical incision above your TT scar...I would heed their recommendations.  The have had the benefit of examining you and are interested in keeping you safe and giving you the best cosmetic result.  Base on your photos you have a long torso, high belly button and not a tremendous amount of laxity...these are observations and can only be confirmed with examination.  In this situation, leaving a small vertical scar where the original belly button exited is the safest and most prudent way of avoiding over resection and skin necrosis and wound separation.  These are all complications that you should avoid.  A small vertical scar that heals well and fades with time is a small price to pay for a safe and uneventful recovery.  All the best.

Robert F. Centeno, MD, FACS
Columbus Plastic Surgeon
4.9 out of 5 stars 77 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.