Redo Mini Tummy Tuck to Correct Upper Abdominal Area?

Hi there,

One week after Mini-Tummy Tuck to correct diastasis, PS removed 450 cc's and minimal skin, but I am left with the odd upper-abodminal area looking not as tight as the lower abs. The procedure was performed endoscopically with sutures all the way up the abdomen. At my fifth-day visit, the doctor's first words were "this is unacceptable"...The two options were that: 1) it was just swelling and it will decrease or 2) worst case scenario the issue was worse than he thought and would have to perform a full procedure. Can anyone offer advice or suggestions here?

Doctor Answers 21

Upper abdominal swelling after Tummy Tuck is usually excess skin or muscle bulge

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Dear confused,

It is early and hopefully swelling will resolve and you will get better.

In my experience, when I have had a patient with persistant swelling above the umbilicus or belly button, it has been because the upper abdominal muscles were not adequately repaired and continued to bulge in marked contrast to the tightened lower abdomen.

The other possibility is that by not doing a full abdominoplasty with skin excision and transposition of the umbilicus, excess upper abdominal skin is being held in place by the tethered belly button.

If either of these situations exists you may need a revision.

It sounds as though your surgeon recognizes the problem, so I would follow his/her advice.

Mini tummy tuck revision should wait

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Dear Confusedinca,

From the comments of your surgeon in California it sounds like the verdict is not out. It can be hard to tell at five days if your are experiencing swelling, or is the skin and tissue in the upper abdomen bunching or showing through the muscle plication performed underneath. Your doctor expressed concern and no doubt you are anxious as well. As surgeons we all have times when we have felt this way, and with experience we learn how to guide patients through uncertain recoveries.

Most often our initial fears are unwarrented. Swelling resolves, tissues relax and conform and the expected results appear. It is well worth the wait as you and your surgeon have time on your side in the healing process. If the surgeon recognizes the problem and it can be corrected right away to his and your satisfaction you can safely go forward, but there is nothing wrong in any case to wait several months to be sure.

Talk to your surgeon so you understand things fully, and continue with the aftercare recovery instructions.

Best of luck.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Unfortunately, I think you will need a full abdominoplasty

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Hi, confusedinca!

Of course, you should not do anything for 6 months, and I don't exactly know what you look like. But I think I can picture your appearance in my mind, because I have seen at least a dozen patients in this situation.

The mini tummy tuck has real limitations, and is not good for many patients. The main problem is that the skin above the belly button is not tightened. When you tighten the lower skin, it makes the upper skin look even bulgier and more loose by comparison.

The second problem with the mini, as noted by Dr. Khoobehi, is that it is very difficult to adequately repair the separation of the rectus muscles (diastasis) in the upper abdomen. So this can be a second reason for an upper bulge. I have stopped doing endoscopic abdominoplasties because I wasn't happy with the results.

You have a surgeon with integrity who recognizes that you don't have a good result. That's great. You will be just fine after a thorough revision.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Too soon to judge the outcome of your Tummy Tuck

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It is too soon to make a judgement regarding your outcome. One possibility is that when the muscle separation was repaired that it caused the skin to bunch in the midline. Most of the time, liposuction will allow the skin to spread out and appear even after time. Continue to wear a garment and give it some time.

Michael Chiaramonte, MD
Washington DC Plastic Surgeon
4.9 out of 5 stars 35 reviews

You will need to wait at least a month

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You may have too much swelling, but if the result is not acceptable to your doctor, you may be better of to have redo surgery early than late.

The most common cause for your situation is that rectus muscle was not repaired correctly.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Revisional Tummy Tuck Surgery

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Minimally invasive procedures are attractive to patients for a variety of reasons.  Unfortunately these procedures may not always get the job done and frequently leave patients unhappy.  This isn’t because the procedure is flawed, but instead occurs because the procedure is asked to do more than is reasonable.

We frequently see this scenario arise when mini-abdominoplasty is asked to do the work that should require a full abdominoplasty.  When this occurs patients are often unhappy with the endpoint and require revisional surgery.

Although you are still early in the post-operative course and swelling is still an issue, you will probably require revisional surgery.  It’s important that a decision regarding revisional surgery be delayed until your swelling has resolved and you have reached your final result.

It appears that your lower abdominal muscles are tight relative to your upper abdominal muscles and this is why you have an upper abdominal bulge.  Although it’s impossible to know with certainty which option is best for you, it’s clear that you will need a more aggressive procedure.

This will most likely involve conversion of your current procedure to a full abdominoplasty with a minimal lower vertical abdominal incision.  The access provided by this procedure will allow the muscles in the upper abdomen to be repaired.  This should correct your problem and give you a much better result.

It’s important that you discuss your concerns with your plastic surgeon.  Be patient, and give your swelling time to resolve, but realize that you will probably require revisional surgery.

Reverse Upper Abdominoplasty

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Not infrequently I see patients in whom there is as much skin laxity in the upper abdomen as there is in the lower abdomen. In fact, some patients after pregnancy will have fairly 'toned' lower abdominal skin, but very lax and redundant upper abdominal skin. In these situations, the removal of skin in a vertically downward direction ( a conventional tummy tuck) is not adequate to correct the upper abdominal skin laxity. Such patients are often very good candidates for what I refer to as a 'reverse upper' abdominoplasty.
This surgical technique involves removing excess abdominal skin vertically upwards using incisions hidden in the inframammary folds underneath the breasts.  THERE IS NO INCISION MADE BETWEEN THE BREASTS. In general, this operation is best reserved for patients with fairly full or at least slightly droopy breasts, which serve to nicely conceal the inframammary folds. An important part of this procedure is the placement of permanent lifting sutures that elevate the lower skin edge, following removal of excess skin, to the upper skin edge in the inframammary fold. These permanent sutures ensure that the resulting surgical scar remains hidden within the inframammary fold.

A great advantage of this procedure is that the patient's original belly button is preserved, and thus there are absolutely no surgical scars that are visible when wearing a two-piece swimsuit or typical underwear (bra and panties). Additionally, because this procedure generally requires less skin undermining and thus less interruption of the normal blood supply of abdominal skin, more thorough liposuction of the waist and back can be performed at the same time.
Many patients having this surgery, therefore, undergo a reverse upper abdominoplasty combined with a lower 'mini' abdominoplasty, tightening of the entire length of the rectus abdominis muscles, and liposuction of the circumferential trunk - and keep the belly button with which they were born. I usually refer to this operation as 'reverse upper / modified lower abdominoplasty'.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Re-Doing a MINI Tummy Tuck for Upper Tummy Bulging and Excess Skin

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Regarding: "Redo Mini Tummy Tuck to Correct Upper Abdominal Area?
Hi there, One week after Mini-Tummy Tuck to correct diastasis, PS removed 450 cc's and minimal skin, but I am left with the odd upper-abodminal area looking not as tight as the lower abs. The procedure was performed endoscopically with sutures all the way up the abdomen. At my fifth-day visit, the doctor's first words were "this is unacceptable"...The two options were that: 1) it was just swelling and it will decrease or 2) worst case scenario the issue was worse than he thought and would have to perform a full procedure. Can anyone offer advice or suggestions here

The absolute key to a winning treatment is a complete diagnosis and a "tick list" of all the deficiencies that need correction. Only by doing this inventory can a surgeon hope to correct all the interacting deficiencies.

In the case of the abdomen, women are seduced and sometimes mislead into believing that "non-invasive" and MINI-Tummy Tucks are every bit as good at addressing ALL the deformities of the post-pregnancy tummy as are the FULL and EXTENDED Tummy Tuck procedures. That is NEVER the case.

The same forces of stretch and aging which split the 6 pack (Rectus) muscles and cause "the pooch" also stretch the skin. The skin is not stretched uniformly. There is always more excess skin in the area of the belly button than above the pubis or the hips. As a result, in woman with moderate skin laxity (IE excess skin centrally extending to the sides) and an underlying muscle separation (Diastasis) which extends ABOVE the Belly Button, a MINI-Tummy Tuck is a problematic, sure to disappoint procedure. But, as you and thousands of others demonstrate, it is done way too frequently.

To restore the abdomen to its youthful flat appearance ALL the skin excess (not just the lower central portion) needs to be removed and the whole length of the diastasis (6 pack muscle separation) must be repaired NOT just the portion below the belly button. Finally, the length of the scar required to effect these changes depends on YOUR skin excess NOT on the surgeon's or your wishes in pre-determining the scar length.

 Hope this helped.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

Improving Mini-Tummy Tuck Results

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The upper abdominal area after a mini-tummy tuck occasionally has what looks like extra skin or fat due to incomplete redistribution of excess tissues.  The belly button that is attached to the abdominal wall restricts the inferior movement of this upper abdominal skin for removal.  I have found to help with skin tightening in this area your options would be:
  • Try a variation of Vaser Liposuction called Vaser Hi Def Liposculpture that releases the skin to allow the skin to "shrink wrap".  This combined with addressing the superficial and deep layers of fat in the area can produce tightening and shrinking in the area.  I have performed this in similar situations with satisfied patients.
  • The tummy tuck can be revised by elevating the tissues up to the top of the abdomen, followed by cutting the belly-button at its base, and "floating" in inferiorly to new lower position, and similarly the upper abdominal skin is also pulled lower and now tighter.  The belly button is then fixated at its new lower position.
 I hope you are able to clear this up, and Good Luck!

Mini-tummy tuck (abdominoplasty) is seldom a good operation.

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Most patients with mini abdominoplasties are dissatisfied because the skin above the navel is loose, there is a noticeable transition of tension centrally to laterally below the navel, and commonly they are left with dogears.  I very seldom do a mini tuck because almost always a full abdominopasty is indicated.  The convalescence is not that differenct and the scar is usually not much longer.

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.